diLaura Cuppini
The aim of the therapy is to compensate for the hormones that are lost with the end of the menstrual cycle, in order to bring the organism back to a state of balance and reduce or eliminate any symptoms.
It is true that only a few Italian women resort to hormone replacement therapy in menopause? Second a Censis surveyconducted in 2021 on over a thousand women between the ages of 45 and 65, in the presence of moderate to severe symptoms, in particular hot flashes – present in approximately 40% of cases – Italian women mainly resort to herbal medicines (63,3%) e only 7.6% use hormone therapy.
A tailor-made treatment
What are the reasons for this? hormone replacement therapy (Tos) is prescribed to some women to alleviate and cure menopause disorders. These are drugs based on estrogen and/or progesterone. The aim of the therapy is to compensate for the hormones that are lost with the end of the menstrual cycle, so as to bring the body back to a state of balance similar to the period before menopause, reducing or eliminating any symptoms (hot flashes, insomnia, vaginal dryness, pain during sexual intercourse). It is important to know that HRT cannot be prescribed to all women (and this partly explains why few Italian women follow the therapy): only the doctor can establish whether it is necessary in the individual case, evaluating a series of parameters; furthermore, the treatment must be “tailor-made” based on the characteristics of the individual patient. It is available as pills to be taken by mouth, as a patch, and as vaginal gels or creams.
Increased risk of some cancers
It is known that Tos can increase the risk of some cancers: this is another worrying factor for many women. But it is necessary to clarify this point. In 2002 a large American study observed a slight increase in cases of breast cancer in women taking estrogen and progestin. In reality the risk of developing breast cancer (or even endometrial cancer) is small, it refers to high dosages and is linked to very long periods of intake (more than five years); it is null if the therapy is followed for a year or if it is done vaginally, with an absorption of hormones in circulation practically equal to zero. Not only that: the American study refers to old drugs, with the medicines used today the risk is more contained. However, it is important to carry out the therapy in strictly necessary cases indicated by the doctor, at the minimum effective doses, with latest generation products. Furthermore, some categories of women should not take hormone replacement therapy: those with a history breast cancerespecially if estrogen-dependent, those who have had heart attacks, strokes, thromboembolism (because HRT increases the risk of thrombosis).
Combined estrogen-progestin TOS
Second a recent studypresented at the annual congress of the American Society of Clinical Oncology (Asco), women who have taken a certain type of hormone replacement therapy (with only conjugated equine estrogens, the so-called CEE) experience increased risk of both developing and dying from ovarian cancerwhile those who have used another type (conjugated equine estrogens combined with medroxyprogesterone acetate or Mpa) not only run no risks, but are also less likely to develop a uterine cancer. These data confirm that Combined estrogen-progestin HRT (the most prescribed in Italy) is currently the safest solution. Several studies also show another piece of data in favor of HRT, namely a decrease in the risk of developing colon cancer.
Decreased sexual desire
One of the most relevant aspects of menopause is the onset of sexual desire disorders. «About 40% of women aged 45 and over complain of a decrease in desire and 15% report associated stress – explains Rossella Nappifull professor of Obstetrics and Gynecology at the University of Pavia, as well as president-elect of the International Menopause Society (IMS) -. The progressive decline of male hormones, testosterone and DHEAS (dehydroepiandrosterone sulphate), and the deficiency of these hormones during menopause estrogensfemale hormones that regulate Vaginal lubrication and genital congestionare the main causes of the decrease in sexual desire. Sometimes the woman manages to compensate thanks to the strong sense of intimacy that you feel towards your partner and the complicity of the couple, but in some cases the state of health of both contributes to a less satisfying sexual life. Even the general symptoms of menopause, such as hot flashescan lead to a decrease in desire.”
Tips for finding intimacy with your partner
How to address the problem? To date there are no drugs specifically designed for the decrease in libido during menopause. «It is always of fundamental importance to try to improve the health of the vagina and genitals with hormonal products to be applied locally, or with oral tablets such as ospemifene, a special estrogen that works only on the vulvo-vaginal tissues and reduces vaginal dryness and sexual pain, or tibolone, a hormone replacement therapy that has the advantage of having a small androgenic action, as well as estrogenic – continues Nappi -. All HRTs, if effective on the symptoms of menopause, can benefit sexual desire.remembering however that to improve it it is really important to put it at the centre of one’s thoughts and daily interactions with one’s partner, to keep alive the imagination and the personal and couple’s affective and cognitive motivation”.
September 8, 2024 (edit September 8, 2024 | 15:52)