Hormone replacement therapy

Natalya Lelyukh – gynecologist-endocrinologist, (Ukraine, Kiev)

The normal aging process is accompanied by certain changes in the skin. The skin becomes thinner, becomes atrophic and loses elasticity, its surface is dry, as lipid production is reduced. The secretion of sebum decreases, the life expectancy of fat gland cells increases. There is a compensatory increase in the number of these glands due to a decrease in collagen synthesis. All these effects occur due to the normal age-related decrease in testosterone, and no pathological processes on the skin should be observed. This period in a woman’s life is called menopause.

Symptoms and prevention of menopause

First of all, it is worth noting that women who are going through menopause are not sick, and any medications should be prescribed only if there are clear indications. The opinion that taking hormone replacement therapy can be a “preventative measure” for the development of menopausal syndrome is wrong! Preventive measures in this case are:

• stopping smoking, as well as reducing alcohol and caffeine consumption;
• physical exercises that regulate weight (walking, cycling, dancing, aerobics, jumping rope, jogging);
• a diet rich in calcium and vitamin D, with plenty of vegetables and fruits;
• relaxation techniques, meditation and massage;
• maintaining regular sexual activity (to eliminate vaginal dryness, you can use oil- or water-based lubricants);
• Wearing several layers of light clothing or using a folding fan to feel more comfortable in case of hot flashes;
• communication – you shouldn’t close yourself off, you need to look for new opportunities for self-realization;
• a woman over 55 years of age needs to make efforts to reduce the risk of falling: do not use sliding mats at home, avoid poorly lit places and slippery surfaces, wear shoes that support the foot well and have good grip on the surface, avoid unnecessary use of psychotropic medications, many of which cause dizziness .

If a woman is bothered by a small number of “hot flashes” during the day, increased sweating, sleep disturbances and causeless mood swings, this is not because “hormones have disappeared”, but because their ratio has changed, and it is necessary not to “replace lost hormones”, but to change the image life in the light of new hormonal connections.

If, unfortunately, the transition period has followed the “wrong” path of development of pathological symptoms, that is, a woman develops a picture of menopausal syndrome, then the prescription of replacement therapy should occur according to all the rules of rational pharmacotherapy - taking into account the mechanism of action of the drugs, indications and contraindications for them applications. And only a doctor should do this and only if the woman fully understands all the possible risks of taking hormone replacement therapy (HRT).

Indications and contraindications

Today, the high effectiveness of HRT in the treatment of a complex of menopausal disorders and the pronounced effect of such therapy on the condition of the skin is not disputed by anyone. The use of HRT for three months is accompanied by an increase in the thickness of the epidermis by 2 times. Over 5 years of estrogen therapy, it is possible to restore all the collagen mass in the skin lost during menopause (about 30% of the original amount). However, all this is possible no later than 2–4 years after the onset of menopause. In the future, this process is difficult to correct.

The prescription of hormone replacement therapy is indicated for women with a pathological course of menopause, with artificial abrupt menopause (after surgical removal of the ovaries). This is a justified prescription of drugs with mandatory monitoring by a doctor - examination every 6 months, mammography, transvaginal ultrasound.

Unfortunately, estrogens do not always show their positive side. Their ability to stimulate the proliferation of cells in the reproductive system can play a fatal role in the development of uterine tumors and breast cancer. Therefore, the attitude of doctors towards hormone replacement therapy remains wary, despite the fact that a number of clinical studies have confirmed its positive effect on the health of women during menopause (increased bone density, improved plasma lipid profile, reduced risk of cardiovascular diseases, improved general well-being and mood). The doctor who decides on the need for HRT first examines the woman for the presence of hidden tumors and finds out whether there are predisposing factors (heredity, smoking, cancer in the past, etc.).

Before prescribing hormone replacement therapy, the doctor must:

• study all “women’s” history and heredity;
• conduct a specialized gynecological examination (examination of the mammary glands and examination of the cervix, and an oncocytological examination are mandatory);
• study the results of mammography;
• study the results of a study of the functioning of the blood coagulation system;
• study the results of ultrasound examination of the pelvic organs;
• study the results of a lipid profile (especially for obese women), blood glucose tests, and glucose tolerance test.

Absolute contraindications for prescribing HRT are:

• vaginal bleeding of unknown origin;
• liver diseases;
• thrombophlebitis;
• history of breast cancer and/or endometrial cancer;
• coagulopathies, acute thrombosis, thromboembolism;
• severe forms of diabetes mellitus;
• meningioma.

Preparations for HRT are available not only in the form of tablets, but also in the form of creams, gels and patches for transdermal therapy (steroid hormones are well absorbed through the skin). All of them are pharmaceuticals and cannot be used in cosmetology.

Weak sides

However, do not forget about a number of side effects of HRT. The most unpleasant of them are the effect on the blood coagulation system and the provocation of venous blood clots. In addition, side effects of therapy include:

• engorgement of the mammary glands;
• decrease or increase in body weight (4–5%);
• nausea, pastiness;
• fluid retention, headaches;
• copious discharge of cervical mucus;
• cholestasis;
• decreased or increased libido.

Therefore, long-term use of estrogens for aesthetic purposes requires a sober assessment of all the pros and cons on the part of both the doctor and the patient - the risk of side effects may exceed the possible benefits. And besides, it’s important to remember: menopause is not a disease. Menopause is a unique chance given to a woman to try to change her life and find new facets of it.

First published: KOSMETIK international journal, No. 2(36), 2009, pp. 20-21