Should menopausal symptoms be treated with hormones or not? “This remains an open question with incomplete answers, even for doctors”

Should menopausal symptoms be treated with hormones or not?  “This remains an open question with incomplete answers, even for doctors”

Menopause occurs around the age of 45-50 and is accompanied by a series of disadvantages that can profoundly affect women’s quality of life, both physical and psychological. For a time, hormone replacement therapy, with estrogens, was very fashionable, but in recent years, studies have shown that the administration of estrogens is associated with a risk of neoplasms of the genito-mammary sphere, but also at increased cardiovascular risk, with risk of stroke and heart attack.

Woman taking medicationPhoto: GARO/PHANIE / Editorial Shutterstock / Profimedia

All this means that the possibility of treating the manifestations that accompany menopause remains, for endocrinologists and not only, an open problem, with incomplete answers, explains Dr. Diana Păun, primary endocrinologist at the CI Parhon Institute of Endocrinology in Bucharest.

“The health of postmenopausal women is a real public health issue. More than half of the world’s population is represented by women, and as life expectancy increases and the population ages, more and more women are reaching a period that many tend to view as on the edge of pathology,” says Professor Diana Paun.

What is menopause and what are the most important symptoms

Menopause is defined by the World Health Organization as the time when the definitive cessation of menstruation occurs following the loss of ovarian activity. Currently, we recognize menopause as a physiological period where the transition from normal ovarian activity to its definitive cancellation takes place.

According to Doctor Diana Păun, many consider menopause as something pathological because, in addition to amenorrhea (absence of periods), a number of other symptoms and manifestations appear, of which the best known and most frequent are hot flashes or hot flashes. .

“Many women leak urine when they sneeze, cough, or strain – things that may seem physiological, but are distressing and obviously affect their quality of life. What about weight loss? epidermis and wrinkles of the skin – an aesthetic element that, let’s face it, obviously affects us. For this reason, implicit psychological changes also appear”, explains Dr. Diana Păun.

These symptoms are very annoying, “they wake you up at night, they can put you in embarrassing situations in public,” explains Dr Diana Păun.

Dr Diana Păun, treating endocrinologist / Photo: Agerpres

The most common symptoms of menopause:

  • permanent amenorrhea – absence of periods
  • urogenital atrophy with dyspareunia (pain or discomfort during sexual intercourse)
  • genital and urinary infections
  • urinary incontinence, especially stress
  • thinning of the epidermis and skin wrinkles
  • mental changes: irritability, depression, anxiety, insomnia, decreased sexual interest
  • cardiovascular problems: coronary heart disease, cerebrovascular disease, hypertension and peripheral vascular disease
  • decreased bone mass with increased susceptibility to fractures.

Hot flashes during menopause / Photo: Katie Nesling |

Finally, Doctor Diana Păun emphasizes that “menopause itself is a life context that can seem unhappy. This is the so-called “empty nest” moment, where the woman often loses her parents – they reach the age where, physiologically, the pathologies that lead to death occur – then the children reach the age where, in turn, , they reach to start a family and leave home because they want to create their own household. Let’s be real, often even the husband does not find the woman as attractive as when she was young and prefers to stay more in the office, where he may be surrounded by young and beautiful girls, in which case the wife feels lonely. After years of being the pillar of the family, he feels that no one asks for his help anymore, and the psychological impact is devastating.”

“Nature has ensured that at a given moment, ovarian activity disappears, both in terms of fertility and hormonal production. Which does not happen in men – in men, andropause is a rather controversial notion, even today. The explanation could be that at a certain age, the woman must set aside enough years to be able to raise her child and see him stand. Perhaps this is the reason why, around the age of 50-52, she ceases to be fertile”, according to the doctor.

Are we treating menopausal symptoms or not? “A woman’s approach to menopause must be personalized”

For a long time, the question arose whether or not to treat menopause. There are countries that do not even define this period in a woman’s life – for example in Japan, menopause is not talked about and it is not recognized as a separate period in a woman’s life , explains Doctor Diana Păun.

There are, however, some general rules that women should follow once they reach this period of life – lifestyle, exercise, healthy diet, rich in vegetables and fruits, dairy products, dietary supplements, calcium and vitamin D for the prevention of osteoporosis, but there is also the possibility of hormone replacement therapy.

Menopause / Photo: Motortion |

The therapeutic approach for menopausal women includes:

  • conditions/way of life
  • hormone replacement therapy

Hormone therapy aims to correct estrogen deficiency to improve symptoms. If at one time it was very fashionable for women to take estrogen to combat the symptoms of menopause, today this drug has entered a cone of darkness, explains Dr. Diana Păun.

In the case of hormone replacement therapy, there are certain eligibility criteria, as well as contraindications, that we need to be aware of, explains Doctor Diana Păun.

“We must be very careful when recommending estrogen therapy to postmenopausal women, because if until now we were absolutely convinced that estrogens only have benefits, studies have shown over the years the risk of neoplasms in the genito-mammary sphere under the action of estrogens. Even if we thought that estrogens protected you for life from cardiovascular diseases, it turns out that only estrogens naturally secreted by our ovaries do so. And after the menopause, estrogen administration is associated with increased cardiovascular risk – and until proven otherwise, cardiovascular disease is the leading cause of death in Romania – risk of heart attack, risk of stroke, it “That’s why these things need to be taken into account when we recommend estrogens,” says senior endocrinologist Diana Păun.

The medic / Photo: Monkey Business Images |

What is very important, however, is that a self-medicating woman is much more careful with herself and does what she needs to do, says the doctor: periodic annual check-ups – general, genital and breasts: “In the event of bleeding during treatment, there is no doubt that the woman is warned and must go to the gynecologist for a transvaginal ultrasound, possibly a curettage by biopsy if the bleeding is suspicious.”

Also, bone densitometry – the main investigation recommended for the diagnosis of osteoporosis – is important: “Until proven otherwise, it has been proven that estrogens are the most effective in recovering bone mass, even up to values ​​similar to those of fertile women”, says the doctor.

In conclusion, the general idea is that a woman’s approach to menopause “must be personalized”, explains endocrinologist Diana Păun: “Of course, any indication must take into account the indications, side effects and pathology woman’s associate.

“The possibility of treating the manifestations which accompany menopause continues to remain, for endocrinologists and not only, an open problem, with answers often incomplete, sometimes insufficiently argued, but in some way justified by our desire to continue our life in the best possible way. possible conditions and after that the possibility of perpetuation ceased”, concludes Dr Diana Păun.




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