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The who’s who of menopausal hormone therapy

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The who’s who of menopausal hormone therapy

The who’s who of menopausal hormone therapy

 

You may have heard of menopausal hormone therapy (MHT), previously called hormone replacement therapy (HRT). But do you know which hormones are involved, and how they may help?

                                

MHT is the most effective treatment available for the relief of the physical symptoms of menopause (e.g. hot flushes and night sweats).1 There are two main hormones relevant during menopause. They are:2

  • Estrogen
  • Progesterone

 MHT refers to replacing one or both of these through medication.2

 

What types are available and who are they for?

 

During menopause one of the main causes of symptoms is fluctuating levels of the hormone estrogen.3 Taking medication with estrogen can help to alleviate these symptoms.1,2 Estrogen levels affect your brain, your bones and your uterus.2 In fact, taking estrogen can cause an overgrowth of the cells in your uterus.1,2 If you have had a hysterectomy (your uterus removed) this is not a problem and MHT with estrogen alone is OK to use.

 

Progesterone affects the womb and uterus, it prevents the overgrowth of cells.2 Because of this protective action progesterone is combined with estrogen to lower the risk of cancer in women who still have their uterus.1,2

                                

 Selective estrogen receptor modulators (SERMs) also block the unwanted effects of estrogen on the uterus and can be used instead of progesterone in combination with estrogen.1,4

 

So, in summary;

  • Estrogen-alone MHT is for women without a uterus
  • Estrogen + progesterone or SERMs MHT is for women with an intact uterus

 

Consult with your healthcare professional to find out which option is best for you.

 

Pill, patch or implant?

 

MHT is available in various forms. These include:2

  • Pills – estrogen and progesterone as separate tablets or in combination, or estrogen and SERM combination tablets. During perimenopause the contraceptive pill may help alleviate some symptoms. Tibolone is a synthetic hormone and its actions are similar to estrogen, progesterone and testosterone.1
  • Patches – Also available as estrogen-only or estrogen-progesterone combinations, these allow the hormones to be absorbed through the skin.
  • Gel – Estrogen-only, available in single dose sachets for daily application to the skin
  • Vaginal creams or pessaries – as the name suggests, applied directly into the vagina, mainly used to treat vaginal or bladder symptoms
  • Intrauterine device (IUD) – progesterone released from an IUD may be prescribed during perimenopause in combination with estrogen in the form of a tablet or patch.

 

A note on hormone names

As you start to read more about menopause and MHT, there can be several terms that look very similar and seem to be used interchangeably. Here is a quick guide to knowing what is what:4

  • Estrogen (oestrogen): A group of hormones produced by the ovaries
  • Estradiol (oestradiol): The main estrogen produced by the body
  • Estriol (oestriol): The least potent estrogen made by the body
  • Progesterone: A female hormone produced by the ovaries
  • Progestin: Synthetic compounds that act like progesterone
  • Progestogen: Natural or synthetic form of progesterone (umbrella term for both progesterone and progestin)
  • Selective Estrogen Receptor Modulator (SERM): Used in combination with estrogen to block its unwanted effects

                                

©Pfizer 2017 Pfizer Australia Pty Limited. Pfizer Medical Information: 1800675 229. Sydney, Australia 2000. PP-DUA-AUS-0475, 08/2019.

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REFERENCES

1. Jane FM and Davis SR Climacteric 2014;17(5):564–579.

2. Jean Hailes, Menopause Management. Available from https://jeanhailes.org.au/health-a-z/menopause/menopause-management (Accessed August 2019).

3. Australasian Menopause Society, The Perimenopause or Menopausal Transition. August 2016. Available from https://www.menopause.org.au/hp/information-sheets/1057-perimenopause (Accessed August 2019).

4. The North American Menopause Society, Menopause Glossary. Available from https://www.menopause.org/for-women/menopause-glossary (Accessed August 2019).