Troublesome hot flushes, severe night sweats and headaches causingchronic insomnia are characteristic symptoms of the menopause.These symptoms may last for many years. Apart from being socially embarrassing they result in tiredness and depression because of lack of sleep. These symptoms can almost invariably be cured with the correct small dose of estrogen. Although selective serotonin re-uptake inhibitor antidepressants have been suggested for the treatment of vasomotor symptoms, no other treatment is nearly as effective as estrogen. Women who still have a uterus should still have 7–12 days of progesterone in order to produce a withdrawal bleed and prevent endometrial hyperplasia.
Estrogens will treat vaginal dryness
Thinning of the pelvic tissues producing vaginal dryness and occasionally bleeding is another characteristic result of estrogen deficiency that occurs after the menopause. This also can be successfully treated with estrogen either by tablets or through the skin by patches or gels or implants. Trans-dermal estrogen therapy is probably the safest and most effective route as hepatic coagulation factors are not stimulated. Local estrogen’s can also be given for this symptom using local vaginal applications of weak estrogens such as oestriol that are hardly absorbed. Other related problems of painful intercourse, loss of libido and recurrent ‘cystitis’, if due to pelvic atrophy are also effectively treated by systemic or long-term local vaginal estrogens.
HRT improves libido
HRT certainly improves libido if estrogens are used to cure vaginal dryness and painful intercourse. Even without these characteristic symptoms, estrogens can improve sexual desire.However, if necessary, the addition of testosterone has a more dramatic effect upon libido, frequency of intercourse and intensity of orgasm. Testosterone patches licensed in women after hysterectomy and testosterone gels in the appropriate dose are often and should be used ‘off license’ with full consent and explanation. Women must be aware that testosterone is not only a male hormone but it is an essential female hormone present in women in about10 times the blood levels as estrogen. It is an essential hormone, important for energy, mood and sexuality.
HRT increases bone density
Every study confirms that estrogens are the most effective way of increasing bone density and preventing osteoporotic fractures even in low-risk women. This treatment is very safe when started in women under the age of 60. It is more effective and beneficial than the bisphosphonates that are frequently used by bone physicians as first choice and by general practitioners unsure about the safety of estrogen therapy. These non-hormonal drugs with their considerable long-term complications should have no place in maintaining bone density in women under the age of 60.
HRT protects intervertebral discs
Important recent studies have shown conclusively that estrogens prevent collagen being lost from the intervertebral discs, thus maintaining their strength and function. These discs make up one-quarter of the length of the spinal column and actas cushions preventing crush fractures of the vertebral bodies. It is these crush fractures that lead to loss of height and the lordosis of the upper spine known as the Dowager’s hump. This important protective effect of estrogen seems to be unique as bisphosphonates and the other non-hormonal treatments of low bone density do not have any beneficial effect upon the discs.
Protects from heart attacks
There are about 30 years of evidence from many observational trials that estrogens reduce the incidence of coronary heart disease. This has subsequently been questioned by the 2002 WHI Study, which showed an increase in heart attacks. However, this study looked at patients of the wrong age and who were using the wrong dose of estrogen and progesterone. Subsequent reports from the same investigators have shown a very much reduced incidence of heart attacks in women who start HRT below the age of 60.
Decrease risk of depression
Estrogens are more effective in the treatment of depression in premenopausal or peri-menopausal women than post- menopausal women. However there is no doubt that depression is helped in post-menopausal women who have been suffering from night sweats, insomnia or vaginal dryness, painful intercourse and marital problems in that most of these problems can be effectively treated and removed. This depression often occurs in women who are sensitive to abrupt changes in their hormones
HRT improves texture of skin
After the menopause, women lose about 25% of their body collagen, which is manifested by thin inelastic skin, brittle nails, loss of hair and loss of the collagenous bone matrix. This latter loss is an essential cause of osteoporosis and osteoporotic fractures. Estrogen therapy replaces the lost collagen in the skin and the bone. Its affect on the facial skin is a very obvious useful cosmetic effect.
Be a nicer person to live with
This is a quote from a patient. Many women say that when estrogen therapy stops their depression, their loss of libido and their irritability, they become more agreeable people for their partners to live with. The depression, irritability, grumpiness, and loss of energy and disinterest in sex can usually be improved considerably by the appropriate doses of the appropriate hormones that may include testosterone as well as estrogen.
HRT is safe
In spite of the press reports stressing bad news, virtually all claims of major adverse effects from the WHI study have been reconsidered even by the investigators. It seems quite clear that the reported major side-effects of breast cancer,stroke and heart attacks occurred in women who started the wrong dose of HRT over the age of 60. In women who started below the age of 60 there were fewer heart attacks, fewer deaths, fewer osteoporotic fractures and even less breast cancer in this study.
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