Our results show that several women aged 80 and over are still using hormone therapy and that most women who started a new treatment period received only one. Hormone therapy (HT) may be safe for women over 65, according to a recent study published in Menopause, the journal of The Menopause Society. As researchers learn more about menopausal hormone therapy and other menopausal treatments, recommendations may change. However, if you have menopausal symptoms that interrupt your sleep or interfere with your daily life, it's worth talking to your healthcare professional about treatment options.Hormone replacement therapy improves the quality of life and extends the lives of many older women, whether they start menopause or much later.
Hormone replacement therapy counseling should be provided to all postmenopausal women. Patients should be warned that estrogen will reduce the chances of death and disability from cardiovascular disease and osteoporosis. Those who have low bone density or are at risk of cardiovascular diseases, such as smoking and high blood pressure, will benefit more than those who don't.Older age may predispose women to the carcinogenic potential of estrogen. However, this must be placed in a statistical perspective for the patient, since the benefits of estrogen clearly outweigh the risks.
In evaluating her personal history and attitudes, the doctor must help the patient decide if the potential benefits outweigh the risk or inconvenience of side effects. Although the available data reveal the general advantages of estrogen replacement, there is a need to further study the optimal dose, the type of estrogen, the time of initiation and the duration of treatment in the geriatric population. When it comes to bone health, hormone therapy has many bone health benefits for women up to 60 years of age. In some cases, they may continue hormone therapy after age 60, depending on their bone density and general health, and other factors.
However, keep in mind that it's not very common to start hormone therapy for bone health at age 60 or later. This is because, when we reach the age of 60, our arteries become stiffer and women are at greater risk of suffering from cardiovascular diseases. Short periods of hormone replacement therapy (HRT) are often used to treat vasomotor symptoms around the time of menopause, but adherence to long-term therapy is low. However, there is increasing evidence supporting the initiation or resumption of hormone replacement therapy as a subsequent intervention for a variety of progressive conditions associated with menopause and aging.
If the risk-benefit ratio is favorable to hormone replacement therapy, several strategies can be used to improve acceptance and minimize side effects, with the goal of improving the quality, if not the quantity, of life. If a risk-benefit analysis favors hormone replacement therapy, it may be appropriate and acceptable to initiate local or systemic hormone replacement therapy in some older women to improve their quality of life. Intuitively, prevention is preferable to treatment of the established disease. However, universal therapy for disease prevention may not be practical, affordable or acceptable.
Many of the health consequences of menopause and aging can be modified through hormone replacement therapy (HRT), which involves using estrogen alone or estrogen plus a progestin. In recent years, standard teaching suggested that HRT should be continued during menopausal years to provide maximum relief from vasomotor symptoms, optimal effects on bones, lipids, and the urogenital tract, and the possibility of protection against cardiovascular diseases, cerebrovascular diseases, colon cancer, and neurodegenerative disorders such as Alzheimer's disease. Few therapies in modern medicine have the potential to offer such a wide range of health benefits at a relatively low cost. However, acceptance and continuation rates of hormone replacement therapy remain low. Concern about a possible increased risk of breast cancer seems to be the biggest obstacle to starting hormone replacement therapy, while the main reason for discontinuing treatment is intercurrent bleeding or withdrawal.
As an alternative to long-term use of hormone therapy as a preventive strategy, there is increasing support for periods of hormone therapy use adapted to women's current health problems. This model focuses on treatment rather than prevention and, therefore, has inherent limitations. However, it may be more attractive to those who do not like to take medication unless absolutely necessary, for those who prefer to avoid medicalization at this stage of life, and for those who fear that the risk of breast cancer will increase as the duration of hormone therapy increases. In this model, hormone replacement therapy could be used for 1 to 5 years in the perimenopausal interval to control vasomotor symptoms and irregular bleeding.
A second conversation about the use of hormone replacement therapy (and other therapies), in particular to protect bones and alleviate urogenital symptoms, may begin later in life, depending on individual symptoms, health status and risk factors. Evidence is now accumulating to support the use of HRT as an afterintervention for a variety of progressive conditions associated with menopause and aging. Vasomotor symptoms (table 1) are usually more problematic in perimenopause and in the early years of menopause, but they usually improve spontaneously over a period of 2 to 5 years. Some women have residual bothersome symptoms that persist for years or decades.
Unlike vasomotor symptoms, which appear early and tend to disappear over time, urogenital symptoms tend to develop progressively in the years or decades following menopause (table). Urogenital conditions can affect 30 to 50% of menopausal women and can be a source of significant daily discomfort. Vaginal dryness during sexual arousal is usually the first symptom and may precede physical symptoms. It is clear that a short period of use of hormone replacement therapy, of 2 to 5 years, around the time of menopause, will not provide effective bone protection in the long term.
Conversely, if its current use protects bones and most fractures occur in older women, selective administration of TRH (or other antiresorptive treatment, as needed) to older women may be justified who are at greater risk of fracture. However, these findings suggest that continuous combined HRT (i.e., these recommendations) cannot be extrapolated to primary prevention or applied to other HRT preparations or combinations. Currently, data do not support changing the current hormonal therapy regimen in older women, with or without coronary heart disease. Until the data indicate otherwise, it does not seem logical to discontinue hormone therapy in older women without established coronary heart disease, especially if the risk-benefit ratio is favorable to hormone replacement therapy.
The results of large randomized trials, such as the Women's Health Initiative, can help clarify this issue. The recent wave of media attention has caused many postmenopausal women to ask about the use of hormonal hormone therapy for the prevention or treatment of disorders such as Alzheimer's disease. Estrogen appears to have a neuroprotective function, probably mediated by its antioxidant properties and its ability to improve cerebral blood flow, improve brain glucose metabolism and reduce ß-amyloid deposition. It follows that the loss of these protective effects after menopause may contribute to the neurocognitive impairment that occurs with normal aging.
While the evidence linking HRT to Alzheimer's disease is interesting, it is still of limited quality and requires confirmation in large placebo-controlled trials, such as the one currently being conducted by the National Institute of Health as part of the Women's Health Initiative. Until these results are available (probably after 200 years), it doesn't seem prudent for doctors to promote the use of hormonal hormone therapy in older women solely as neurocognitive protection. However, it would not be logical to deprive motivated women who want to try it for neurocognitive protection, as long as the risk-benefit ratio is favorable to HRT. Women who haven't been exposed to appreciable levels of estrogen for many years may be particularly susceptible to estrogen-related side effects, such as swelling, breast tenderness, and vaginal discharge.
Older women may not need or tolerate doses of estrogen that were traditionally considered osteoprotective (Table), particularly in light of recent evidence suggesting that some bone protection can be achieved with lower doses. As it is not urgent to achieve full therapeutic doses of hormone therapy, side effects can be minimized by starting with half the intended dose, administering it daily or every other day. Subsequent dose increases may occur gradually over the following weeks until symptoms ease (if appropriate), unwanted side effects occur, or the desired dose is reached. In women with a uterus, it may be prudent to delay the addition of progestin for a few weeks to differentiate side effects attributable to estrogen components.
and progestogen. Compared to women who have recently been in menopause, older women tend to have a lower incidence of menstrual bleeding or bleeding that occurs with hormone replacement therapy, although bleeding can be much more annoying and distressing for them. Continuous combined hormone replacement therapy would seem most logical under these circumstances, as there is little reason for the use of cyclic hormone replacement therapy, as it can cause withdrawal bleeding in this age group. If the risk-benefit ratio favors hormone therapy, several strategies can be used to improve acceptance and minimize side effects.
These include instituting therapy slowly, considering lower doses, and evaluating systemic therapy. in front of the local one. While menopause and aging have many unavoidable health consequences, initiating systemic or local hormone replacement therapy may be appropriate and acceptable in some older women to improve the quality, if not quantity, of life. Vulvovaginal vaginal dryness, pruritus, discharge, dyspareunia, postcoital bleeding Urinary frequency, urgency, dysuria, recurrent urinary tract infections, emergency incontinence, stress incontinence, vaginal sexual dryness, dyspareunia, reduced genital sensitivity, coital incontinence, loss of libido Dr.
Fluker is co-chair of the Canadian Consensus Conference on Menopause and Osteoporosis (Society of Obstetricians and Gynecologists of Canada), co-director of the Genesis Fertility Center and clinical professor in the Department of Obstetrics and Gynecology from the University of British Columbia. An alternative version of the ICMJE style is to additionally include the month in which an issue number appears, but since most journals use continuous pagination, the shorter form provides enough information to locate the reference. The NLM now includes all authors. Do all of these findings relate equally to bioidentical hormones? The BCMJ is a general medicine journal that shares knowledge and, at the same time, establishes connections between doctors in British Columbia.
If you want to start hormone replacement therapy, be sure to talk to your doctor first about the benefits and risks, and be sure to consider your medical history, age, personal preferences and risk factors. Talk to your healthcare professional about these risks when deciding if menopausal hormone therapy might be an option for you. Findings from 2002 from the Women's Health Initiative show that hormonal hormone therapy may slightly increase the chances of breast cancer, stroke, and heart disease in women who went through menopause and took a combination of estrogen and progestin (a form of progesterone).). Your healthcare professional can help you choose the best way to take these hormones based on what works for you and has the least number of side effects.
The average duration of hormone therapy use among new users was 257 days (25 to 75 percentiles, 611-120 days). HRT is an approved treatment for the prevention of osteoporosis and may also be the treatment option for people who start treatment before age 60, especially those who have a premature or early menopause (early menopause, or menopause before age 45, may mean that you don't have enough estrogen to protect your body, so you may need HRT to prevent the disease). In the WHI hormonal therapy clinical trial, 16,608 women with an intact uterus were randomly assigned to a daily combination of oral conjugated equine estrogen (CEE, Premarin) at a dose of 0.625 mg and oral medroxyprogesterone acetate (MPA, Provera) at a dose of 2.5 mg or placebo. CEE is the estrogen in the urine of pregnant mares and, although it is natural, eight of the ten estrogens in Premarin are not bioidentical to human estrogen. This is because taking estrogen without a progestin can thicken the lining of the uterus, which can increase the risk of endometrial cancer.
The results revealed that, compared to women who never used hormone replacement therapy or discontinued it after age 65, the use of estrogen alone after age 65 was associated with a significant reduction in the risk of mortality, breast cancer, lung cancer, colorectal cancer, congestive heart failure, venous thromboembolism, atrial fibrillation, acute myocardial infarction and dementia.
