Potential Benefits and Risks of Estrogen Therapy for Menopausal Symptoms

Estrogen is a hormone that plays various roles in the human body. In females, it helps develop and maintain both the reproductive system and female characteristics, but it also plays a vital role to mental health, bone health, cardiovascular health and other necessary processes in the body.

Women’s estrogen levels start to decrease during a period called perimenopausal. Perimenopausal is when a woman’s hormones start to change and cause symptoms, just before her menstrual period fully stops, which is known as menopause. Menopause typically occurs between the ages of 45 to 55 years and is associated with a decrease in estrogen production.

What are the signs and symptoms of low estrogen?

 Symptoms of low estrogen may include:

• Hot flashes
• Night sweats
• Mood changes
• Sleep disturbances
• Joint aches and pain
• Vaginal discomfort which may include the symptoms of:
  • Dryness
  • Burning
  • Itching
  • Irritation
  • Soreness
  • Discharge
  • Spotting or bleeding

What is estrogen therapy?

Estrogen therapy, which can also be referred to as hormone replacement therapy can help manage menopausal symptoms which can be categorized as vasomotor symptoms and vaginal symptoms. The treatment consists of estrogen alone or it may include a combination of estrogen and progestin, a synthetic form of progesterone. All women with a uterus need a progestin to be added to their estrogen therapy to prevent endometrial hyperplasia, which is an overgrowth of the lining of the uterus, which may progress to endometrial cancer. Estrogen therapy is available in many different forms including oral, transdermal, topical gels and lotions, intravaginal creams and tablets, and vaginal rings.

Potential benefits and risks of estrogen therapy

Estrogen therapy can help manage menopausal symptoms such as, hot flashes, vaginal discomfort and mood changes and it may also help reduce the risk of osteoporosis, which increases when women enter menopause.

Estrogen therapy can increase the risk of breast cancer, dementia, blood clots, strokes and endometrial cancer with estrogen alone.

Who is a candidate for estrogen therapy?

Estrogen therapy may be a safe option in healthy women who are experiencing menopausal symptoms and who are within 10 years of menopause or younger than 60 years and who do not have any contraindications to hormone replacement therapy.

Women who have a history of breast cancer, coronary heart disease (CHD), a previous blood clot of stroke, transient ischemic attack, active liver disease, unexplained vaginal bleeding and high risk of endometrial cancer should avoid the use of use of estrogen therapy.

For women with moderate to severe hot flashes who are not a candidate for hormone therapy, nonhormonal therapy agents such as SSRIs, SNRIs, anti-epileptics, clonidine and oxybutynin and centrally acting drugs have been recommended.

Estrogen therapy may not be right for everyone and estrogen (oral and topical products) with or without progestins should be avoided in women over the age of 65 years. If you think you may be experiencing menopausal symptoms, talk to your healthcare provider.

 

References:

1. Barbieri LR, Martin AK. Treatment of menopausal symptoms. In: UpToDate; 2020. www.uptodate.com. Accessed September 29, 2020.
2. Cobin HR, Goodman FN. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY POSITION STATEMENT ON MENOPAUSE–2017 UPDATE. Endocrine Practice. AACE. 2017 Jul;23(7):869-880.
3. Eastell R, Rosen JC, Black MD, Cheung MA, Murad HM et al. Pharmacological Management of Osteoporosis in Postmenopausal Women: An Endocrine Society Clinical Practice Guideline. JCEM. 2019 May;104(5):1595–1622
4. Goodman N, Cobin R, Ginzburg S, Katz I, Woode D. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the Diagnosis and Treatment of Menopause. Endocrine Practice. AACE. 2011 Nov;17(6):1-25.
5. Practice Bulletin No. 141: Management of Menopausal Symptoms, Obstetrics & Gynecology. 2014 Jan;23(1):202-216