Hormone Therapy – Medical Overview
Menopause is diagnosed after a woman has not had a menstrual period for twelve consecutive months. At this time, her ovaries have stopped releasing eggs and have largely stopped producing the hormones estrogen and progesterone. According to The North American Menopause Society (NAMS), “Most women experience menopause between ages 40 and 58. The average age is 51.”1 A woman may experience menopause as early as her thirties, brought on by medical interventions such as having a hysterectomy or undergoing chemotherapy.2 The American Congress of Obstetricians and Gynecologists (ACOG) states that hot flashes and vaginal dryness are the most common menopause symptoms – with as many as 75% of menopausal women experiencing hot flashes.3
Postmenopausal women may experience vulvar and vaginal atrophy (VVA), a component of genitourinary syndrome of menopause (GSM). VVA is a medical condition caused by loss of estrogen after menopause. One of the most bothersome symptoms of VVA is dyspareunia (vaginal pain from sexual activity). Additional symptoms may include vaginal dryness, itching, irritation, and painful urination. Approximately 50% of menopausal women or 32 million women in the United States experience VVA symptoms, yet only about 7% (2.3 million) of these women use prescription treatment.4
ESTROGEN AND ESTROGEN/PROGESTIN THERAPY
Hormone therapy has been used for more than one-half century for the management of menopausal symptoms, such as vasomotor symptoms (VMS – hot flushes, night sweats) and postmenopausal symptoms associated with vulvar and vaginal atrophy (VVA).
Vasomotor Symptoms (VMS)
The use of estrogen alone therapy is used in the treatment of moderate to severe vasomotor (VMS) symptoms associated with menopause. These symptoms, appearing in postmenopausal women, are called hot flashes or hot flushes. The severity of VMS symptoms may range from:
- Mild – the sensation of feeling hot without sweating
- Moderate – the sensation of feeling hot, accompanied by sweating, and able to maintain activity
- Severe – the sensation of feeling hot, accompanied by sweating, and needing to cease activity
Prescription estrogen-alone therapy may be recommended for women who experience moderate to severe vasomotor symptoms and have had a hysterectomy.
Estrogen/progestin therapy may be recommended for women who experience VMS symptoms, particularly severe hot flashes, and have not had a hysterectomy. The addition of progestin is used to help counteract possible adverse effects of estrogen alone on the endometrium of women with their uterus intact.
Vulvar and Vaginal Atrophy (VVA)
Estrogen therapy alone is also used locally in the treatment of moderate to severe vulvar and vaginal atrophy (VVA) symptoms associated with menopause. VVA symptoms may include:
- Vaginal dryness
- Dyspareunia (vaginal pain associated with sexual intercourse)
- Dysuria (painful urination)
- Vaginal itching or irritation
- Bleeding after sexual intercourse
- North American Menopause Society online. Menopause 101: A primer for the perimenopausal. The Basics. http://www.menopause.org/for-women/menopauseflashes/menopause-symptoms-and-treatments/menopause-101-a-primer-for-the-perimenopausal
- Menopause. Diseases and Conditions. The Cleveland Clinic online. http://my.clevelandclinic.org/health/diseases_conditions/hic-what-is-perimenopause-menopause-postmenopause
- Menopause: Resource Overview. The American Congress of Obstetricians and Gynecologists. http://www.acog.org/Womens-Health/Menopause
- Kingsberg S, Wysocki S, Magnus L, Krychman M. Vulvar and Vaginal Atrophy in Postmenopausal Women: Findings from the REVIVE (REal Women’s VIews of Treatment Options for Menopausal Vaginal ChangEs) Survey. J Sex Med. 2013;10:1790–1799.