Menopause is a natural passage in the life of every woman: the term designates the end of the menstrual cycle and the female reproductive life. A woman is considered to be in menopause when 12 months have passed since her last menstruation.

Menopause is characterized by an abnormal fluctuation (before) and cessation (after) of the production of estrogen, the female sex hormones, and a phenomenon that often leads to a set of symptoms.

As Dr. Elena Zannoni, a specialist in gynecology and reproductive medicine at Humanitas, explains, symptoms can be controlled by non-hormonal therapies and hormone replacement therapy.


Non-hormonal therapies

In the control of postmenopausal symptoms, non-hormonal drugs or preparations with an estrogen-like action are often used. For this reason, they are called phyto-estrogens or natural estrogens.

The best known and most used is soybean. The use of this substance in the treatment of menopausal disorders stems from the consideration that Eastern women (notoriously large soy consumers) have lower rates of osteoporosis. In fact, soya has been shown to be poorly effective in controlling the most frequent symptoms (hot flashes and night sweats), particularly in the long term. In addition, efficacy on bone has not been demonstrated. The fact that the East consumes soya for life while in the West it is administered only after menopause, could be one of the causes of inaction.

Other natural remedies that are proposed are the red clover or the intake of preparations based on cimifuga racemosa, a plant native to North America that has the ability to counter hot flashes especially.


Hormone Replacement Therapy

Hormone Replacement Therapy (HRT) in menopause consists in giving the woman back their sexual hormones. Basically, it is a matter of taking estrogens, but they must be administered together with progesterone or substances with a similar action to protect the uterus. It goes without saying that women who have had their uterus removed can only take the estrogenic part of the therapy.

The introduction of these hormones makes it possible to counteract many of the symptoms and/or problems deriving from the menopausal state (flushing, depression, irritability, insomnia, tachycardia, vaginal dryness, decrease in bone mass).

In the past, HRT has been very much fought for because of the fear that it could increase the onset of breast cancer. On the other hand, several studies have shown that these assumptions are unfounded and have made the use of these drugs available again, where necessary.


For which women is HRT indicated?

However, HRT must be prescribed and taken under the supervision of a specialist and after evaluating the advantages and disadvantages of using it.

Patients who have an early menopause and/or report a reduced quality of life with one or more menopausal symptoms may benefit from HRT. It is also indicated in the presence of a pattern of decreased bone mass (osteoporosis), which is more frequent in women after the production of ovarian estrogen has stopped. Of course, even women who do not benefit from so-called natural therapies are candidates for actual hormone replacement therapy.


Contraindications to HRT

The absolute contraindications for using HRT are having a breast tumor and history of a previous thrombotic disease. In these patients, the use of HRT is precluded and alternative, non-hormonal therapies will have to be used.

There are also relative contraindications, which have to be examined case by case with the specialist, who has to balance the advantages and disadvantages of the individual patient.

Hormone replacement therapy can be prescribed in various ways (oral pills, creams, vaginal rings, transdermal patches). The woman and the doctor will evaluate together which mode is most accepted and preferred.