Dr Samina Javaid - Consultant Gynaecologist and Menopause Specialist

Hormone Replacement Therapy (HRT)

Hormone Replacement Therapy (HRT) is commonly used to alleviate symptoms of menopause, such as hot flashes, night sweats, and vaginal dryness. It can also help prevent osteoporosis by maintaining bone density and improve muscle strength. However, HRT is not without risks. It can slightly increase the risk of breast cancer, blood clots, stroke, and coronary heart disease, particularly with long-term use. The decision to use HRT should be based on a careful consideration of individual health risks and benefits, ideally in consultation with a healthcare provider.

There are several types of Hormone Replacement Therapy (HRT), each tailored to different needs and preferences:

1. Estrogen-only HRT: Typically prescribed for women who have had a hysterectomy. It helps alleviate menopausal symptoms and prevent osteoporosis.
2. Combined HRT: Contains both estrogen and progestogen. This type is for women who still have their uterus, as progestogen helps protect against endometrial cancer.
3. Sequential HRT: Involves taking estrogen continuously and adding progestogen for part of the month. This mimics the natural menstrual cycle and is often recommended for women in the early stages of menopause.
4. Continuous Combined HRT: Both estrogen and progestogen are taken every day without a break. This is usually recommended for postmenopausal women.
5. Local HRT: Includes creams, pessaries, or rings that release estrogen directly into the vaginal area. This is particularly useful for treating vaginal dryness and urinary symptoms.

Each type has its own benefits and potential risks, so it's important to discuss with a healthcare provider to determine the best option for your individual needs.

Some lifestyle measures can also help greatly in managing menopausal symptoms:

• 1. Exercise:
  • a) Aim for at least 150 minutes of moderate intensity or 75 minutes of vigorous intensity exercise per week.
  • b) Moderate intensity: Activities like brisk walking, biking, or water aerobics.
  • c) Vigorous intensity: Running, swimming, hockey, or fast cycling.
  • d) Benefits:
  • - Improves bone density: Weight-bearing exercises (e.g., walking, dancing) help prevent osteoporosis.
  • - Strengthens muscles: Resistance training (lifting weights, using bands) maintains muscle health.
  • - Cardiovascular health: Exercise supports heart health and blood vessels.
• 2. Nutrition:
  • a) Healthy diet can reduce the severity of menopausal symptoms.
  • b) Include plenty of fruit, vegetables, and calcium-rich foods (e.g., milk, yogurt, kale) to support bone health.
• 3. Mental Wellbeing:
  • a) The menopause can impact mental health.
  • b) Consider cognitive behavioral therapy (CBT), a talking therapy that helps with low mood, anxiety, and sleep problems.
• 4. Sexual Activity:
  • a) Address vaginal dryness with over-the-counter moisturizers or lubricants.
  • b) If using condoms, opt for water-based lubricants to avoid damaging them.
  • c) Consult a doctor for other treatments (e.g., HRT, vaginal rings) if needed.
• 5. Rest and Relaxation:
  • a) Prioritize adequate rest and maintain regular sleep routines.
  • b) Engage in relaxing activities like yoga, tai chi, or meditation.
• 6. Avoid Smoking and Excessive Alcohol:
  • a) Quit smoking to protect overall health.
  • b) Limit alcohol intake to recommended levels.

Remember that individual experiences vary, so consult with a healthcare provider to tailor these lifestyle measures to your specific needs.

Premature ovarian insufficiency (POI), also known as premature ovarian failure, is a condition where the ovaries stop functioning normally before the age of 40. This leads to reduced estrogen production and irregular or absent menstrual periods, similar to menopause. POI can result from genetic factors, autoimmune disorders, or medical treatments like chemotherapy. Women with POI often experience symptoms such as hot flashes, night sweats, and vaginal dryness, which can significantly impact their quality of life. Management of POI primarily involves hormone replacement therapy (HRT) to compensate for the decreased estrogen levels, which helps alleviate symptoms and reduce the risk of osteoporosis and cardiovascular disease. Additionally, psychological support is crucial, as the diagnosis can be emotionally challenging. Fertility options, such as in vitro fertilization (IVF) with donor eggs, may be considered for women wishing to conceive. Regular monitoring and a multidisciplinary approach involving endocrinologists, gynecologists, and mental health professionals are essential for comprehensive care.

Menopause can significantly impact mental health, leading to psychological issues such as anxiety, depression, mood swings, irritability, and cognitive difficulties like "brain fog". These symptoms are often exacerbated by hormonal changes, sleep disturbances, and the stress of navigating this life transition. Effective management strategies include hormone replacement therapy (HRT), which can help stabilize mood by balancing hormone levels. Cognitive-behavioral therapy (CBT) is also beneficial, providing tools to manage anxiety and depression. Additionally, lifestyle changes such as regular exercise, a balanced diet, and mindfulness practices can improve overall well-being. Support from mental health professionals and peer support groups can offer emotional relief and practical advice, helping women navigate this challenging period more smoothly.

Vaginal dryness (atrophy) in menopause: Genitourinary Syndrome of Menopause (GSM) is a condition that encompasses a range of symptoms affecting the genital and urinary systems due to decreased estrogen levels during menopause. This syndrome includes vaginal dryness, burning, and irritation, as well as urinary symptoms like urgency, frequency, and recurrent urinary tract infections. The thinning and inflammation of the vaginal walls, known as vaginal atrophy, can lead to discomfort and pain during intercourse, significantly impacting sexual health and quality of life. Additionally, the loss of estrogen can cause the vaginal tissues to become less elastic and more fragile, making them more susceptible to injury and infection. Treatment options for GSM include over-the-counter moisturizers and lubricants, as well as prescription therapies like low-dose vaginal estrogen, which can help restore vaginal health and alleviate symptoms². It's important for women experiencing these symptoms to consult with their healthcare providers to determine the most appropriate treatment plan and improve their overall well-being during menopause.

One of the less discussed but impactful aspects of menopause is its effect on libido, or sexual desire. Many women experience a decrease in libido during menopause, which can affect their quality of life and intimate relationships. Testosterone replacement therapy (TRT) has emerged as a potential solution for managing this issue. The reduction in testosterone levels during menopause can lead to symptoms such as decreased libido, less pleasurable sex, and difficulty achieving orgasm. Additionally, other menopausal symptoms like vaginal dryness, hot flashes, and mood swings can further diminish sexual desire and enjoyment. Testosterone replacement therapy involves supplementing the body with testosterone to restore levels closer to those experienced before menopause. TRT can be administered in the form of gel applied to skin. Some studies also suggest that TRT may have additional benefits, such as improved mood, energy levels, and overall quality of life.