Menopausal hormone therapy:
Menopausal hormone therapy (MHT), formerly known as hormone replacement therapy (HRT), is the best way to control menopausal symptoms such as hot flushes and vaginal dryness and to prevent bone loss.
- MHT can be given either as oestrogen only or as oestrogen and progesterone (known as combined MHT).
- Progesterone is only needed in women who have a uterus. Progesterone prevents the womb lining from undergoing excessive thickening (hyperplasia) as a result of the effects of oestrogen. Women who have had a hysterectomy can use oestrogen on its own and do NOT require progesterone.
- Oestrogens can be given as tablets, skin patches, gels, vaginal creams and vaginal pessaries.
- Progesterone is more difficult to get into the body. Progesterone used for MHT can be given as tablets, patches or vaginal pessaries.
- There are different oestrogen and progesterone preparations. Some have the same chemical structure as those found in the body and are referred to as “body-identical” hormones. Other preparations have a modified chemical structure.
Tibolone is a unique hormone that has been engineered to have the combined effects of oestrogen, progesterone and male hormones (or androgens).
Studies show that tibolone is helpful in:
- Reducing hot flushes. Tibolone may not be as effective as MHT in treating hot flushes.
- Reducing bone loss and risk of fractures.
- Improving sexual function.
Tibolone does not increase breast density and does not appear to increase the risk of clots in the veins.
There are some concerns that tibolone may cause an increased risk of cancers of the breast and ovary as well as stroke in women over 60.
The benefits of non-hormonal treatments are mostly restricted to treating hot flushes and night sweats.
- Serotonin-Noradrenaline Reuptake Inhibitors (SNRIs). Examples are Venlafaxine 75-150 mg/day and Desvenlafaxine 100-150 mg/day
- Selective Serotonin Reuptake Inhibitors (SSRIs). Examples are Paroxetine 10-20 mg/day and Escitalopram 10-20 mg/day.
- Gabapentin is used for treating seizures and neuropathic pain. It has a similar structure to the neurotransmitter, gamma-aminobutyric acid (GABA). The starting dose is usually 100 mg three times daily building up to 300 mg three times daily.
- Pregabalin is also similar to GABA. It is used at a dose of 75-150 mg twice daily.
- Clonidine is an alpha adrenergic agonist used for treating hypertension and migraine. The starting dose is 25 mcg twice daily, building up to 50-75 mcg twice daily.