DEFINITIONS AND INTRODUCTION:
Menopause is the permanent cessation of menses following the loss of ovarian follicular activity. Perimenopause is the transitional period prior to and the first year after menopause, which lasts a total of approximately 5 years. Approved indications of postmenopausal hormone therapy include the usually short-term treatment of menopausal symptoms (i.e., hot flushes, night sweats, and urogenital atrophy) and long-term treatment for osteoporosis prevention.
HORMONAL REGIMENS:
In women with intact uterus, hormone therapy consists of an estrogen plus a progestogen. In women who have undergone hysterectomy, estrogen therapy is given unopposed by a progestogen.
Hormone Replacement Therapy in the Women
The continuous combined oral estrogen-progestogen limb of the Women’s Health Initiative (WHI) learn was ended prematurely after a mean of 5.2-year follow-up because of the occurrence of a pre-specified level of invasive breast cancer. The study also found increased coronary disease events, stroke, and pulmonary embolism. Beneficial effects included reduce in trendy fracture and especially colorectal growth.An oral estrogen-alone arm was stopped early after a mean of 7 years of follow-up. Estrogen-only therapy had no effect on coronary heart disease risk and caused no increase in breast cancer risk. A subsequent large epidemiologic study found a greater risk for breast cancer with combined estrogen-progestogen use, as well as increased risk for estrogen-only therapy and tibolone.
BENEFITS OF HRT:
Relief from Menopausal Symptoms-
Most women with vasomotor symptoms need hormone treatment for less than 5 years. Without treatment, hot flushes usually disappear within 1 to 2 years. Hormone therapy can usually be tapered and stopped after about 2 or 3 years.
RISKS OF HRT:
-coronary heart disease
-breast cancer
-uterine cancer
-ovarian cancer
-thromboembolic events
-cholecystectomy
OTHER EFFECTS OF HORMONE REPLACEMENT THERAPY:
Women with vasomotor symptoms taking hormone therapy have better mental health and less depressive symptoms compared to those taking placebo, but hormone therapy may worsen quality of life in women without vasomotor symptoms.
The WHI study found that postmenopausal women 65 years or older taking oestrogen plus progestogen therapy had twice the rate of dementia, including Alzheimer’s disease. Combined therapy also did not prevent mild cognitive impairment.