The use of hormone therapy in women who have premature menopausal symptoms is not widely used because of the fear of negative consequences; however, the risk associated with HT that is observed after natural menopausal symptoms are not relevant for young women According to a lecturer.
Menopausal prematurely, as defined by the onset of menopausal symptoms before age 40 and can cause a significant emotional impact on young women especially if the desire for fertility is a priority, Ekta Kapoor, MBBS, FACP, MSCP, associate professor of medicine at Mayo Clinic in Rochester, Minnesota spoke about during a plenary talk during the annual Meeting of The Menopause Society.
The risks associated with HT that are seen in natural menopausal symptoms do not apply to women who have menopausal symptoms as per a lecturer.
Early loss of estrogen and loss of estrogen, estimated to happen in around 3percent of women can increase the risk of osteoporosis and cardiovascular disease as well as cognitive decline. Women can also experience symptoms of menopausal change, such as hot flashes and sleep disorders as well as mood swings and anxiety. Alongside the spontaneous menopausal symptoms, the causes that are iatrogenic are pelvic surgery, including bilateral oophorectomy or chemotherapy and radiation.
If there is no contraindication, the replacement of estrogen is suggested to restore the hormonal environment similar to the premenopausal woman without the presence of signs that suggest estrogen deficiencies, Kapoor said.
“If women are done with having children, should need to fret about the loss of estrogen this person in the early years?” Kapoor said. “The conclusion is “yes. It is the absence of female hormone that was running through her veins at the age of her birth, but she’s been deprived of it before the time she could have had if the circumstances were to go as they normally do. It is an endocrine deficit condition, and this is the way it should be handled.”
Essentiality of the estrogen treatment
If you have a woman with an endocrine deficit estrogen can be considered a an alternative therapy for hormones, similar in nature to the replacement of thyroid hormones therapy in hypothyroidism Kapoor stated. Furthermore, discussions on risk-benefits regarding CVD don’t apply for women who have menopausal symptoms.
“I often repeat this because patients frequently be told by their doctors that ‘your risk of developing breast cancer increases due to HT use; you’re not experiencing menopausal symptoms, and we might be able to remove you from high-risk therapy. This is not the case. This isn’t simply symptom-management. It is intended to decrease mortality and morbidity associated with deprivation of hormones prematurely.”
The results of randomized controlled trials that inform HT decisions in menopausal prematurely are insufficient, and standards for consensus have not been established, Kapoor said. The experts recommend using HT as long as it is at the time of menopausal natural but with the possibility of prolonging the use based on the symptoms, and also risk-benefit factors and also the use of greater doses of estrogen that approximate the levels of hormones in premenopausal women. It could be patches of estradiol that deliver 100 ug daily or oral estradiol with 2 mg/day or equivalent dosages of different kinds of estrogen.
“Our objective is to treat women at high doses since it is a replacement strategy,” Kapoor said. “Remember that you are trying to create the premenopausal hormone environment.”
Studies on long-term effects of the right dosage of progestogens for protection against endometrial cancer for women who are taking high doses of estrogen aren’t currently available. The generally accepted practice is to take larger doses of progestogens Kapoor explained.
Making an diagnosis
Women who experience spontaneously premature menopausal changes must undergo a comprehensive history as well as medical examination as well as a laboratory test to establish the diagnosis as well as diagnosing the causes of menopausal. The initial laboratory test includes pregnancy tests in the serum as well as follicle stimulating hormone (FSH) as well as thyroid-stimulating hormone levels and levels of prolactin. If the FSH levels are elevated tests should be conducted every 4 to 6 weeks. If you have a persistently high FSH with a higher than 40 IU/L substantiates that there is a diagnosis for ovarian insufficiency even though some guidelines recommend less thresholds Kapoor explained.
“For the majority of women who suffer from spontaneous Ovarian insufficiency, the symptoms may be infrequent [andfrequently fluctuating,” Kapoor said. “This results in delays in diagnosing. A lot of times, patients are able to tell you is they’ve been waiting for several months or even years without seeing many doctors before getting an diagnosis.”
Kapoor believes that genetic tests is a must for every woman, but especially those who have a family history of ovarian insufficiency or who are younger than at the time of symptoms beginning.
“It is crucial to realize that many women that we consider to be premenopausal idiopathic conditions may actually be suffering from undetermined medical conditions we do not have a clue of,” Kapoor said.
Kapoor suggested screening for the most common auto-immune disorders, including Hashimoto’s thyroiditis, adrenal deficiency and type one diabetes. The testing of ovarian antibodies isn’t advised due to the low specificity and sensitivity. Kapoor has also suggested the use of a bone density baseline test.
Alongside the HT itself, goals for management must include psychological counseling and assistance; control of symptoms and assistance in conceiving, should you desire it; and a reduction in the risk of long-term illness through reducing CV risk factors. Women who want to have children are advised to consult an reproductive endocrinologist.
The use of testosterone therapy could be a treatment option for patients suffering from hyperactive sexual desire disorder particularly following bilateral oophorectomy. Kapoor explained.
“You are able to achieve two objectives with treatment. The first is to reduce the mortality and morbidity that comes by estrogen deprivation, and the alternative is] controlling symptoms,” Kapoor said.