Menopause Hormone Therapy

Meaning

Menopause Hormone Therapy (MHT) involves administering exogenous hormones, primarily estrogen, often with progestogen, to alleviate menopausal symptoms and manage associated health risks. This therapy addresses the physiological decline in ovarian hormone production during menopause. Its primary objective is symptom management and supporting long-term health.

Context

MHT operates within the human endocrine system, targeting hormone receptors responsive to estrogen and progestogen. During menopause, ovarian estradiol and progesterone production ceases, causing systemic hormonal deficiencies. MHT aims to restore a more physiological hormonal balance, mitigating estrogen deprivation’s effects on the brain, bone, cardiovascular system, and genitourinary tract.

Significance

The clinical importance of MHT stems from its efficacy in mitigating bothersome menopausal symptoms, including vasomotor symptoms and genitourinary syndrome. Beyond symptom relief, it prevents bone mineral density loss and may offer cardiovascular benefits when initiated appropriately. Individual patient profiles and risk factors guide its careful prescription.

Mechanism

MHT exerts effects by binding to estrogen receptors (ERα, ERβ) and progesterone receptors (PR-A, PR-B) in target tissues. Estrogen agonists modulate gene expression, influencing cellular function in areas like the hypothalamus, bone, and vaginal epithelium. Progestogen is usually included for women with an intact uterus to counteract estrogen-induced endometrial hyperplasia, reducing endometrial cancer risk.

Application

MHT is clinically applied via various formulations, including oral tablets, transdermal patches, gels, sprays, and vaginal inserts, enabling systemic or localized hormone delivery. Treatment protocols are individualized based on symptom severity, patient preference, and medical history. Regular clinical evaluations assess therapeutic response, monitor adverse effects, and facilitate dosage adjustments.

Metric

MHT efficacy is primarily assessed by symptomatic improvement, such as reduced hot flash frequency and severity, resolution of genitourinary symptoms, and improved quality of life. Bone mineral density is monitored via DXA scans. While serum hormone levels can be measured, clinical response rather than specific concentrations typically guides dosage adjustments.

Risk

MHT carries potential risks, including increased venous thromboembolism, stroke, and breast cancer risk, especially with prolonged use or certain formulations. Contraindications include a history of estrogen-dependent cancers, undiagnosed vaginal bleeding, active liver disease, or prior thromboembolic events. Clinical oversight is essential to weigh benefits against risks for safe, appropriate use.

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∞ Atherosclerosis
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∞ Adipose Tissue
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