Hormonal treatment of menopause

In practice, we need to distinguish between:
- Climacteric syndrome associating hot flashes, night sweats, sleep or mood disorders, joint or muscle pain, vaginal dryness making intercourse painful...
- longer-term pathologies, such as increased cardiovascular risk and bone fragility (osteoporosis).
Hormonal treatment of the menopause (HRT) may be indicated for certain women suffering from sometimes disabling symptoms, after ensuring that there are no contraindications (see contraindications sheet).
The key hormone in HRT is estradiol, as all the consequences listed above are linked to its deficiency. Initiating estradiol-based treatment not only rapidly alleviates vasomotor symptoms (hot flushes and night sweats), but also counteracts the other harmful effects of hormone deficiency. In particular, it plays an essential role in combating bone loss, with a significant preventive effect in reducing osteoporosis and bone fractures.
However, estrogen therapy must be combined with progesterone to avoid the risk of uterine mucosal disease. Estrogens used without progesterone increase the size of the uterine lining, which can have serious consequences. Progesterone or progestins counterbalance this action locally.
HRT therefore most often combines an estrogen administered via the skin (gel or patch) or orally (tablet) with a progestin molecule, most often a natural progesterone administered orally or vaginally. Thus, only women who have had their uterus removed (hysterectomy) can benefit from estrogen-only treatment.
How long can I use it for? This "magic" treatment for some women has been the subject of much controversy, however, due to the potential risks attributed to it. HRT increases the risk of certain cancers, such as breast and ovarian cancer, but reduces the risk of others, such as colon, esophageal and pancreatic cancer. These cancer risks remain low, however, and in published studies are only significant for long treatment durations. Current recommendations from international scientific societies therefore suggest short courses of treatment, regularly reassessed with each woman. This treatment has its advantages when used in conjunction with certain rules. For example, prescription relatively soon after menopause (less than 10 years after its start) in "young" women under 60 is associated with a significant reduction in all-cause mortality and the risk of myocardial infarction.
and well-tolerated treatment, provided the contraindications and precautions for use are respected and the woman is properly informed. The decision to initiate and then continue treatment therefore depends, for each woman, on an assessment of the balance between the expected benefits and the potential risks, which vary from one patient to another, but also over the years for the same woman.
The use of HRT therefore relies on strict prescription rules and at least annual monitoring to verify its good tolerance and the need to continue it.