Rejuvenation with hormone replacement therapy
Estrogens, together with the action of progesterone, are the hormones responsible for the development and proper functioning of the female genital system (uterus, fallopian tubes and ovaries).
Among other things, estrogen prepares girls from puberty for ovulation and fertilization (menstruation), lowers blood pressure, influences fat and cholesterol metabolism, protects bones and, together with androgens, they stimulate the libido.
“When I got the menopause, with its paired hot flashes, irritability, mood swings, vaginal discomfort or lackluster skin, truncated my well-being and happiness. I requested an urgent appointment with Dra. Sala and I said to him: “You have to solve this problem for me no matter what.”
“My trust has always been placed in it and I knew that its response would be unbeatable”, he says.
“He told me about hormone replacement therapy (HRT), warning me that there were specialists who did not agree with this treatment. But she told me that the benefits, in my case, could be very good.”
“After a series of tests and previous analyses, I started the hormonal treatment and it changed my life… And if before the therapy I already wanted Carmen, now, with the THS working wonderfully, I want it very much more”, he underlines.
“Eva is a happy woman. She no longer suffers from suffocation, insomnia, her skin and hair show beauty and her sexual relations have returned to being fluid and without discomfort”, points out our reference expert in the quality of life of the woman of yesterday, of today and tomorrow at the Gine-3 Clinic in Barcelona.
The rebirth of hormone replacement therapy, by Carmen Sala
“Hormonal replacement therapy (HRT) refers to the treatment with hormones that is administered to the woman to supplement or equalize the values that she has below normal, and that provide her with unpleasant symptoms.
Actually, I don’t like the title of this article, since in our case, who started HRT treatments about 30 years ago, we have never stopped prescribing them, despite the indications of scientific societies, that they advised against it based on the analysis of poorly conducted studies.
Fortunately, the review of these studies again emphasize the goodness of this type of treatment.
It is true that the drugs have been changing based on availability and the indications have been increasing. We have also fine-tuned the list of contraindications, and instead increased the indications.
It must be well understood that the treatment is not unique, that there are multiple possibilities of product combinations, and that in any case it must be an absolutely individualized therapy.
If the fundamental indication is the low level of hormones, and fundamentally of estrogen, with its consequent effects, it is clear that it is necessary to start as soon as possible and there is no need to suspend it as long as the beneficial effect can be maintained.
The side effects of a lack of estrogen, or lower values than necessary, are basically the appearance of suffocation, sleep instability, decreased sexual appetite, mood disorders, memory failures, ‘atrophy of the skin and mucous membranes, the discomfort or even the impossibility of maintaining sexual relations, the worsening of joint discomfort and the development of osteoporosis.
Some or all of the symptoms may appear, depending on the characteristics of each woman, the age at which they appear or the abruptness with which the hormonal decline occurs.
It is not the same as a sudden onset of hormonal cessation, for example, after a surgical intervention in which the ovaries were removed, or if this took place at the age of 45, or at the age of 50.
Many times, the hormonal cessation is slow, progressive and gives the body the opportunity to adapt; the symptoms are easier to assume, even if they are difficult to be aware of. When the hormonal cessation is abrupt, it is undoubtedly the woman who comes and demands a solution.
It is our obligation to be aware of this situation and, from the age of 45, if there have been no symptoms that could put us on alert, to spend time at the annual gynecological examination to ask about these symptoms.
If there were doubts, a simple blood test, the result of which we obtain within 24 hours, will confirm the situation.
Each woman, an individualized hormone therapy
It is a good time to inform the woman about the benefits that a treatment of this type can bring her, to dispel her fears and to explain what checks we do in case we need it.
In addition, to make a good medical prescription it is always essential to proceed to a gynecological examination that includes a cytology, a transvaginal ultrasound, a mammogram and, if necessary, a breast ultrasound.
Likewise, a general analysis and another hormonal analysis in order to rule out abnormalities in the coagulation factors, check good liver function and assess the good or bad health of the metabolism (glucose, cholesterol, triglycerides).
In complex cases, due to family or personal history, existence of varicose veins, we must request a thromboembolic disease screening test, even ask for advice from the specialist in Angiology and Vascular Surgery.
With this comprehensive study already completed, we will quote the woman to explain to her what type of treatment we have chosen for her, what dose and how the symptoms will disappear; and, above all, which controls you will have to follow and what to do in the event of someone forgetting to take the pills or the appearance of unexpected symptoms.
If the woman is close to the 50 yearswe can offer you the variant of THS that will keep you menstruating or an alternative that will have the same effectiveness and that will prevent you from unnecessary bleeding.
It is also the time to agree on the route that the woman wants for the administration of the medicines.
It can be oral, transcutaneous, intramuscular, subcutaneous or vaginal. The way can be in relation to your wishes and your preferences; but sometimes it is required as, for example, in the case of intolerance to the excipients of the oral medication.
The global value of hormone replacement therapy
We must take the opportunity to propose to him, if he is not doing it, improvements in his life habits; especially, reducing or eliminating smoking, minimizing alcohol consumption, engaging in some age-appropriate aerobic activity, and eating a balanced diet low in fat and carbohydrates, such as the Mediterranean diet.
It is a good time because the woman is receptive, and she must understand it as a global treatment that is not only pharmacological.
Most of these treatments are based on estrogens and progestogens, but they do not take into account the small amount of male hormone that every woman needs to maintain an adequate level of libido and a good tone of the muscle mass. Except for tibolone, the other preparations do not take into account this variant, which is so important and that you need to know how to administer it.
Medication doses must vary with the patient’s age, according to needs, and the pharmaceutical industry does not always offer us the appropriate preparations. We have to assess the half-life of medicines in the blood and, if the ideal preparation does not exist, we can achieve the appropriate level by spacing the intakes.
If we follow the logical indications to indicate the beginning, the appropriate doses and the monitoring controls we will achieve a woman in a state of health with benefits not only at a gynecological level, but as we have already explained at an osteoarticular, mental and even cardiovascular level .
Increasingly, and once the initial studies have been reevaluated, more points appear in favor of the indication for hormone replacement therapy and the fears of causing cancer are moving awaysituation that tends to disappear with data, information and disclosure.
Perhaps, when the average life of the woman was less than 65 yearsthere was no need for HRT, but currently, where the average life is easily surpassed the 80sand women are increasingly decisive in all aspects of our societies, we need healthy, mentally stable and competitive women“, he concludes.
Eva, and what would you say to women about hormone replacement therapy?
“This therapy is fantastic. I feel with great energy in my personal, family and social day to day”, he replies.
“And I’ll tell you an anecdote: a few years ago I decided to stop the treatment for a month… and it was scary. All the ghosts of the past suddenly returned and I had to resume hormone therapy because my quality of life was, again, depressing,” he explains.
“I want to add that I have friends my age who live daily with the same problems I suffered before this therapy (hot flashes, insomnia, irritability, sexual difficulties, etc.). They have doubts because their gynecologists do not advise them”, he explains.
“On the other hand, I will always be very grateful to you, Carmen, since you helped me change the course of my life with this hormonal therapy”, he concludes.
Conversation at the gynecological consultation between Dra. Sala and Eva, his patient.