Are there reasons to advise or advise against hormone replacement therapy in menopause?
All the current evidence, as expressed by the scientific menopausal societies, places hormone replacement therapy for menopausal syndrome (hot flashes, irritability, insomnia, malaise, inhibition of sexual desire, etc.) in the therapeutic framework for the woman who needs it. This is done for an adequate time, usually no more than five years postmenopausal or no more than 55 years old, as long as there are no formal contraindications such as thromboembolic risk or current hormone-dependent cancer, and it is prescribed and controlled by a specialist in Gynecology.
What type of hormonal treatment can be prescribed?
It must consist of a combined treatment of estrogens and progesterone. The dose is recommended to be the minimum necessary to alleviate symptoms. In women who do not have a uterus, the treatment would be exclusively estrogen.
Does hormone treatment cause cancer?
The answer to this question in general is: NO. Only an increase in the incidence of hormone-dependent cancer, some breast cancers, has been demonstrated after more than five years of use. However, and this is important to note, estrogen replacement therapy alone is protective for breast cancer after more than 3 to 5 years of treatment.
Is there a way to know which women might be harmed before starting hormone treatment at menopause?
Genetic factors linked to estrogen-transforming enzymes into estro-oncogenic metabolites have recently been discovered. If this mutation were to occur, it would increase the susceptibility to develop hormone-dependent cancers or thrombosis associated with hormone treatment.
These genes and their mutations can be studied to decide who may have this increased estrogen-oncogenic susceptibility when prescribing HRT.
Have new treatments been developed?
As novel treatment options have been created:
A new Selective Estrogen Receptor Modulator (SERM) that is indicated as an oral treatment for the treatment of vaginal dryness and as an alternative to classical vaginal treatment. This drug acts as a vaginal epithelium agonist, bone and breast protector and has a neutral effect on the endometrium and cardiovascular system. It is also a safe option in women with breast cancer.
On the other hand, there is a combination of low-dose equine estrogens and another drug of the SERM family with the indication of treatment of symptoms derived from estrogen deficiency in postmenopausal women with uterus (more than 12 months without menstruation). It has a dual action that serves to protect against osteoporosis at the bone level and to treat hot flashes. It has the advantage of not requiring the addition of progesterone.