When entering menopause, many changes occur, and symptoms may arise from estrogen deficiency. Some women may have no symptoms or only mild symptoms for a short period, while others may experience severe symptoms that disrupt daily life. Hormonal changes during menopause can cause the following important symptoms:
- Changes in menstruation The menstrual characteristics in women entering menopause vary. Some may stop menstruating completely, while others gradually have less bleeding until it stops, which is normal. However, if bleeding lasts longer than 7 days or there is abnormal spotting, a thorough examination is necessary, and cancer should be considered until it is confirmed not to be menopause. Some women mistakenly believe these symptoms are normal for this age and neglect proper examination or take medications, health supplements, or certain herbs to cleanse or detoxify the body, leading to complications such as abnormal bleeding or lower abdominal pain. By the time they see a doctor, the symptoms may have worsened significantly.
- Hot flashes and night sweats These are changes in the autonomic nervous system, including hot flashes that usually spread from the chest to the neck and face, often accompanied by sweating and followed by chills. These symptoms can disrupt daily life, and if they occur at night, they may disturb sleep.
- Easy irritability Estrogen deficiency affects mood and mental state, causing irritability, mood swings, lack of concentration, headaches, fatigue, and depression.
- Vaginal dryness Effects on female reproductive organs include vaginal dryness. Estrogen deficiency causes the tissues and muscles around the urethra and bladder to shrink and sag, leading to burning pain during urination, frequent urination, urinary leakage when coughing, sneezing, or laughing, and increased susceptibility to bladder infections.
- Osteoporosis and fragile bones Normally, the body continuously builds new bone and breaks down old bone. In childhood and adolescence, bone formation exceeds bone resorption. Studies in Thailand show that bone density in Thai women peaks at ages 30-34 and then slowly decreases by about 0.3-0.5% per year after age 35. This bone loss continues for about 5-10 years, potentially leading to osteoporosis in this age group. Without prevention, bones may become fragile and fracture from minor injuries. Osteoporosis usually shows no symptoms until fractures occur, making it a silent threat for menopausal women.
- Possible coronary artery disease Effects on lipids and blood vessels include increased cholesterol and LDL (“bad” cholesterol) levels and decreased HDL (“good” cholesterol) levels due to estrogen decline. This promotes blood clot formation on vessel walls, especially in coronary arteries, increasing the risk of coronary artery disease.
- Memory loss Menopause may cause easy forgetfulness, reduced ability to remember names or important information. Alzheimer’s disease, caused by brain cell degeneration, accounts for about 70% of dementia cases in the elderly. Its incidence rises rapidly after age 65 and is more common in women than men, especially in those who do not frequently engage their brains. Menopausal women should keep their brains active with activities like math or puzzles.
- Insomnia Some may experience complete inability to sleep until dawn, while others have fragmented sleep with multiple awakenings each night. These symptoms prevent the brain from getting adequate rest, significantly affecting overall health and potentially leading to other diseases.
What is hormone replacement therapy?
Hormone replacement therapy is a treatment for menopause using hormone drugs. In women, natural estrogen (Bio-identical Hormone) with the same structure as the body’s female hormones is used, sometimes combined with another female hormone, progesterone, which has similar properties to natural hormones. Most commonly, natural forms are used in oral medication. Doctors may also consider other forms such as transdermal patches, gels, vaginal suppositories, or nasal sprays, especially for patients with liver problems, gastrointestinal issues, diabetes, high blood lipids, or migraine headaches.
Hormone replacement therapy can also be given to men using testosterone in oral or injectable forms to improve overall health, comfort, and sexual function. However, sexual dysfunction has many causes and is not solely due to hormone decline.
Benefits of hormone replacement therapy
Women: It can help treat menopausal symptoms, especially those related to reproductive organs such as vaginal dryness, thinning vaginal lining, loss of elasticity, and moisture leading to inflammation.
Men: It can help reduce fatigue, low energy, decreased libido, erectile dysfunction, and muscle weakness.
It also helps reduce depression, fatigue, palpitations, and insomnia, improves skin firmness and moisture, reduces skin inflammation, enhances memory and concentration, and increases bone density. However, the effects of hormone replacement therapy vary depending on individual health factors.
Are there contraindications or side effects of hormone replacement therapy?
Hormone replacement therapy is given at low doses equivalent to normal levels, so side effects are minimal. In women, side effects may include vaginal bleeding, mostly occurring at the beginning of treatment but usually resolving with continued use. Other side effects may include breast tenderness and migraine headaches, which typically occur only at the start of therapy.
In men, hormone replacement therapy is contraindicated in those with prostate cancer because testosterone can accelerate cancer progression. Doctors will evaluate whether to use it and schedule follow-ups to assess treatment outcomes.
However, hormone replacement therapy alone does not improve overall health but is just one method of health care. The important factors are lifestyle habits such as regular exercise, healthy diet, avoiding high-fat foods, alcohol, smoking, getting enough rest, and managing stress. These components help navigate this life stage without problems.
