Hormone replacement therapy in menopause: Who is it suitable for?

More than nine million women are currently in Germany during the menopause. A third of them suffer from significant complaints, so that their quality of life and performance are severely impaired. Hot flashes, sleep disturbances, mood swings, and heart palpitations accompany them over a long period, as statistically, menopause lasts seven years - for some women, significantly longer.

One way to alleviate the symptoms is hormone replacement therapy (HRT). While it was previously viewed critically due to possible health risks, the therapy has evolved significantly in recent years. New research findings and modern therapeutic approaches have made the application safer and increased the benefits for many women.

But the uncertainty remains - according to a study by Techniker Krankenkasse, only around six percent of women in menopause in Germany take hormones, although many more suffer from severe complaints Suffering. The decision for or against HRT should always be made individually with a doctor.

What is hormone replacement therapy?

The hormone deficiency that occurs during menopause is compensated with medication. However, HRT does not aim to restore hormone levels to what they were before menopause, but rather to use precise dosing to treat and even eliminate the symptoms and diseases caused by estrogen deficiency, provided that these symptoms first appeared in menopause and other causes can be ruled out. Complaints and treat diseases, improving or even fixing symptoms - as long as these complaints first appeared in menopause and other causes can be ruled out.

Why was hormone replacement therapy considered risky for a long time?

HRT fell into disrepute mainly due to the Women's Health Initiative (WHI) study from 2002. This large US study examined the long-term effects of HRT in postmenopausal women. Initial results showed an increased risk of breast cancer, heart attacks, strokes, and thrombosis in women who received combination therapy with estrogen and progestin. The study was prematurely terminated, which increased concerns and uncertainties in the medical world.

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In the last 20 years, further studies have shown that the risks of HRT must be considered in a more differentiated manner: because the average age of the study participants was very high, some suffered from pre-existing conditions, and the hormones used neither matched today's preparations in dosage nor in their form of administration, the study is now considered "limited in significance".

“HRT has undergone several changes and developments in recent years,” explains Dr. Petra Eisenmann, a gynecologist at the Munich group practice Pranner15, who accompanies many affected women on their way. "The focus is on individualized therapy. The risks and benefits have been re-evaluated. Hormones are used transdermally, for example as gels or patches that are tailored to the needs of the woman. Compared to earlier preparations, transdermal application has a lower thrombotic risk."

What benefits does hormone replacement therapy have?

HRT can alleviate numerous symptoms of menopause and thus significantly improve quality of life. The main benefits include:

• Relief from hot flashes and night sweats
• Protection against osteoporosis: Estrogen deficiency can accelerate bone loss, and HRT can reduce the risk of osteoporosis and fractures.
• Improvement of mood and Mental performance
• Protection of skin and mucous membranes: HRT helps reduce dryness of the skin and mucous membranes (e.g., in the vagina)
• Reduced risk of cardiovascular diseases: In women who start HRT early in menopause, there is evidence of a lower risk of cardiovascular diseases

Bioidentical hormone therapy

What exactly are bioidentical hormones and where are the advantages over synthetic hormones? “Bioidentical hormones have the same chemical structure as the body's own hormones,” explains Dr. Petra Eisenmann. “In short: They perform the same function and target the same receptors as the body's own hormones. The most common bioidentical hormones include estradiol, estriol, DHEA, progestan progesterone, and testosterone. Synthetic hormones do not correspond to the body's own hormones and are produced in the laboratory. They are used, for example, in the contraceptive pill.”

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Which preparations are used in hormone replacement therapy?

Hormone replacement therapy has long been available in oral form (tablet, capsule). The hormones reach their site of action via the gastrointestinal tract and liver. With transdermal application (spray, gel, patch), the body absorbs a significantly lower amount of hormones than with oral application. Consequently, the risk of unwanted side effects is also lower. If the symptoms are predominantly local, for example in vaginal dryness, HRT can be administered through hormone-containing creams or vaginal tablets/suppositories.

What risks are associated with hormone replacement therapy?

Despite the progress, HRT still carries certain risks that should be weighed individually with the treating physician. Possible risks include:

• Increased risk of breast cancer: Long-term use of HRT, especially with a combination of estrogen and progestin, may slightly increase the risk of breast cancer
• Risk of thrombosis: Estrogens can increase the risk of blood clots (thrombosis) and strokes, especially in older women or those with pre-existing conditions
• Cardiovascular diseases: While an early start of HRT may have a protective effect, its use in older women may be associated with an increased risk of heart attack

So who should not consider HRT? "For patients with breast cancer or a history of coagulation disorder," said Dr. Petra Eisenmann.

How long should HRT be used?

Dr. Petra Eisenmann: "According to guidelines, HRT is beneficial for 5 - 7 years in the 'window of opportunity,' meaning up to the age of 60. After this timeframe, the risk of hormone-dependent breast cancer increases. This is partly due to the age of the users and not solely the use of HRT."

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