In the discussion about the hormone treatment of menopausal women, there has been a decisive turnaround: From now on, such treatment should only be given in the case of pronounced symptoms. This is the conclusion of the Federal Institute for Drugs and Medical Devices (BfArM). The reasons for this significant reassessment are the risks that have been shown in several published studies: After these increases the hormone treatment during menopause increases the risk of breast cancer and ovarian cancer. In addition, thrombosis, stroke and myocardial infarction are increasingly common.
Drugs for the treatment of menopausal symptoms should therefore only be used for pronounced symptoms and if the quality of life is severely limited by the symptoms. Even then, the BfArM recommends keeping the treatment period as short as possible while using the lowest effective dose. It has also been stated that drug manufacturers will have to list all of the above risks in the product information in the future.
It is also recommended to check if women who have been taking hormones for many years can stop treatment. It has not yet been discussed whether the hormone treatment for the prevention of osteoporosis, ie bone loss, is still one of the clear areas of application.
Hormone therapy: study results
The results of one of the world's largest studies on hormone treatment for menopausal women has given a decisive turn to years of discussion. The UK One Million Study, which involved more than one million women, confirmed that treatment with menopausal hormones significantly increases breast cancer risk. Regardless of which hormones are given and whether the treatment is done on tablets or patches. Also irrelevant was whether the treatment was continuous or with breaks.
Increased breast cancer risk after hormone treatment
After one year of hormone therapy, the risk increased and the longer the treatment, the greater the risk of developing breast cancer. The risk was a little lower if the women received a drug that contained only estrogen, as if both estrogen and progestin were taken.
Reassuring: After stopping hormone treatment, the risk of breast cancer decreased again.
Side effects of hormone therapy
Another study that had a major impact on current decisions was the so-called "Woman's Health Initiative". There were 16, 000 women between the ages of 50 and 79 years. Originally, the investigation was to take place over eight years. But it was canceled prematurely last year. Because an interim analysis of the data after five years had shown that women who took hormones, more often received breast cancer than women who received only placebo, so drug-free tablets.
Other alarming results: Stroke, pulmonary embolism and heart attacks were more common with hormone treatment, especially in the first year of treatment. The positive effects were that women with hormone therapy are less likely to develop colorectal cancer and also less likely to have hip fractures than women without treatment. Nevertheless, this "added value" could not outweigh the risks in any way.
Hormone Therapy: Who wants to stop
Affected women who want to use this discussion as an opportunity to stop treatment should not simply stop taking the product. Go to your gynecologist and ask for a detailed conversation. For yourself, you should first clarify how much the symptoms actually affect you. After all, a basis for your doctor's decision will be your well-being.
But remember: Menopausal symptoms are even worse, sometimes weaker, and sometimes, after just a few months, they completely disappear. Maybe you have been taking hormones for a long time without really needing them? Or you think that only the hormones have improved the symptoms, and your body has already changed.
Only discontinue hormone therapy under supervision
Especially if you have been practicing hormone therapy for several years, you should therefore venture an outlet attempt. Ask your doctor for help. He will advise you on how to most gently stop the treatment. Because in principle, the hormones should not be discontinued from one day to the next. This could, especially if previously taken high hormone doses, again provoke complaints such as sweating and hot flashes.
It is better to slowly reduce the dose and to see how it works. And always thinking about it: Do these complaints actually affect my life as much as I thought, or is it just the fear of the discomfort? Maybe you get along better with the disturbing symptoms now, or they have even disappeared completely.
If it must be hormones
Nevertheless, there will continue to be people for whom hormone therapy is the right solution. Especially those women who suffer very much from the above-mentioned complaints and are extremely impaired, for example, in professional life. For research has shown that a hormone treatment is good for menopausal symptoms such as sweating, hot flashes or sleep disorders helps and has also proven itself. Therefore, the doctor will discuss with the affected woman together whether hormone treatment is appropriate or not in the particular case.
Should a longer treatment be necessary, it must be checked annually whether the treatment still makes sense. The doctor should prescribe the lowest possible dose.
Normally, a woman will be prescribed a supplement containing estrogen plus progestogen on at least ten days a month. This is necessary to prevent neoplasms of the uterus. However, if the uterus has been removed, only a pure estrogen preparation will be prescribed.
Women taking hormones must be made aware that this may result in changes in the breast tissue. Therefore, self-examination of the breast should be self-evident. In addition, the gynecologist must periodically scan the breast for changes and mammograms should be made annually under hormone treatment.
Hormone therapy: risks and contraindications
Under no circumstances should hormone treatment be given if there are certain contraindications. No matter how strong and distressing the symptoms are. These contraindications, that is, reasons prohibiting hormone therapy, include, for example, breast cancer and ovarian cancer. Even women with a history of vascular disease, such as deep vein thrombosis or pulmonary embolism, are excluded from hormone treatment.
The same applies if a woman recently had a heart attack or is suffering from angina pectoris. Because these diseases increase the known risk factors of hormone therapy enormously. Especially close monitoring during treatment with hormones is necessary if a close relative in the family - mother, sister or daughter - has breast cancer.
Also, if a woman smokes or is severely overweight, then the risk factors for a vascular disease are higher than for other women. Another disease requiring regular, close-knit care is lupus erythematosus, an autoimmune disease. The treatment must be stopped immediately, if suddenly high blood pressure values occur or a woman gets for the first time strong migraine-like headache. Because these can be harbingers of a vascular disorder.
Incidentally, the intake of hormones to prevent osteoporosis always means a long-term treatment. Because only over a longer period, the protective effect can unfold. Since a longer treatment is also associated with a greater risk of side effects, this treatment indication should be very well balanced. In principle, we have to think about alternative preventive measures.
Hormone Therapy: Healthy Alternatives
In a nutshell, the best alternatives to menopausal symptoms are those that increase physical well-being, such as diet, exercise and physical exercise. These are natural ways of preventing osteoporosis, feeling more productive, and helping the body to cope with menopausal symptoms such as tiredness and sleep disturbances. A reduction in coffee and nicotine consumption can also alleviate the symptoms.
Nutrition: In the diet should be paid to prevent osteoporosis, for example, on a sufficient calcium intake. Calcium is present in milk and dairy products. Even calcium-rich mineral water can provide the body with plenty of calcium. Otherwise, a vitamin and mineral rich diet makes sense, which gives the body the necessary Fitmacher for daily life.
Sports: It is also an important factor in the prevention of osteoporosis. But not only that: Sport also lifts the mood, it makes you feel more balanced and more efficient. And a lot of exercise in the fresh air is the best remedy for insomnia. Sports doctors now recommend walking; It should be 2.5 hours a week - and the more often, the better. For women who regularly exercise after the menopause experience a heart attack less frequently than women who do not, as the survey of 70, 000 healthy participants of the WHI (Women's Health Initiative) revealed. The pulse rate should not exceed 180 minus age, then the load is right and does the heart well.
Hormone Therapy: Herbal Alternatives
There are also herbal remedies called phytopharmaceuticals to alleviate mild menopausal symptoms. The rootstock of Cimicifuga racemosa, the black cohosh, is widely prescribed to help with hot flashes, sweating, irritability and vaginal dryness. They contain phytoestrogens, ie plant estrogens. Also a bone-protecting property should have the preparations. And it is believed that extracts of black cohosh have no adverse effect on the mammary glands.
Red clover or soy products, which also contain phytoestrogens, have different opinions as to their effectiveness in menopausal complaints. For example, a recent study showed that red clover herbal estrogens, called isoflavones, help against hot flashes no longer than placebo. However, it is supposed to have a softening effect here.
If depression and depression are involved, the doctor should be asked if a therapy with St. John's wort is useful. However, it is important to know that when treated with herbal supplements, the effect only occurs after a longer period of ingestion. It takes about four to six weeks on average, until it comes to a first relief.
A section of life
Maybe it helps some women to remember that menopause is like puberty to life. Both are not diseases, but sections in certain phases of life. The problem is, of course, that the two phases are valued differently: For puberty is the gateway to life, almost spring, in which everything awakens. The menopause, however, announce: The summer of life is over, it goes into the fall. But even autumn has many beautiful sunny days, and today's life expectancy can be quite a few!