Hormone Replacement Therapy
Definition of menopause
Menopause, the word meaning is the name given to the last menstruation. It is a natural period in women's life between the ages of 45-55, which starts with irregular menstrual bleeding and ends with complete cessation of menstruation.
Menopause, in fact, is a term used after the period when women are cut off from menstruation, but the most important event in this period is the termination of the reproductive ability and the end of the reproductive period.
Transition to menopause affects estrogen deficiency symptoms, irregular hemorrhages, concerns about conception or non-conception, and increased risk of cardiovascular diseases, as well as accelerating bone loss according to studies, affecting women both physically and socially and psychologically. Some women experience very severe, various symptoms during the perimenopausal period, while some women do not have any symptoms or the symptoms are minimal.
Age of menopause
While the average life expectancy of women was 81-82 in developed countries, this rate was 72.2 in our country. On the other hand, the average age of menopause to enter and change again showed the average age of menopause in Turkey between 46 and 52 years of age was found to be 46.5 by sophistication.
Since menopause is known to be roughly 45-50 years old, it is clear that a woman who is expected to live an average of 75 years will spend one third of her life during the menopause. For this reason, every aspect of menopause should be examined in every aspect, and this period of women should be tried to ensure a healthy and quality life.
Menopausal changes: Epidemiology
Some physiological changes that start to occur before menopause have some undesirable and disturbing acute symptoms, as well as consequences that may affect the quality of life of a woman in a long time.
Irregular menstruation
Vasomotor symptoms include hot flashes, palpitations, excessive sweating, insomnia and night sweats, gastrointestinal spasm, tingling sensations and paracetesis. Approximately 75% of women experience bas hot flashes döneminde during transition to menopause. “Hot flashes ir is a feeling of warmth that suddenly develops and spreads from the face and neck to the chest. It'il take a few minutes.
Estrogen deficiency in menopause causes atrophic changes in vaginal and urogenital mucosa after menopause occurs in real terms.
Osteoropause is an increase in the risk of fracture by decreasing bone mass. Osteoropausal fractures are usually post-menopausal, respectively, vertebra, hip and forearm. In women, menopausal hormone replacement therapy essentially helps reduce the rate of bone resorption from the elderly.
Frequency of menopause symptoms
Menopause can be spent without any other symptoms or discomfort except menstrual disorders and eventually complete menstruation. However, the proportion of these women was only 24% compared to the number of women in all menopause. Menstrual irregularities are due to decreased hormone production in the ovaries. As decreasing hormone production affects the heat centers, disorders such as hot flashes and night sweating usually occur following menstrual irregularities.
Although the menopausal transition varies from woman to woman, it is completed in 10-15 years and usually 65 years old climacteric symptoms no longer disappear. The following table presents the main symptoms associated with menopause.
Hormone replacement therapy
The periods in women's life, which are caused by hormonal effects, are as shown in the graph above. Hormone Replacement Therapy (shortly referred to as HRT) is a replacement therapy aimed at bringing low estrogen and progesterone levels of the woman in the climacteric period (the period before and after the last menstrual period) to relieve symptoms.
HRT was first designed in the 1930s. However, intensive use in the clinic is from the 1950s. The development of products used today was in the late 70s.
HRT is administered by administering estrogens and progesterones in different combinations and by specific methods. HRT can be administered orally (with oral tablets), transdermal (with skin-adhesive patches, gels applied) or by local route (vaginal cream, tablets). HRT regimens are described below.
Estrogen-only HRT
This treatment is administered at a fixed dose and only by oral administration of estrogen-containing tablets or transdermal products.
However, this treatment is only valid for patients who have received uterine surgery. The results of the studies have shown that women receiving only estrogen for a certain period of time in the uterus end up with some changes that increase the tendency to uterine cancer. Therefore, this method of treatment is suitable for women taken from the uterus.
HRT with combined estrogen and progesterone
The combined treatment can be selected according to the symptoms experienced by the woman in the climacteric period and whether she wants to have menstruation:
Sequential treatment
Progesterone is added to the treatment on certain days as well as continuous estrogen taken for the whole period (28 days). Monthly menstrual bleeding occurs following the termination of tablets of different colors containing progesterone. This type of treatment, in which monthly menstrual bleeding occurs in accordance with the natural menstrual order, is more suitable for perimenopausal women who are not completely menses but have irregular menopausal symptoms. This treatment also allows women whose menstrual periods have completely ceased to regain menstruation.
Continuous combined treatment
Continuous and combined estrogen + progesterone provides a complete cessation of bleeding by regressing the structure that forms the monthly bleeding in the uterus. Tablets containing a balanced amount of estrogen and progesterone, taken for 28 days, prevent both menopausal complaints and prevent monthly bleeding.
Although uninterrupted combined regimens offer bleeding-free treatment, spotting or small bleeding that exceeds staining may occur during the first months of treatment. For less hemorrhage, treatment must be started at least 1 year after the last menstrual period.
This undesirable effect, which disrupts treatment compliance, is greatly reduced in the use of the widely preferred Low Dose HRT preparations which have been widely discussed in recent years.
Local hormone therapy
It is used in the form of creams, ovules, gels or vaginal tablets used to eliminate or prevent the unwanted effects of estrogen deficiency in the vagina and urinary tract (thinning of the vaginal wall, dryness of the vagina, infection of the vagina or urinary tract).
HRT, short and medium-term symptoms during menopause, as well as the removal of post-menopausal women with increased risk of osteoporosis has been shown to be reduced in studies.
Menopause and osteoporosis
Osteoporosis is a disease of the skeletal system. It is characterized by a decrease in bone density and mineral content. The risk of fracture increases rapidly due to the decrease in the strength of the skeletal system. The prevalence of osteoporosis in post-menopausal women is high, especially in the elderly population. Bone mineral density during menopause is related to the maximal bone mass that the woman reaches in adulthood and bone loss after 35 years of age.
There are two types of osteoporosis in women. Type I or menopausal osteoporosis occurs within the first 15 to 20 years of menstrual cessation and is characterized by increased bone resorption in which the production destruction cycle deteriorates in favor of destruction due to decreased estrogen levels.
Diagnostic methods of osteoporosis
Studies have shown that bone density measurements are a good method to determine fracture risk.
Some biochemical methods provide information on bone formation and destruction.
Risk factors for osteoporosis
Osteoporosis does not naturally occur in the same way in every individual. Certain factors play a role in the development of osteoporosis. These risk factors are listed below.
Removal of the ovaries
Early Menopause
Low Body Weight
Osteoporosis in Family
Calcium Absorption Disorder
Smoking
Inactivity
Life style
Excessive Alcohol Use
Estrogen Deficiency
Long Term Corticosteroid Use
The role of HRT in the treatment of osteoporosis
The purpose of antiresorptive drugs used to treat postmenopausal osteoporosis is to reduce and stop destruction. The main effective drug in this group is estrogen.
In studies on bone density, it was observed that women receiving HRT had higher bone density than those who did not.
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