new canadian guidelines for menopausal hormone replacement therapy
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outside of the medication route, dressing in layers and drinking cold drinks can reduce the symptoms of hot flashes and night sweats. getty
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new canadian guidelines have been released on when to prescribe menopausal hormone therapy — and when it might heighten health risks,
menopausal hormone therapy (mht), according to the new guidelines, is the most effective treatment to relieve menopause symptoms, especially when they are severe. long-term data suggests that mht should not increase the risk of cardiovascular disease if it isn’t prescribed for women who are already at an increased risk of heart disease and isn’t prescribed for an extended period.
here’s the catch. menopause officially begins 12 months after a woman has had her last period. menopause symptoms, like hot flashes, night sweats, insomnia, mood swings, vaginal dryness and discomfort during intercourse, can last for many years for some women, or intensify at different points.
this change of life for women can be complicated. symptoms can also start in perimenopause, typically when women are in their 40s, when menstrual cycle length and flow can be irregular and unpredictable. and the hormones necessary for reproduction, estrogen and progesterone, fluctuate, causing confusing and uncomfortable symptoms, dr. jerilynn prior, a professor of endocrinology in the department of medicine at the university of british columbia and the scientific director at the centre for menstrual cycle and ovulation research, told healthing early this year.
during menopause, the there is a significant decrease in estrogen produced by the ovaries, according to up to date. mht works by replacing this estrogen, often combined with progesterone, that the body may no longer be producing.
but it’s not as simple as a one-for-one replacement, cardiologist and university of toronto professor dr. beth abramson explained to ctv.
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“estrogen is a hormone and a hormone by definition has multiple effects on the body … and the issue with estrogen is that there is a consistently small, but important, increased risk of blood clots in the legs and the lungs. we call it venous thromboembolism. that has to be weighed against the risk of benefit to that individual patient.”
hormone replacement therapy for menopause may pose risks if started later in life
women who are a decade past menopause — roughly 60 years or older — have a higher risk of blood clotting, so mht is not recommended for this cohort.
“there have been several studies and analyses that have come out in the last few years to inform and appropriately give health-care providers the information to have a conversation with their female patients,” abramson told ctv news.
abramson is one of the authors of the new guidelines and says they are designed to give doctors, nurses, pharmacists and other health professionals the tools to better understand the therapy protocols and risks. she also says each patient has individual risks and circumstances that factor into treatment.
“the women who are under 60 years of age who’ve had menopausal hormone therapy initiated shortly after their last menstrual period, there seems to be no increased risk for cardiovascular disease,” she told ctv. “and we have seen in general, there’s low risk for adverse events, including stroke, in the next few years,”
that being said, research indicates mht may decrease the risk of cardiovascular disease in certain circumstances. women who start menopause early may be at higher risk of heart disease, however, when these women underwent mht from their start of menopause until the average age of menopause, 51, risk of cardiovascular trouble appeared to decrease.
different approaches to menopause are available
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approximately 20 per cent of women experience severe menopausal symptoms, with around 80 per cent in total experiencing some symptoms, according to mount sinai hospital.
for women who do not want to use, or cannot use, hormone therapy, other treatments are available, according to the society of obstetricians and gynaecologists of canada. various antidepressant medications show promise in treating hot flashes, while other medication is available to reduce night sweats.
outside of the medication route, dressing in layers and drinking cold drinks can reduce the symptoms of hot flashes and night sweats. quitting smoking and maintaining a healthy weight can also help relieve symptoms, as well as meditation and exercise.
karen hawthorne is a toronto-based writer.
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