Menopause, an inevitable stage in a woman’s life, is often accompanied by unpleasant symptoms called climacteric (hot flashes, sweating, fatigue, etc.) which significantly affect their quality of life. To alleviate these symptoms, various hormonal treatments have been developed, however giving rise to controversy and questions about their risks and benefits. With the expertise of Dr Isabelle Héron, gynecological endocrinologist and president of the FNCGM, Ma Santé takes stock of the hormonal treatment of menopause.
The subject was in fact at the heart of the discussions at the National Gynecology Meetings, organized every two years by the National Federation of Medical Gynecology Colleges and the French Society of Gynecology. A meeting which allows the profession to become aware of new therapeutic practices and innovations, to share their experiences but also their concerns, like this questioning on the obvious decline in the use of hormonal treatment for menopause.
Menopause: how does it happen?
Why are menopausal symptoms likely to be complicated?
Menopause is associated with a set of symptoms known as “climateric syndrome”, which includes various physical and psychological disorders. Hot flashes, one of the most common symptoms, manifest as episodes of intense heat and redness, often accompanied by sweating. “These episodes can come on suddenly and disappear within five minutes or last longer in some women” underlines Dr Isabelle Héron.
Sleep disorders are also common. Nocturnal hot flashes make rest unrefreshing. As a result, postmenopausal women may experience chronic fatigue, exacerbating other symptoms like anxiety, depression and irritability. Joint pain and vaginal dryness add to the overall discomfort, making this period even more difficult to manage. “This stage in a woman’s life is very detrimental to her quality of life, both personal and professional.”.
The risk of osteoporosis increases during menopause
Osteoporosis is a condition that can be triggered by the onset of menopause, mainly due to the drop in estrogen levels. Estrogens are essential hormones for maintaining bone density. When estrogen levels decrease, bone resorption (the process where bones break down) increases, and new bone formation slows, leading to a net loss of bone mass and making bones more fragile and prone to fracture.
Hormonal treatment for menopause: risks and benefits
How does menopause hormone treatment work?
To relieve the symptoms of menopause, several hormonal treatments are available. Hormone replacement therapy (HRT) is commonly used, consisting of administering estrogen and sometimes progesterone to compensate for the natural hormonal decline. In France, the use of natural estrogens is favored, because they do not significantly increase cardiovascular risks or breast cancer.
This treatment works by replacing hormones that the body no longer produces in sufficient quantities, thereby reducing climacteric symptoms. Estrogen helps ease hot flashes, sleep disturbances and joint pain, while progesterone is used to protect the endometrium against the effects of estrogen. “It’s a real change for women who take the treatment, the associated symptoms disappear and they can go through this natural stage more peacefully.”
Are there non-hormonal treatments to treat associated symptoms?
Faced with the risks associated with hormonal treatments, many women are turning to non-hormonal alternatives to manage their symptoms. This is particularly crucial “for women who have had breast cancer, for whom hormonal treatments are absolutely contraindicated” insists Isabelle Héron.
These women must turn to non-hormonal treatments to manage symptoms associated with perimenopause and menopause. “Homeopathic treatments may be helpful for premenopausal symptoms”. Regular physical activity also plays a crucial role in helping maintain bone density (read WHAT TO KNOW) and improving overall mood.
The future of hormonal treatments
Why is hormonal treatment for menopause not systematically recommended?
Despite their benefits, hormonal treatments carry risks. Studies, including a 2002 study by the Women’s Health Initiative (WHI) in the United States, found that HRT may increase the risk of stroke, breast cancer and cardiovascular disease. These findings led to a significant decrease in the use of HRT, “because the risks were considered more important than the benefits”.
ATTENTION : this study was carried out on American and not French treatments and indicators! In France, the estrogens used are natural and do not increase the risks.
Unfortunately, distrust of hormonal treatments remains, exacerbated by crises such as that of the contraceptive pill and a general lack of knowledge of the subject among health professionals and patients.
How can we counter this persistent decline in hormonal treatments?
“To encourage rational use of hormonal treatments, it is essential to increase awareness among doctors and women about the real benefits and risks of HRT.” It is crucial to create a climate of trust between patients and their doctors to allow personalized follow-up and open communication.”
Continuing training of health professionals is also necessary to better understand and manage menopause.
TO KNOW
The FNCGM wishes to raise awareness among the professional community through dedicated training to develop practices and best support women at this pivotal period in their lives. From September this awareness system will be implemented throughout the national territory.
