Using menopausal hormone therapy

Despite uncertainties, hormone replacement during menopause is becoming increasing common and predicted to rise to the majority of women in the developed world. Hormone replacement therapy should begin before regular menstrual periods cease. Oestrogen and progestin in a pill are one of the most common treatments. A testosterone supplement can restore libido if that is low. Other therapies, such as dietary changes, can also help.

The production of oestrogens by the ovaries starts dropping at about the age of 35, long before a woman goes through menopause, but the decline accelerates at menopause when a woman's ovaries shut down and her menstrual cycles ceases. Many tissues throughout the body have receptors for oestrogen. Thus, the lack of oestrogens affects genital organs (vagina, vulva and uterus), urinary organs (bladder and urethra), breasts, skin, hair, mucous membranes, bones, heart and blood vessels, pelvic muscles and the brain.

Perimenopausal women experiencing some of the symptoms of menopause should have their oestrogen level tested during the second, third or fourth day of the menstrual cycle. If symptoms include changes in menstrual pattern or hot flashes, a test for follicle-stimulating hormone should be done on blood drawn during the first 6 days of the menstrual cycle, and repeated the next month. A baseline bone density test, a cholesterol test, a mammogram and an electrocardiogram are also wise.

In the USA in 1992, about 15 to 18% of postmenopausal women took hormone replacements.

Hormone replacement therapy seems to cut the death rate in half during the postmenopausal years, when women's bodies produce little of the oestrogen hormones that naturally protect them against atherosclerosis. Without oestrogen treatment, women's coronary mortality rate rises thirtyfold within 15 to 20 years of menopause. Oestrogen replacement also slows the aging of the bones that can lead to fractures. Women who take oestrogen replacement sustain 40% fewer hip fractures than those who do not. Oestrogen replacement can restore the lining, depth and secretions of the vagina that are important to sexual pleasure.

There is an undisputed link, first discovered in 1975, between oestrogen replacement and endometrial cancer. In addition, there are conflicting findings about oestrogen's effect on the risk of breast cancer. Other concerns are psychological effects of treating a natural body process as a deficiency disorder, and the as yet unknown risks of prolonged powerful hormone treatment over three to five decades.