Combined menopausal hormone therapy

Combined Menopausal Hormone Therapy (CMHT), also known as hormone replacement therapy (HRT) or menopausal hormone therapy (MHT), is a medical treatment used to relieve symptoms of menopause in women. This therapy combines forms of estrogen and progesterone, two hormones that the body's ovaries produce less of leading up to and after menopause. CMHT is designed to mitigate menopausal symptoms such as hot flashes, night sweats, vaginal dryness, and to prevent osteoporosis. The therapy can be administered through various methods, including oral tablets, skin patches, gels, and vaginal creams.

Indications

CMHT is primarily indicated for women experiencing moderate to severe menopausal symptoms that adversely affect their quality of life. It is also indicated for the prevention of osteoporosis in postmenopausal women at high risk of fractures where non-hormonal treatments are not suitable.

Risks and Benefits

The decision to use CMHT involves weighing the potential benefits against the risks, which can vary depending on a woman's health history and how long the therapy is used.

Benefits

• Relief from vasomotor symptoms, such as hot flashes and night sweats.
• Prevention of bone loss and reduction in the risk of osteoporosis-related fractures.
• Improvement in urogenital symptoms, including vaginal dryness and discomfort during intercourse.

Risks

• Increased risk of breast cancer with long-term use.
• Higher risk of venous thromboembolism (VTE), especially in the first year of use.
• Possible increased risk of stroke and coronary heart disease in older women or women who start CMHT several years after menopause.

Types of Hormones

CMHT typically involves a combination of estrogen and progestogen. Estrogen therapy alone is associated with an increased risk of endometrial cancer in women with a uterus, so progestogen is added to counteract this risk.

• Estrogen: Can be natural or synthetic, and is the primary hormone used to treat menopausal symptoms.
• Progestogen: Can be natural progesterone or synthetic progestins. It is used to protect the endometrium (lining of the uterus) from the effects of estrogen alone.

Administration Methods

CMHT can be administered through various methods, each with its own set of advantages and disadvantages. The choice of administration method depends on the individual's preferences, medical history, and the specific symptoms being treated.

• Oral Tablets: The most common form of administration, but associated with a higher risk of VTE and stroke.
• Transdermal Patches: Applied to the skin, offering a lower risk of VTE compared to oral forms.
• Vaginal Estrogens: Used primarily for urogenital symptoms, with minimal systemic absorption and risks.
• Gels and Creams: Applied to the skin or vaginally, providing an alternative for those who cannot take oral forms.

Conclusion

CMHT is a valuable treatment option for women experiencing significant menopausal symptoms or at risk of osteoporosis. However, the decision to start CMHT should be made after a thorough discussion with a healthcare provider, considering the individual's health history, the severity of symptoms, and the potential risks and benefits of the therapy.

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