Menopausal women are turning to hormone therapy to ease symptoms; but does it also help manage diabetes, osteoporosis, heart disease?
Menopause is a natural part of a woman’s life, which can also bring about many physical and emotional changes. The hormonal changes during menopause, which usually begin at the age of 45-55 years, can cause a variety of symptoms including hot flashes, night sweats, vaginal dryness, mood swings, and sleep disturbances. But these symptoms can be more debilitating in many cases and can lead to issues like discomfort during sex, urinary urgency, and dryness in the skin, around the eyes, and the mouth. However, experts suggest that there are many treatment options available to help manage these symptoms, one of which is hormone therapy.
“In India, hormone therapy is becoming increasingly popular as women seek to manage the symptoms of menopause. Many women are turning to this therapy as a safe and effective way to manage their symptoms and improve overall health,” Dr Vaishali Sharma, laparoscopic surgeon and IVF specialist, told indianexpress.com.
Considering this popularity, and in the same breath, the growing need to be more aware of its effects, we reached out to experts to understand more about the therapy, how it works, and whether it can also help manage other health issues like diabetes, osteoporosis, and heart diseases in women.
What is hormone therapy?
Also known as hormone replacement therapy (HRT), the medical treatment replaces the hormones (estrogen and progesterone) the body no longer produces as a result of menopause. “Your ovaries no longer generate large quantities of estrogen and progesterone when you enter menopause. Changes in these hormone levels might result in unpleasant sensations,” explained Dr Shalini Vijay, senior consultant obstetrician and gynaecologist, Motherhood Hospitals, Lullanagar.
So hormone therapy treatment is basically intended to increase hormone levels and “alleviate some of the symptoms of menopause”. “Whether or if you should try the treatment is something you should explore with your doctor,” Dr Shalini said.
Hormone therapy can be classified into several categories, based on the specific hormones used and the method of administration.
Experts say there are two methods of administering hormone therapy: systemic and local. Systemic hormone therapy involves taking pills, patches, gels, or injections that deliver hormones throughout the body. Local hormone therapy, on the other hand, delivers hormones directly to the vagina via creams, rings, or tablets.
The following are the main types and categories of HT, according to ChatGPT analysis:
Estrogen-only therapy: This type of HT involves supplementing the body with estrogen, either alone or in combination with other medications. Estrogen-only therapy is usually prescribed for women who have had a hysterectomy and no longer need to take progesterone. “Estrogen-based hormone therapy can help relieve menopausal symptoms such as hot flashes, night sweats, and vaginal dryness. It can also help prevent bone loss and reduce the risk of heart disease. However, estrogen-based hormone therapy can also increase the risk of breast cancer, endometrial cancer, and blood clots,” said Dr Vaishali.
Combined estrogen-progestin therapy: This type of HT involves supplementing the body with both estrogen and progesterone, or a synthetic form of progesterone known as progestin. This type of therapy is usually prescribed for women who have not had a hysterectomy and still have their uterus.
Transdermal therapy: This type of HT involves applying hormones, such as estrogen or a combination of estrogen and progesterone, to the skin through patches, gels, creams, or sprays.
Oral therapy: This type of HT involves taking hormones, such as estrogen or a combination of estrogen and progesterone, in pill form.
Injectable therapy: This type of HT involves injecting hormones, such as estrogen or a combination of estrogen and progesterone, into the body through subcutaneous injections or intramuscular injections.
Vaginal therapy: This type of HT involves using low-dose hormones, such as estrogen or a combination of estrogen and progesterone, in the form of creams, rings, or tablets, to address symptoms such as vaginal dryness and painful intercourse.
The choice of the specific type and category of hormone therapy will depend on a woman’s individual symptoms, medical history, and personal preferences, and should be determined by a healthcare professional after considering all the benefits and risks.
So, does it also help those with diabetes?
These hormones help in decreasing HOMA IR (Homeostatic Model Assessment for Insulin Resistance), which helps in increasing insulin sensitivity. They have also been shown to improve carbohydrate metabolism in type 2 diabetes, said Dr Aafrin Shabbir, senior consultant- Internal Medicine, Gleneagles Global Health City, Chennai.
Interestingly, according to a ChatGPT analysis, studies have suggested that estrogen-only therapy may have a beneficial effect on glucose metabolism and insulin sensitivity in postmenopausal women. Some studies have found that estrogen supplementation can improve insulin sensitivity and glucose tolerance, potentially by increasing insulin receptor sensitivity and glucose uptake in the muscle and liver.
Additionally, the impact of HT on glucose metabolism and insulin sensitivity may also depend on other factors, such as the woman’s overall health, medical history, and lifestyle factors. If you have diabetes and are considering HT, it’s important to discuss the potential effects on glucose metabolism and insulin sensitivity with your healthcare professional.
How about bone health and osteoporosis?
Experts opine that menopause significantly expediates bone loss due to fall in the levels of reproductive hormones, oestrogen and progesterone.
Hormone therapy influences the usage of calcium in the body which helps preserve bone mineral density, thereby, rendering it helpful in maintaining bone health and preventing osteoporosis, said Dr Aafrin.
What is known about the link between hormone therapy and the risk of heart disease?
Scientists are still learning about how the therapy affects the heart and blood arteries, said Dr Shalini. “Many significant clinical studies have been conducted in an attempt to solve issues concerning hormone therapy and heart disease. Some studies found favourable results in women who began the therapy within 10 years of menopause, whereas others found detrimental effects in those who began the therapy beyond 10 years of menopause. Some research have raised greater concerns regarding its possible advantages. Based on the findings, the American Heart Association made a recommendation for the use of HT. They claim: Hormone treatment is not indicated for the primary goal of avoiding heart disease (particularly, heart attack or stroke),” Dr Shalini noted.
What are the risks associated with hormone therapy?
Hormone treatment, like any other drug, has adverse effects, said Dr Vaishali. The following are the most prevalent side effects:
*Monthly bleeding (if you have a uterus and use cycled progestin (oestrogen for 25 days of oestrogen each month, progesterone for the final 10 to 14 days of the month, and 3 to 6 days of no medication).
*Tenderness in the breasts.
Who should not opt for hormone replacement therapy?
Combination hormone treatment resulted in a rare absolute risk increase of fewer than one extra instance of breast cancer per 1,000 person-years of usage, Dr Shalini said. According to the expert, in women who had hysterectomies and were on estrogen-only treatment, there was a non-significant decrease in breast cancer. Systemic hormone treatment should not be used if you have been diagnosed with breast cancer,” added the expert.
Dr Shalini said that hormone therapy is typically not advised if you:
*Have or have had breast or endometrial cancer.
*Have irregular vaginal bleeding.
*Have experienced or are at high risk of having a blood clot.
*Have a history of stroke, or heart attack, or are predisposed to vascular illness.
*You are pregnant or believe that you are pregnant.
*Suffer from liver illness.