WOMEN: HOW IS HRT (HORMONE REPLACEMENT THERAPY) GIVEN? NON-HORMONAL RELIEF FOR MENOPAUSAL SYMPTOMS
How is HRT given?
Oestrogen is given
in the form of oral tablets, vaginal creams, pessaries or hormone-releasing rings, skin patches, or pellets implanted under the skin. Progestogens can be given by mouth. Combinations of both hormones are available as tablets, skin patches and intravaginal rings. Your doctor will discuss the methods of treatment with you, and advise you which type to try and how to use it.
You’ll hear a lot about ‘natural’ and ‘synthetic’ hormones. No naturally occurring human oestrogens are used for HRT. Some are obtained from mares and the remainder are manufactured. Some of manufactured oestrogens are basically same as those produced by the human ovary. Others, called synthetic oestrogens, are chemically slightly different from any naturally occurring oestrogens, but close enough to attach to oestrogen receptors and produce the same effects in cells. At present it is thought that synthetic oestrogens may have potential for more side-effects than natural oestrogens.
HRT needs to be individualized. All the oestrogens have similar effects, so it doesn’t matter much which is used, but different women need different doses. There’s more variation in how women respond to progestogens and no reliable way of predicting which will be most suitable. Some women need to try several to see which suits them best. Your doctor will suggest a visit within two to three months of starting treatment to see how you’re going and make any necessary adjustments.
Note the following points.
• It can take two to three weeks before you feel the full benefit of HRT. If after three weeks you’re still having some flushes, see your doctor: you may need a higher dose.
• It’s generally less expensive in the long ran (especially if you have broad-cover health insurance) to buy larger quantities of hormone tablets than those available on the Pharmaceutical Benefits Scheme. It may also be cheaper to buy larger-dose tablets and divide them: some are scored in halves or quarters to make this easier. Discuss treatment costs with your doctor.
How long should HRT be continued? This question can’t be answered confidently yet. Some doctors prefer to replace hormones only for as long as they’re needed to relieve symptoms like hot flushes. If you’re taking HRT to prevent the risk of fractures from osteoporosis and other long-term health problems resulting from a lack of oestrogen, it is necessary to continue treatment indefinitely. Studies are proceeding on women who choose to continue treatment into old age, but it will be at least another 10 years before results can be analyzed.
Non-hormonal relief for menopausal symptoms
There is no doubt that oestrogen replacement provides the most effective treatment of menopausal symptoms. However, if you can’t or don’t want to use oestrogen, the following measures may help relieve hot flushes and other symptoms.
• Avoid things that you know trigger hot flushes such as those mentioned.
• Reducing caffeine intake (coffee, tea, cola drinks, chocolate) may help with flushes, insomnia and palpitations.
• Many women are helped by body-mind exercises such as yoga, T’ai chi, meditation, massage and relaxation techniques.
• Some women get relief from alternative health therapies such as herbal or homeopathic remedies, hypnotherapy, acupuncture, naturopathy.
• If you regularly take other medicines, ask your doctor whether they may be aggravating menopausal symptoms.
• If you can’t use HRT by mouth, implants or skin patches, vaginal oestrogens may be suitable for relieving a dry vagina and vulva itch.
• Look after your general health.
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