Menopause Hormone Therapy: Is the Same Medication Prescribed for Everyone?

As menopause approaches, the secretion of oestrogen and progesterone gradually decreases, and menopausal symptoms begin as that change affects the function of the autonomic nervous system. The body stays in a constant state of tension, which brings palpitations and anxiety. The face flushes hot, and changes also appear in the regulation of body temperature, sleep and mood. Some women experience vaginal dryness or atrophic vaginitis.

Even when menopausal symptoms are mild, the decline in the role of oestrogen continues inside the body all the same. The ability to protect the blood vessels falls, so the incidence of cardiovascular and cerebrovascular disease rises. The activity of osteoclasts, the cells that break down bone, increases and exposes the body to the risk of osteoporosis, and as insulin sensitivity decreases, the proportion of abdominal fat increases as well.

• Myocardial infarction and stroke — the ability to protect the blood vessels declines, and the incidence of cardiovascular and cerebrovascular disease rises
• Osteoporosis — osteoclast activity increases, exposing the body to the risk of weaker bones
• Metabolic disease — insulin sensitivity decreases, and the risk of abdominal obesity and diabetes grows

Hormone therapy is used to supplement the female hormones that have become deficient, with the aim of relieving symptoms and preventing complications, and menopause treatment is broadly divided into hormonal therapy and non-hormonal therapy. The North American Menopause Society's paper on hormone therapy, published in The Journal of The Menopause Society, also acknowledges its effectiveness while pointing out that the risks of the same medication change with the way it is used.

When oestrogen alone is given over a long period, the endometrium is continuously stimulated, proliferates and becomes hyperplastic, which increases the risk of cancer, so progesterone is prescribed in combination for women who have a uterus. Conversely, women with a past hysterectomy have no risk of endometrial proliferation, so oestrogen can be prescribed alone.

Age and the time that has passed since menopause are also important criteria for choosing a medication. Oestrogen has a protective effect before the age of 60, but when changes in the blood vessels and bones have already progressed, as in a 65-year-old woman whose menopause came more than 10 years ago, the synthesis of proteins related to blood clotting increases and the likelihood of clot formation rises, so it is preferable to consider the systemic risk and use a different medication as an alternative.

Menopause treatment does not mean keeping one prescription unchanged to the end. It is a process of adjustment in which the patient's response is checked at regular intervals, the dose is reduced or increased, the formulation is changed, and treatment is switched to non-hormonal therapy if necessary. When vaginal dryness or urinary incontinence is prominent, procedures such as laser or injection treatment are sometimes combined.

• Presence of the uterus — if the uterus is present, progesterone is combined; if it is not, oestrogen alone is possible
• History of breast cancer, blood clots or cardiovascular disease — this serves as the basis for gauging the systemic risk of hormone medication
• Response to hormone medication — dose adjustment, a change of formulation or a switch to non-hormonal therapy is decided after watching the course