From the age of 40, the subject of menopause begins to enter the radar of women. Although the end of the reproductive period is something natural, many women fear the supposed consequences of the drop in hormones. Incredibly, there is still a lot of misinformation about the topic, taboos and prejudices of society in general, including the female gender itself. World Menopause Day proposes to clarify the myths on the subject and make women aware that it is possible to deal with the discomfort caused by this transformation and face it without fear and prejudice.
Even for women who have already talked to their gynecologists and decided on hormone replacement, the question is common: what risks am I taking? What are the chances of getting breast cancer? The good news is that the way the hormone is replaced in the body – dosage applied, route of administration and the period when the replacement begins – as soon as the first symptoms of menopause start to appear – make all the difference in treatment, reducing the risks of complications arising from hormone replacement.
“Currently, whenever possible, we choose to use estrogen via the transdermal route (skin), avoiding the oral route. This route of administration reduces the risk of thrombosis compared to the oral route”, explains gynecologist Fernando Guastella, trained by USP and specialist in climacteric. According to Guastella, the estrogen administered by mouth, when passing through the liver, generates substances that favor blood clotting, increasing the risk of thrombosis. “When estrogen is administered through the skin, this risk is eliminated, as the hormone goes directly into the bloodstream.”
Guastella explains that not every woman can do hormone replacement. It all depends on the patient’s health history. “For those who already have a personal history of breast cancer, endometrial cancer or pre-cancerous lesions of this nature, replacement is not recommended,” he says.
However, in almost all other cases, hormonal therapy is possible and often even recommended. “Whether or not to do hormone replacement is a joint decision between the patient and the doctor. It is the duty of the gynecologist to clearly discuss with the patient all the benefits and risks involved in the replacement. The woman must also receive information about non-hormonal treatments that, likewise, way, they present risks and side effects “, explains Guastella.
According to the gynecologist, the patient should feel good about the treatment chosen, as this increases personal satisfaction and helps control symptoms. “It is no use for a person to continue with a treatment that he does not agree with. The treatment of perimenopause and postmenopause should only be done for those who are suffering because of the reduction of hormones. It should promote health, prevent diseases and well-being and not the other way around “.
In addition to breast cancer, another big bogeyman for those who are afraid of hormone replacement is the increased risk of cancer of the uterus. This is another example that everything can change depending on the regimen adopted in hormone therapy. “Studies show that hormone replacement with estrogen alone increases the incidence of endometrial cancer. But if estrogen is combined with progesterone, the protection for women against this problem is greater than if there was no adoption of hormone compensation,” explains Guastella.
According to Fernando Guastella, based on the most recent studies, it is known today that starting hormone replacement treatment is only indicated for women in perimenopause or for those who are in the interval up to 10 years after menopause. “We call this the window of opportunity. After this period, hormone replacement is not recommended because the risk of heart disease increases.”
History of Hormone Replacement
In the 80s and 90s, studies in the laboratory and with women showed great benefit from the use of hormone replacement against menopausal symptoms in women. In 2002, the WHI study conducted in women over 10 years of menopause and administered estrogen orally in high doses demonstrated an increased risk for cardiovascular events such as heart attack and stroke, in addition to the risk of breast cancer. More recent studies, however, such as KEEPS and Elite, which used estrogen in lower doses and transdermally in women in the menopausal transition, have shown a reduced risk of disease such as heart attack and stroke.
What is hormone replacement therapy?
Hormone replacement therapy is the administration of estrogen to menopausal women. Progesterone administration is only indicated for women who have a uterus, as those who have removed the uterus with surgery do not need to use progesterone. Hormone replacement therapy can also involve the administration of male hormones in specific situations.
Benefits of hormone replacement therapy
• Improves menopausal symptoms;
• Prevention and treatment of osteoporosis;
• Decreased risk of endometrial cancer;
• Decreased risk of cancer in the large intestine;
• Provides well-being;
• Reduces symptoms that can impair sexual life such as vaginal dryness or pain during intercourse
• Improves skin and hair, reducing the perception of aging.
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