Menopause is a change that most women in their 40s and 50s go through as female hormones decline, but if it is left unmanaged it can lead to complications such as osteoporosis and metabolic syndrome, so it needs care. Hormone therapy is not a treatment to be avoided outright because of breast cancer risk; when the ingredients and dose are adjusted to the individual, it can be used safely. This article looks at the changes in the body, the evidence behind treatment and the criteria used for prescribing.
What changes happen in the body during menopause?
Falling oestrogen makes the body's temperature-regulating centre unstable, causing hot flushes and night sweats, and it also affects the regulation of melatonin and serotonin, which in many cases leads to sleep problems. When the environment of the vaginal mucosa breaks down, vaginal dryness and pain during intercourse can also appear, and a considerable number of women experience discomfort in daily life.
Oestrogen is also involved in muscle and joint metabolism, so when its level falls the risk of osteoporosis rises. Blood vessels, lipid metabolism and blood pressure control are unsettled as well, and the risk of complications such as arteriosclerosis and metabolic syndrome grows with them. Even women without symptoms are advised to begin menopause care for the sake of their health.
- Hot flushes and night sweats — caused by reduced function of the temperature-regulating centre
- Sleep problems — become more frequent as melatonin and serotonin regulation becomes unstable
- Risk of osteoporosis and metabolic syndrome — rises as bone and blood vessel metabolism is unsettled
Is it true that hormone therapy raises the risk of breast cancer?
The concern is not without basis, because oestrogen acts as a growth signal for breast tissue and can lead to cellular changes, but the actual research findings are not simple. A paper by the Korean Society of Clinical Health Promotion, listed in the KCI database of the National Research Foundation of Korea, compared 119 late-postmenopausal women receiving hormone therapy with 109 receiving non-hormonal treatment. The hormone therapy group showed more positive results on two measures: attitudes towards menopause and ageing, and quality of life.
However, hormone use must be restricted in women who are being treated for breast cancer or have a past history of it, and in those with vaginal bleeding caused by changes in the endometrium. The key is therefore to check first for any reason to restrict treatment, and then to prescribe with the ingredients and dose adjusted to the individual.
What tests and criteria are used before starting treatment?
A comprehensive examination and assessment is a step that must come before treatment: blood pressure, urine and blood tests, as well as uterine and breast ultrasound, are carried out so that a suitable medication can be chosen. Because hormone therapy helps prevent bone loss, it is an appropriate first-line treatment for women aged 60 or under whose fracture risk has increased.
For women over 60 who are 10 or more years past menopause, the situation is different: using hormones solely to prevent fractures is not recommended, and other ingredients should be used in view of the risk of blood clots or stroke. Symptoms rarely appear in just one form, so treatment has to be designed around each individual.
- Blood pressure, urine and blood tests — the basic tests for understanding overall health
- Uterine and breast ultrasound — an essential check before hormone therapy
- Lifestyle and medical history — the reason prescriptions differ from person to person
Besides medication, what should be managed in daily life?
Including enough protein and calcium in the everyday diet helps preserve muscle mass and bone density, while alcohol upsets hormonal balance, so it is better avoided during menopause. A habit of resting enough or exercising regularly about 2 times a week can help on its own.
Two things need to be remembered in order to pass through menopause without strain and continue into a healthy later life: choosing medication suited to one's state of health, and making lifestyle changes alongside it. Women who make lifestyle changes alongside treatment recover more quickly.
