Hormone Replacement Therapy Drugs For Menopause

Hormone replacement therapy in menopausal women is useful for reducing symptoms caused by menopause. However, the use of hormone replacement therapy in postmenopausal women is still debating in terms of safety considering significant side effects such as an increased risk of cancer. Therefore the use of hormone replacement therapy should consider the benefits and risks for patients.

Menopause is a condition in which the menstrual cycle stops permanently. Menopause can occur naturally with age. Menopause usually occurs in the age range of 48-52 years or more. Secondary menopause is caused by other things, for example due to surgery to remove both ovaries or side effects from chemotherapy / radiotherapy.

Clinical manifestations caused by hormonal changes during menopause include complaints of burning (hot flush), especially on the face and neck accompanied by excessive sweating. This disorder is caused by vasomotor instability which causes vasodilation of blood vessels and usually occurs before menopause for several years after menopause. Decreasing estrogen levels in the body at menopause can cause tissue thinning or atrophy in the vaginal, vulvar, bladder and urethral areas resulting in symptoms such as dry vagina, pain during intercourse, burning and recurrent urinary tract infections.

Estrogen also plays a role in regulating the resorption process and bone formation. Decreasing estrogen levels in the body causes increased bone resorption and reduced bone formation so that bone mass becomes brittle or has osteoporosis. Less estrogen in the body can also increase the risk of dyslipidemia and increase the risk of cardiovascular disorders such as stroke or coronary heart disease. In addition to providing physical complaints, hormonal changes during menopause can also have an impact on psychology such as depression.

Hormone Replacement Therapy in Menopausal Women

Hormone replacement therapy (HRT) is a small dose of synthetic estrogen hormone to reduce various menopausal symptoms based on a decrease in estrogen levels in the body. Hormone replacement therapy can be given before menopause (perimenopause) and post menopause. Hormone replacement therapy can also be used for women who experience early menopause or who have surgical removal of the ovary (before the age of 45 years). Aside from administering estrogen, it can also be given an additional hormone progesterone But administration of the hormone progesterone should only be given to women with a complete uterine condition to reduce the risk of endometrial cancer.

Giving hormone replacement therapy can be given systemically (oral, transdermal, implant) or locally (cream, pesarium). Available hormone replacement preparations can be in the form of estrogen alone, a combination of estrogen and progesterone, selective estrogen receptor modulator (SERM) and gonadomimetics such as Tibolon (containing estrogen, progesterone and androgens). Low-dose estrogen therapy can be given every day, while combination estrogen and progesterone therapy can be given daily or cyclic where progesterone can be given on the 10th day to the 14th day every 4 weeks. Hormone therapy preparations in Indonesia include conjugated estrogens, conjugated estrogens and medroxyprogesterone acetate, diethylstilbestrol, estradiol, estradiol valerate, estradiol valerate and cyproterone acetate, estradiol and didrogesterone, estradiol and drospirenone, estradiol hemihydrate, estradiol hemihydrate, estradiol hemihydrate and norethisterone and Tibolon.

Provision of hormone replacement therapy is known to be effective in reducing the frequency and severity of complaints of vasomotor disorders such as hot flush in menopausal women within a few weeks after use. Provision of hormone replacement therapy in the form of low-dose estrogen, a combination of estrogen and progesterone and transdermal estrogen has been shown to reduce these symptoms. Systemic and local estrogen therapy can reduce urogenital symptoms. Estrogen therapy can restore normal flora, reduce vaginal pH, thicken and revascularise the vaginal lining. Giving estrogen therapy locally to the vagina can improve vaginal atrophy without causing proliferative effects of the endometrial layer. Transdermal estrogen therapy can be used for menopausal women who have complaints that are very disturbing with complications of type 2 diabetes mellitus, obesity or have a high cardiovascular risk, which these symptoms cannot be reduced by non-hormonal therapy.

Side Effects and Contraindications for Hormone Replacement Therapy

Hormone replacement therapy can increase the risk of breast cancer, especially for combination hormone replacement users for more than 5 years. The increased risk of breast cancer in the use of 5-year hormone replacement therapy stated in number needed to harm 1100 for estrogen therapy alone and 641 for a combination of estrogen and progesterone. In other words, 1 in 1100 people who were given estrogen therapy alone and 1 in 641 people who were given combination therapy would have breast cancer.

Estrogen therapy in the absence of progesterone in menopausal women who have an intact uterus can increase the risk of endometrial cancer and endometrial hyperplasia. Giving the estrogen hormone orally can increase procoagulant synthesis in the liver so that it can increase the risk of venous thromboembolism. In addition, administering estrogen therapy alone or a combination of estrogen and progesterone can increase the risk of gallbladder disorders.

Hormone replacement therapy is contraindicated in women who have a history of breast cancer, have a high risk of breast cancer (for example, the patient's mother has breast cancer), has venous thromboembolism or has a high risk of thrombosis or stroke. In general, the initiation of hormone replacement therapy is not recommended for women over 60 years of age. There is no limit to the duration of hormone replacement therapy so that it can be used as long as the patient feels that he has benefited from the use of the drug. But giving therapy must be evaluated regularly at least once a year to monitor side effects.