Hormone therapy can raise or lower estrogen levels, as well as reduce testosterone levels, during menstruation. When there is anandrogynous deficiency, the amount of red blood cells in the body may decrease. Coronary heart disease events associated with hormone therapy in younger and older women. In a meta-analysis regarding the occurrence of cholecystitis, the relative risk increased to 1.8 in women who used MHT for less than 5 years, whereas it increased to 2.5 in women who used MHT for more than 5 years. Maki PM, Henderson VW. The WHI study of cognitive aging, another ancillary study about cognitive function, observed a slight improvement in nonverbal episodic memory in the EPT group but a reduction in verbal episodic memory, although no particular effect was observed in the ET group [128]. Hormone therapy during menopausal transition should primarily be conducted based on the frequency and severity of symptoms, and lifestyle adjustments and use of adjuvant therapy could be partially effective. Conjugated equine estrogens and coronary heart disease: the Women's Health Initiative. Safety and efficacy of tibolone in breast-cancer patients with vasomotor symptoms: a double-blind, randomised, non-inferiority trial. Depending on clinical manifestation and individual risk factors, the basic examinations and elective examinations are conducted at an interval of 12 years. Prevalence of sarcopenia in the Korean woman based on the Korean National Health and Nutritional Examination Surveys. Lipid metabolisms showed a similar change as other MHT and did not lead to negative effect on hemostasis [212]. Updated practical recommendations for hormone replacement therapy in the peri- and postmenopause. Nappi RE, Domoney C. Pharmacogenomics and sexuality: a vision. Akhila V, Pratapkumar A comparison of transdermal and oral HRT for menopausal symptom control. Alzheimer's Disease Cooperative Study. A randomized, placebo- and active-controlled trial of bazedoxifene/conjugated estrogens for treatment of moderate to severe vulvar/vaginal atrophy in postmenopausal women. The use of this medication should usually last no more than five years for many trans women. Long-term effects on cognitive function of postmenopausal hormone therapy prescribed to women aged 50 to 55 years. Tibolone is effective in alleviating symptoms such as fatigue, headache, insomnia, and perspiration. Similar to standard-dose MHT, low-dose MHT is reported to be effective for treating VMS [16]. In addition, the frequency of abnormal vaginal bleeding was significantly low in the group treated with tibolone during the first 3 months of therapy. Letrozole suppresses plasma estradiol and estrone sulphate more completely than anastrozole in postmenopausal women with breast cancer. 5. Ditkoff EC, Crary WG, Cristo M, Lobo RA. The elective examinations required to be conducted prior to MHT are thyroid function test, breast ultrasonography, and endometrial biopsy conducted as individualized tests according to individual risk factors. Tibolone lowers high density lipoprotein cholesterol by increasing hepatic lipase activity but does not impair cholesterol efflux. Domchek SM, Mitchell G, Lindeman GJ, Tung NM, Balmaa J, Isakoff SJ, et al. In a subsequent WHI analysis, the risk of coronary artery disease actually showed differences according to the starting period of hormone therapy since menopause. For women with the uterus, estrogenprogestogen combination therapy should be administrated to protect the endometrium. The National Institute for Health and Care Excellence (NICE) guidelines state that testosterone supplementation can be considered for menopausal women with low sexual desire if hormone replacement therapy (HRT) alone is not effective. Lindsay R, Gallagher JC, Kleerekoper M, Pickar JH. Muscle strength increased up to 24 months when using MHT, and the maximal voluntary force also increased in the MHT group in contrast to a decrease in the control group. Hot flushes vary among individuals but may appear from 1 year to 3 years prior to the last day of menstruation and are especially severe around the last day of menstruation. Venous thromboembolism has an annual disease frequency of 5.4 diseases per 100,000 adult populations in Europe and the US regardless of gender. Palacios S, Castelo-Branco C, Currie H, Mijatovic V, Nappi RE, Simon J, et al. With regard to the safety of low-dose COCs, if there are no risk factors involved such as obesity, smoking, high blood pressure, and other cardiovascular diseases, it may be used carefully from 40 to 55 years of age. Individual estrogen therapy does not have any effect on invasive colorectal cancer or on the mortality rate due to invasive colorectal cancer [123,124]. It was concluded that even if bone density is temporarily reduced after MHT, it should not be the only reason for changing therapy [168]. There is, however, a set of time limits that women can adhere to. CE/BZA was approved by the Ministry of Food and Drug Safety in July 2014 for the treatment of VMS associated with menopause and the prevention of postmenopausal osteoporosis in women without an excised uterus. In FTM testosterone therapy, testosterone (often called "T" for short) can be administered into the body in a number of ways. Prevalence of sarcopenia and sarcopenic obesity in Korean adults: the Korean sarcopenic obesity study. Eisen A, Lubinski J, Gronwald J, Moller P, Lynch HT, Klijn J, et al. Pelvic floor muscle training, vaginal ring insertion, and topical estrogen treatment improve the function of vaginal epithelial cells and accelerate the ingrowing of connective tissue. Cho HH, Jung JE, Jung IC, Kim MJ, Kim SY, Hwang SJ. According to recent studies, among patients with endometrial cancer, if the patients that belong to endometrioid subtypes I and II had excision of the uterus and bilateral appendages and the estrogen receptors and progesterone receptors tested negative, the recurrence rate and mortality rate of endometrial cancer did not increase, even when MHT was applied [119]. Even an old woman could benefit from the use of MHT if her cognitive function is healthy. However, both hypotheses share a limitation that they were not supported by large-scale random blind studies [90]. 3. Blood tests include tests for liver function, kidney function, anemia, and fasting blood sugar as well as lipid examination, followed by mammography, bone mineral density (BMD) test, and Pap smear screening [3]. Longitudinal changes in sexual functioning as women transition through menopause: results from the Study of Women's Health across the Nation. TSEC is a newly developed treatment that involves a combination of bazedoxifene, a SERM, and conjugated estrogen to improve drug tolerance of the existing progestogen to reduce the risk of breast cancer, breast pain, and vaginal bleeding in addition to treating menopausal symptoms [203,204,205,206]. However, difference of Korean epidemiology from western epidemiology must be considered when indicating the association between breast cancer and MHT after reaching menopause. TRANSGENDER HEALTH There isn't currently much data about the menopause and trans people. Oestrogens and overactive bladder. Cookie Notice In a small number of observational studies, MHT did not increase the risk of breast cancer in women with a family history of breast cancer or who received ovariotomy and have BRCA 1/2 [107,108,109,110]. If premature hypoestrogenism or early menopause (menopause under 45 years of age) is diagnosed, it is recommended to start MHT regardless of whether symptoms of menopause are present [182]. The IMS claimed that based on the analysis of many observational research findings, MHT has a protective effect against occurrence of lung cancer in patients aged less than 60 years. 8:15 am Atrophy is more than just feeling dry. According to a recent randomized controlled study on MHT and occurrence of breast cancer and the consultation instructions by British Menopause Society, ET did not increase breast cancer, whereas EPT showed a tendency of significant increase in breast cancer [93,99]. In a study using a low-dose oral or percutaneous MHT (0.5 mg 17-estradiol and 0.10.25 mg NETA) for 24 weeks, sleep disorder was improved by 40%50% [24]. Cody JD, Jacobs ML, Richardson K, Moehrer B, Hextall A. Oestrogen therapy for urinary incontinence in post-menopausal women. 1. The main symptoms are vaginal dryness, burning sensation, and discomfort; sexual symptoms such as pain due to decreased lubrication; and urinary symptoms such as painful urination, recurrent urinary tract infections (UTIs), and urinary urgency [30]. Privacy Policy. Beral V. Breast cancer and hormone-replacement therapy in the Million Women Study. In an RCT that evaluated the effectiveness of medicine after administering tibolone (2.5 mg) or a placebo for 12 months to menopausal women with a mean age of 54 years, the muscle strength, which was evaluated by assessing the hand grip strength in the 12th month, in the group administered tibolone was improved compared with that in the control group [190]. Systemic MHT and low-dose vaginal ET are effective for treating urogenital atrophy and improve sexual function by increasing vaginal lubrication, blood flow, and sensory function as well as improve dyspareunia in particular. The impact of different doses of estrogen and progestin on mood and sexual behavior in postmenopausal women. Estrogen plus progestin and colorectal cancer in postmenopausal women. In terms of the degree of improvement of VMS for non-hormonal therapies, selective serotonin receptor inhibitor (SSRI)/selective norepinephrine receptor inhibitor (SNRI) showed 40%65%, gabapentin (900 mg/day) showed 50%, and pregabalin (150 mg/day) showed 65% improvement of symptoms [22,23]. 6Department of Obstetrics & Gynecology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea. Influences of hormone therapy to tissue mineral concentration and quality of life in menopausal women. The IMS also mentions that tibolone increases the risk of stroke in patients aged above 60 years but does not increase the incidence of venous thromboembolism [197]. Until 1 year from the time of beginning CE/BZA therapy, hemorrhage and petechial hemorrhage were not reported in 85.3%99.2% of patients; this result was similar to that in the placebo group but was less than that in the CE/MPA control group (48.9%83.2%; P < 0.001) [204]. However, when the administration stops, the prevention effect of colorectal cancer disappears. Symptoms of intersex menopause can vary depending on the underlying cause, but may include hot flashes, night sweats, irregular periods, and vaginal dryness. According to the results of a research on blood lipids, tibolone reduces neutral fats while reducing HDL cholesterol compared with MHT [200]. I had a double incision breast removal with male chest . Compared with placebo, CE/BZA has been shown to significantly improve QoL related to health and sleep. Therefore, additional studies are needed to draw a clear conclusion. GSM chronically progresses and requires long-term treatment because the symptoms recur if treatment is stopped. Moreover, there is a lack of evidence regarding its safety and effects [90,159]. For transgender males who have not had surgery to remove their ovaries, menopause can happen naturally as they get older. For stages III and IV endometrial cancer, clear cell carcinoma, or serous papillary carcinoma patients, MHT is not recommended [120,121]. Evaluation of bazedoxifene/conjugated estrogens for the treatment of menopausal symptoms and effects on metabolic parameters and overall safety profile. Hormone therapies for treating the symptoms of menopause during menopausal transition are combination therapy of levonorgestrel releasing-intrauterine system (LNG-IUS) with oral or percutaneous estrogen, low-dose combined oral contraceptives (COCs), and estrogenprogestogen therapy (EPT) [4]. In the U.S. Preventive Services Task Force (USPSTF) study, in which a meta-analysis was conducted with the WHI study, HERS study, and other references, the risk of venous thromboembolism due to hormone therapy approximately doubled and the risk was higher during the first year of oral estrogen use, with or without progestogen (Table 1) [87,88,89]. Menopausal hormone therapy use and risk of invasive colon cancer: the California Teachers Study. What happens to testosterone levels with age? In case of experiencing VMS, many women aged less than 45 years (50%) were shown to experience only hot flush as a monosymptom, whereas for women aged 4560 years, the cases in which both hot flush and sweating were experienced increased up to 70% [17]. If you are a transgender male experiencing menopause, it is important to talk to your doctor about the best way to manage your symptoms. Tibolone is associated with a lower incidence of irregular abnormal vaginal bleeding compared with estrogenprogestogen combination therapy [198]. Based on the results of previous research, it is not yet possible to provide clear instructions regarding the duration of MHT. Everyone absorbs T differently, so even if you're taking more than other people, it may not be enough for your body. In this article, we'll go over everything you need to know about atrophy: its cause, symptoms, and treatment options. If the individual has any of the symptoms listed above, they may require a different treatment. Cummings SR, Ettinger B, Delmas PD, Kenemans P, Stathopoulos V, Verweij P, et al. The order of frequency of disease as per age is as follows: 40s, 50s, 60s, 30s, and 70s [113,114,115]. Compared with the past results, there is a general tendency of increase in the occurrence age, and from 2010, an increase in the number of patients in their 50s diagnosed with breast cancer was observed. official website and that any information you provide is encrypted Mikkola TS, Tuomikoski P, Lyytinen H, Korhonen P, Hoti F, Vattulainen P, et al. Sleep apnea, abnormal growth of the prostate gland, and prostate cancer stimulation are also symptoms. Kenemans P, Bundred NJ, Foidart JM, Kubista E, von Schoultz B, Sismondi P, et al. Combined administration of vaginal estrogen and antimuscarinic drug is more suitable, and topical estrogen is considered to play an important role in treating an overactive bladder. A comparative study of the effects of local estrogen with or without local testosterone on vulvovaginal and sexual dysfunction in postmenopausal women. MHT could show a positive effect, although limited, on affective disorder during menopausal transition. The North American Menopause Society (NAMS) recommends the use of a moisturizing cream or lubricant as the primary treatment for vaginal atrophy. Due . Because oral estrogen increases the activity of thrombin while reducing the activity of plasmin and has a higher thrombus tendency than that of transdermal estrogen, the use of transdermal estrogen could be better in case of women having a medical history or risk factors of venous thromboembolism [1,22,90]. In case of patients with stages III and IV endometrial cancer or high-risk endometrial cancer, non-hormonal therapy should be used to control menopause symptoms. The frequency in South Korea is 75.1 cases (2015), and the mortality rate is 9.6 cases (2016), which is a significantly low occurrence rate and mortality rate, therefore showing a very different aspect from an epidemiological perspective [113,114,115]. In case of receiving vaginal estrogen therapy due to vaginal atrophy or receiving minimum dose transdermal estrogen therapy to prevent bone disappearance, progestogen may not be administered, but the long-term safety of progestogen administration for more than 1 year remains unclear [90,159]. MHT is an appropriate first-line treatment in menopausal women aged less than 60 years with an increased risk of fracture, but MHT is not recommended solely for the prevention of fracture in women aged above 60 years. To evaluate the ovarian reserve during menopausal transition, measuring the serum level of anti-mullerian hormone (AMH), day 3 follicle-stimulating hormone (FSH), estradiol (E2), and ovarian antral follicle count (AFC) using pelvic ultrasonography is possible, but they are not used as indicators for predicting menopause. Although it has been shown that estrogen therapy has a positive effect on mood disorder in women who had surgical menopause, even without menopausal symptoms [151], it remains unclear whether MHT has a beneficial effect on mood disorder in women who are not diagnosed with depression [22,152]. Furthermore, tibolone users who had undergone surgical treatment for epithelial ovarian cancer and 33 tibolone non-users were retrospectively examined [201]. Kwon HJ, Ha YC, Park HM. However, this beneficial effect was not found when MHT was used in older women aged above 60 years or when used for less than 6 months [175,176]. Rymer J, Chapman MG, Fogelman I, Wilson PO. Occurrence of breast cancer keeps increasing but is still relatively low as it is 1/21/3 of the occurrence in the west. Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, et al. Effects of hormone therapy on bone mineral density: results from the postmenopausal estrogen/progestin interventions (PEPI) trial. Prevalence of sarcopenia adjusted body mass index in the Korean woman based on the Korean National Health and Nutritional Examination Surveys. In addition, when a premenopausal woman reaches menopause while using SSRI to treat depression, compared with SSRI therapy alone, SSRI in combination with estrogen is more effective in improving depression and shows a faster rate of treatment [29]. Heikkinen JE, Vaheri RT, Ahomki SM, Kainulainen PM, Viitanen AT, Timonen UM. Effects of hormone replacement therapy on endometrial histology in postmenopausal women. including FTM (Female-to-Male) top surgery. Increased age and decreased estrogen level lead to harmful effects on sexual function and reduce sexual desire and sexual response as well as cause vaginal dryness and dyspareunia. Medical eligibility criteria for contraceptive use. These side effects may include: Headaches. However, anyone with a female reproductive system who identifies as a man, but hasn't undergone any medical interventions, is likely to go through menopause eventually. Tibolone and low-dose continuous combined hormone treatment: vaginal bleeding pattern, efficacy and tolerability. Prestwood KM, Kenny AM, Kleppinger A, Kulldorff M. Ultralow-dose micronized 17beta-estradiol and bone density and bone metabolism in older women: a randomized controlled trial. Labrie F, Archer DF, Koltun W, Vachon A, Young D, Frenette L, et al. Tibolone does not increase the breast density in mammography and causes less breast pain than estrogenprogestogen combination therapy. Manson JE, Chlebowski RT, Stefanick ML, Aragaki AK, Rossouw JE, Prentice RL, et al. As a library, NLM provides access to scientific literature. The mortality rate of colorectal cancer is the second highest after that of lung cancer. Hormone therapy for the primary prevention of chronic conditions in postmenopausal women: US Preventive Services Task Force recommendation statement. Tibolone does not have biological activation in itself, but as its metabolites show particular medicinal effects according to human tissue, it is categorized as a selective tissue estrogen activity regulator. Because there is a lack of data on the relationship between MHT and migraine, it cannot be concluded that migraine is a contraindication for MHT. Transgender menopause is a term used to describe the loss of reproductive hormones and fertility in transgender men. Rebbeck TR, Friebel T, Wagner T, Lynch HT, Garber JE, Daly MB, et al. Based on the analysis of WHQ scores, low-dose MHT (E2 1 mg/norethindrone acetate [NETA] 0.5 mg) and tibolone have been reported to improve QoL. There are reports showing that long-term estrogen therapy increases the risk of epithelial ovarian cancer, but the absolute number is rare as it was about 0.7 cases per 1,000 people for 5 years. When considering sexual dysfunction, the role of vaginal atrophy should always be considered. Reddit and its partners use cookies and similar technologies to provide you with a better experience. In the 13.2-year cumulative follow-up observation after stopping ET, the occurrence of breast cancer was significantly reduced by 21% [81]. They help recover normal vaginal flora, increase the quantity of vaginal discharge by improving the division of the vaginal epithelium, induce proliferation of capillaries, and improve the maturation index of the vaginal epithelium [31,32,33]. As people age, their bodies go through changes that are sometimes unexpected. Gleason CE, Dowling NM, Wharton W, Manson JE, Miller VM, Atwood CS, et al. Gordon C, Gonzales S, Krychman ML. Moreover, while retaining the advantages of estrogen therapy, it secures stability against the endometrium. Testosterone and Ovulation A trans health expert will tell you that testosterone is a "dose-dependent ovulation suppressant." That's a fancy way of saying "if you take your testosterone the way you're supposed to, it will stop ovulation." But let's be clear that "if" is doing a LOT of work in that sentence. Pelvic health You might be at risk of cancer of the cervix, ovaries or uterus if you have not had surgery to remove them. Zinc also boosts testosterone in athletes and those who are deficient in zinc . Hodis HN, Mack WJ, Henderson VW, Shoupe D, Budoff MJ, Hwang-Levine J, et al. Systemic MHT and low-dose vaginal ET are effective in treating urogenital atrophy and improve sexual function by increasing vaginal lubrication, blood flow, and sensory function. The Writing Group for the PEPI Trial. Seoul National University College of Medicine. For women with the uterus intact, estrogen must be administered together with progestogen to reduce the risk of endometrial hyperplasia and cancer. Stopping menstruation Clitoral growth Transgender men and transmasculine individuals who take testosterone for gender dysphoria also report declines in dysphoria, depression, and anxiety. Classically, testosterone was thought to be predominantly involved in androgenesis and physiology in boys and men. This finding was similar across EPT, ET, and tibolone users. Anxiety, shivering, palpitation, or perspiration may occur alongside, and night sweat is linked to sleep disorder. The Korean Society of Sarcopenia, editors. For women with a body mass index of more than 25, EPT significantly increases the risk of venous thromboembolism [91]. This therapy must be prolonged long term, even after the sex reassignment surgery (SRS). Investigation of sarcopenia and its association with cardiometabolic risk factors in elderly subjects. Additionally, women in their 50s who were previously enrolled in the ET arm of the WHI study showed significantly lower coronary artery calcification scores than those who received placebo [76]. Effects of the menopause transition and hormone use on cognitive performance in midlife women. . Chlebowski RT, Hendrix SL, Langer RD, Stefanick ML, Gass M, Lane D, et al. Sherwin BB. Effects of estradiol withdrawal on mood in women with past perimenopausal depression: a randomized clinical trial. Moreover, CE/BZA was shown to improve QoL in menopausal patients by improving sleep disorders and reducing dyspareunia by increasing the maturity level of the vagina. North American Menopause Society. Some studies show that a vaginal moisturizer has a similar effect to topical estrogen; thus, it could be recommended to women who avoid using MHT [34]. In case of ET, based on the 7.2-year observation, there was a tendency of reduction of the risk of breast cancer (absolute risk: annual reduction of seven cases per 100,000 people), even though it was not statistically significant. There is also a risk of fractures if the condition causes bone density loss and decreased bone density. No RCTs have been conducted with breast cancer, fracture, and cardiovascular disorder as the primary endpoints. The site is secure. Thus, women who are relatively older or for whom a long time has passed since menopause (average age, 63.2 years) in the WHI study may not have experienced any significant effect on cardiovascular protection from hormone therapy as women in early menopause who are in good cardiovascular health. Rethinking the techno vagina: a case series of patient complications following vaginal laser treatment for atrophy. 2. Gabriel CA, Tigges-Cardwell J, Stopfer J, Erlichman J, Nathanson K, Domchek SM. Treatment of symptoms of the menopause: an endocrine society clinical practice guideline. The use of oral or percutaneous estrogen therapy (ET) together with LNG-IUS is not only effective for alleviating the symptoms of menopause but also for preventing endometrial hyperplasia. If a lubricant and moisturizer are frequently used, they improve the symptoms of vaginal dryness, reduce discomfort, and maintain vaginal discharge during sex but do not transform the contracted internal environment of the vagina. In another study, there was an increase in the score of Women's Health Questionnaire (WHQ) and an improvement of physical symptoms, depression symptoms, and sleep disorder in the treatment group receiving MHT [28]. Goldstat R, Briganti E, Tran J, Wolfe R, Davis SR. Transdermal testosterone therapy improves well-being, mood, and sexual function in premenopausal women. Appa AA, Creasman J, Brown JS, Van Den Eeden SK, Thom DH, et al. Blmel JE, Castelo-Branco C, Binfa L, Aparicio R, Mamani L. A scheme of combined oral contraceptives for women more than 40 years old. Men in their late 40s to early 50s may experience depression, loss of sex drive, erectile dysfunction, and other physical and emotional symptoms as a result of stress. Ha YC, Kim TY, Lee A, Lee YK, Kim HY, Kim JH, et al. Therefore, in the presence of the uterus, estrogen and progestogen should be administered in combination. A condition that affects older men is also known as dementia. There is no way to make the diagnosis that this is caused by a sudden drop in testosterone in middle age, just as there is no way to make the diagnosis that this is caused by a sudden drop in testosterone in female. 3. 1. In addition to andropause, the aging male experience androchronism, late onset hypogonadism, and low testosterone. Effects of estrogen with and without progestin on urinary incontinence. The influence of hormone therapies on colon and rectal cancer. In the national statistics released by the Korean Stroke Society in 2018, ischemic cerebral stroke constituted 76.3% and hemorrhagic cerebral stroke constituted 23.4% of the total cerebrovascular diseases (change order) [83]. 1. A study was conducted for 1 year to compare the effect of CE/BZA on bone density with that of placebo and estrogen/MPA (CE/MPA) in a target group of 1,061 healthy menopausal women with ovaries who were aged 4065 years. The risk of VTE was higher in users of oral estrogen plus progestogen than oral estrogen therapy alone [70,85,89]. An official website of the United States government. The impact of multimorbidity on sexual function in middle-aged and older women: beyond the single disease perspective. Ethnic distribution of factor V Leiden in 4047 men and women. As we age, our bodies produce less androgen (testosterone), estrogen and progesterone. Ospemifene, which is a selective estrogen receptor modulator (SERM), is more effective than a lubricant in reducing dyspareunia by treating moderate or severe vaginal atrophy in menopausal women. Humphrey LL, Chan BK, Sox HC. LISA study investigators. CE/BZA significantly improves QoL by improving sleep disorder, GSM, and hot flush while reducing irritation in the endometrium [207,208,209]. However, MHT was not associated with other bile duct surgeries. Most (82%) menopausal women with fractures in the NORA study were reported to have osteopenia with a T score above 2.5, but even though the frequency of femur fracture was the highest in the study, only 6.4% of the patients had a T score below 2.5 [166]. http://creativecommons.org/licenses/by-nc/4.0/, https://www.menopause.org/publications/clinical-care-recommendations, https://www.fda.gov/medical-devices/safety-communications/fda-warns-against-use-energy-based-devices-perform-vaginal-rejuvenation-or-vaginal-cosmetic, http://www.kbcs.or.kr/journal/file/181030.pdf, https://gis.cdc.gov/Cancer/USCS/DataViz.html, https://seer.cancer.gov/statfacts/html/breast.html, http://www.hira.or.kr/bbsDummy.do?pgmid=HIRAA020045020000&brdScnBltNo=4&brdBltNo=2311&pageIndex=1#none. This protective effect rapidly disappeared after stopping MHT, and the long-term follow-up study of WHI reported that the ET group showed a continued reduction effect of all fractures after stopping therapy, whereas the EPT group showed no reduction in all fractures [81]. Particularly, the risk of VTE increases with age and increases in women initiating hormone therapy more than 10 years from menopausal onset. LIBERATE Study Group. V. Meta-analysis of the efficacy of hormone replacement therapy in treating and preventing osteoporosis in postmenopausal women. In case of long-term use of progestogen, there has been a report about the possibility of increasing the frequency of breast cancer occurrence. In case of administering tibolone to patients aged above 60 years, there is an increased incidence of stroke. Kim TN, Yang SJ, Yoo HJ, Lim KI, Kang HJ, Song W, et al. Tibolone in postmenopausal women: a review based on recent randomised controlled clinical trials. EPT is effective not only for treating women after menopause but also for controlling the symptoms of menopause in women in menopausal transition. A case of deep vein thromboembolism and Pulmonary embolism in postmenopausal hormone replacement therapy. Bone response to hormone therapy according to basal bone mineral density and previous response to hormone therapy. In particular, MHT improves HRQoL and MSQoL of women experiencing severe menopause symptoms. The most common method is injection (either subcutaneous or intermuscular) with a syringe. 4. This is because of the westernization of eating habits. 3. A new pharmacokinetics study of a brand of testosterone cream reports that for women after menopause, it took 5 mg, the lowest dose of this . What you need to know about testosterone and menopause | Patient. Tibolone is associated with a lower incidence of abnormal vaginal bleeding as well as decreased breast density in mammography and reduced breast pain compared with estrogenprogestogen combination therapy. Hormone replacement therapy and breast cancer: a qualitative review. In the WHI study, which is a large-scale randomized controlled study, estrogenprogestogen combination therapy has been reported to reduce the risk of colorectal cancer by 38% when compared with a placebo (HR 0.62; 95% CI, 0.430.89) [122]. There have been controversies regarding the association between MHT and breast cancer. Progestin combination therapy also shows a similar tendency. MHT also prevents bone loss in women with premature ovarian failure [90]. Assessment about quality of life in menopausal women with hormone replacement therapy. MHT may be considered if non-hormonal therapy is not effective in early endometrial cancer patients with an excised uterus and bilateral appendages when they show menopausal symptoms. According to the clinical guidelines by the American Endocrine Society, CE/BZA could be used to prevent bone loss and alleviate VMS in menopausal women without an excised uterus as well as to treat side effects such as mood changes, breast tenderness, and progestogen-related vaginal bleeding. 2. ), a randomised comparison: trial stopped. International Menopause Society. Menstrual periods last for four days after the day of your menstruation, and menopause is the time of year when you get this. LIFT Trial Investigators. 2. The results of the Tolerability Trial comparing Activelle with Livial study, which compared the effect on vaginal atrophy, VMS, and abnormal vaginal bleeding by randomly allocating 2.5 mg tibolone or low-dose MHT (E2/NETA, 1 mg/0.5 mg) to menopausal women with a mean age of 55 years, showed that VMS and vaginal atrophy were improved similarly in both groups when compared with the early phase of therapy [184]. Investigative models for determining hormone therapy-induced outcomes in brain: evidence in support of a healthy cell bias of estrogen action. In the results of a long-term follow-up observation up to 13 years after completing the WHI study, stroke risks did not differ significantly between women formerly assigned to hormones and women formerly assigned to placebo, and there was no statistical evidence that risks differed based on age or timing [81]. Based on research findings about women with the average age of 74 years, Zandi et al. Prevalence, frequency and problem rating of hot flushes persist in older postmenopausal women: impact of age, body mass index, hysterectomy, hormone therapy use, lifestyle and mood in a cross-sectional cohort study of 10,418 British women aged 54-65. While the challenges are there, menopause in men is a natural process that can be managed and treated with a variety of therapies. How to diagnose sarcopenia in Korean older adults? Vaginal testosterone therapy, which is another treatment option for GSM, improves dyspareunia, sexual desire, lubrication, and satisfaction when administrated alone or simultaneously with vaginal estrogen three times a week compared with a placebo [64,65,66]. If you have not had a menstrual period in the previous 12 months, you may have a condition known as gonorrhea. Espeland MA, Shumaker SA, Leng I, Manson JE, Brown CM, LeBlanc ES, et al. Zandi PP, Carlson MC, Plassman BL, Welsh-Bohmer KA, Mayer LS, Steffens DC, et al. Kenemans P, Speroff L International Tibolone Consensus Group. 6. and transmitted securely. Odabasi AR, Yuksel H, Kafkas S, Demircan S, Karul A, Kozaci D, et al. Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. In the reported random double-blind study in 2000, no change in cognitive function was observed when administering individual female MHT for 1 year targeting 120 women with Alzheimer's who had undergone hysterectomy due to medical history [146]. Similarly in case of the Cache county study, which targeted 1,889 women, the risk of Alzheimer's in the MHT group was significantly lower by 0.41 times (95% CI, 0.170.86) when compared with the control group [131]. Until now, there have been very few randomized controlled studies on MHT in middle-aged women with depression. No difference was found between the continuous and cyclic use of progestogen, and no effect has been proven to reduce the risk of fractures using low- and ultralow-dose estrogen therapy. Because VMS appear in relation to the reduction of estrogen levels in the central nervous system, MHT is the most effective treatment. In contrast, systemic ET increases the occurrence of urgency urinary incontinence and stress urinary incontinence [40,41,42,43]. government site. However, there was a nonsignificant trend for less accumulation of coronary calcium in the hormone therapy arms than in the placebo arms [76]. If you have been on estrogen for at least five to ten years, your Mammograms should be done at the age of 50. But testosterone is actually one of six hormones produced by the female reproductive organs as well. Testosterone affects many aspects of your body and physical functioning 3. 2. There was no evidence that tibolone negatively affects the overall survival rate as well as the survival-free rate of patients with epithelial ovarian cancer. Recency and duration of postmenopausal hormone therapy: effects on bone mineral density and fracture risk in the National Osteoporosis Risk Assessment (NORA) study. However, clinical evidence lacks such critical window hypothesis yet [90]. A study of the effect of tibolone on the vagina in postmenopausal women. It has been suggested that the results may not apply to women younger than 60 years who have recently experienced menopause. Another observational study reported that although starting MHT at midlife helped prevent cognitive disorder, starting MHT during late life caused a negative effect on cognitive function [134]. Tibolone is effective in alleviating menopausal symptoms such as hot flush, VMS, and GSM. By accepting all cookies, you agree to our use of cookies to deliver and maintain our services and site, improve the quality of Reddit, personalize Reddit content and advertising, and measure the effectiveness of advertising. Quality of life and the role of menopausal hormone therapy. However, as most studies are small with different age, health condition, and exercise program, the interpretation of results could be affected. According to the results of the Tibolone Histology of the Endometrium and Breast Endpoints Study, tibolone does not cause endometrial proliferation or endometrial cancer [199]. In trans men, testosterone is the key hormone administered and no anti-oestrogens are needed. Effect of lower doses of conjugated equine estrogens with and without medroxyprogesterone acetate on bone in early postmenopausal women. By age 40, women produce about half the testosterone we did in our twenties. In the WHI study, based on the analysis according to age, use of ET in women aged 5059 years showed no significant increase in the risk. Lobo RA, Pinkerton JV, Gass MLS, Dorin MH, Ronkin S, Pickar JH, et al. The critical window hypothesis refers to a concept that addresses that the effect of MHT on cognitive function could differ depending on the time of executing the MHT [134,135]. In contrast to WHIMS, in the recently released KEEPS study, MHT did not have any effect on memory or cognitive function. There are treatments available that can help ease the transition and make menopause more manageable. Testosterone therapy doesn't change your risk of these cancers. In particular, low-dose vaginal estrogen is effective and safe, although the quantity of absorption in the whole body is minimal. Challenges to the development of new agents for molecularly defined patient subsets: lessons from BRCA1/2-associated breast cancer. For more information, please see our Jang HC. Women's Health Initiative Investigators. Those. 2. Harman SM, Black DM, Naftolin F, Brinton EA, Budoff MJ, Cedars MI, et al. Most severe VMS appear within 12 years from the last day of menstruation and usually continue for about 45 years. Therefore, MHT is also necessary to prevent bone loss or fracture in women with osteopenia. Because female sex possesses a variety of fundamental characteristics, the effect of MHT on women's sexual dysfunction cannot be clearly proven, and ET or EPT leads to improvement of sexual function and is especially effective in reducing dyspareunia in women in early menopause or with symptoms of menopause [31,54,55,56,57]. In recent studies, CE/BZA did not increase in incidence of breast cancer, breast pressure, or breast density compared with placebo. In a research by the Women's Health Initiative (WHI) on EPT, maintaining MHT for 3 years was shown to help maintain underweight status and prevent transformation into android fat distribution [22]. It is also possible to try alleviating the symptoms via improvement of lifestyles such as weight loss, stress reduction, hypnosis, and cognitive behavioral therapy. There was one case of venous thromboembolism after using MHT in South Korea, but even in this case, there was no factor V Leiden mutation [92]. In contrast to the consistent effect being reported regarding muscle strength, the effect of MHT on muscle mass remains controversial. Nappi RE, Cucinella L. Advances in pharmacotherapy for treating female sexual dysfunction. National Library of Medicine 3. Testosterone is also effective for the treatment of sexual desire disorder and sexual arousal disorder, which are related to antidepressants [59,60,61]. After using EPT for an average period of 5.6 years, the risk of breast cancer increased but for women who were starting MHT for the first time, the risk of breast cancer did not increase until the 7th year. There is no age limit for menopause, but the average age in the United States is 51. Effects of hormone therapy on cognition and mood in recently postmenopausal women: findings from the randomized, controlled KEEPS-Cognitive and Affective Study. There is no one-size-fits-all treatment for male menopause. On the other hand, considering there were differences in the effect of hormone therapy on coronary artery disease between CEE alone and CEE/MPA combination therapy, attention must be paid to the type of hormone used, particularly progestogen. Kaunitz AM. Conjugated equine oestrogen and breast cancer incidence and mortality in postmenopausal women with hysterectomy: extended follow-up of the Women's Health Initiative randomised placebo-controlled trial. Dennerstein L, Dudley E, Burger H. Are changes in sexual functioning during midlife due to aging or menopause? Hammar ML, van de Weijer P, Franke HR, Pornel B, von Mauw EM, Nijland EA. Not only the mortality rate but also the economic burden of diseases are increasing as the number of patients who received treatments for ischemic heart diseases has almost doubled from 510,000 in 2004 to 860,000 in 2016, which led to the more than quadruple increase in health insurance fees from 2,900 billion won to 1 trillion 2,400 billion won; therefore, attention is required. Salpeter SR, Walsh JM, Greyber E, Salpeter EE. In contrast to placebo, for hemostasis variables, CE/BZA reduced the activation of fibrinogen, PAI-1, and antithrombin and increased the activation of plasminogen. Based on the meta-analysis, in ovarian cancer patients, MHT does not increase the mortality rate or recurrence rate of ovarian cancer, but there is almost no data available yet on low-grade serous cancer as well as granulosa cell tumor or cancer, which involve positive estrogen receptors such as SertoliLeydig tumor [118]. and our In the National Osteoporosis Risk Assessment (NORA) study, the risk of new fractures significantly decreased when evaluating 200,160 postmenopausal women using MHT with no history of osteoporosis. The administration of testosterone or "T" for short is done in a number of ways. Nijland EA, Weijmar Schultz WC, Nathorst-Bos J, Helmond FA, Van Lunsen RH, Palacios S, et al. The mortality rate by ischemic heart diseases (myocardial infarction and angina) in South Korean women was 25.0 deaths per 100,000 individuals in 2017, but for women aged above 65 years, the mortality rate was very high, reaching 148.8 deaths per 100,000 individuals. The WHI memory study (WHIMS), an ancillary study to WHI study, reported a significant increase in the risk (2.05) of probable dementia in the EPT group with women aged above 60 years every year, and the risk increased to 1.49 in the ET group, but no statistical significance was observed [126,127]. 5. The safety of CE/BZA for the endometrium has been proven. Estrogen therapy has a lower risk of venous thromboembolism than EPT, and if used in the early postmenopausal period, the risk of venous thromboembolism does not increase. Nelson HD, Humphrey LL, Nygren P, Teutsch SM, Allan JD. Tibolone does not increase invasive breast cancer and endometrial cancer, but when used for patients with breast cancer, the recurrence of breast cancer increases. Cumulative risk of colon cancer up to age 70 years by risk factor status using data from the Nurses' Health Study. In the WHI study, the continuous EPT combination therapy showed a similar result to the comparative group regarding endometrial cancer [117]. In South Korea, the frequency of gallstones is about 2%4% and the number of patients with gallstones has increased by 49% from 129,226 people in 2014 to 192,551 in 2018, according to the data from the Health Insurance Review and Assessment Service. Once you stop the medication, the side effects will go away completely. Transgender women may experience symptoms of both menopause and pre-malignancy. Results Summary Female-to-male (FTM) testosterone therapy, or T therapy, is a treatment that some people may receive to induce "masculine" physical traits and suppress "feminine" ones. Additionally, because the function of the ovaries changes during this period, it is advised not to conduct a hormone test for menopause diagnosis [4]. Hence, the combination therapy of an antimuscarinic drug and topical estrogen is the primary drug therapy for menopausal women with symptoms of an overactive bladder [44,45,46]. This is often done as part of the transition process, in order to lower hormone levels and help the transgender males body better match their gender identity. Recently, there has been a renewed . the contents by NLM or the National Institutes of Health. Testosterone will cause a thickening of the vocal chords, which will result in a more male-sounding voice. In the STEP RCT, which aimed to study the effect of tibolone on osteopenia and compared bone density after administering tibolone (1.25 mg) and raloxifene (60 mg) to menopausal women aged 6079 years with osteopenia for 2 years, bone density in the tibolone group was significantly increased in both the lumbar spine and femur [193]. Pines A, Sturdee DW, MacLennan AH. 3. Clinical practice. Points to consider prior to initiating MHT include checking the indications and contraindications of MHT, which requires history recording, physical examinations, and other tests. Until now, there is no reliable data that could confirm the association between MHT and the occurrence of ovarian cancer. Renoux C, Dell'Aniello S, Suissa S. Hormone replacement therapy and the risk of venous thromboembolism: a population-based study. This implies that the effect of MHT can depend on age [177]. ET or EPT increases the risk of gallbladder diseases. de Villiers TJ, Pines A, Panay N, Gambacciani M, Archer DF, Baber RJ, et al. According to the WHI study, hormone therapy for women with factor V Leiden mutation increases the relative risk of venous thromboembolism to 6.69 compared with that for women without any mutations who do not receive any hormone therapy. TRANSGENDER HEALTH. 11Department of Obstetrics and Gynecology, Soonchunhyang University Seoul Hospital, Seoul, Korea. Chun SW. Archer DF, Oger E. Estrogen and progestogen effect on venous thromboembolism in menopausal women. Based on the analysis conducted by the World Health Organization regarding the life expectancy in 35 Organisation for Economic Co-operation and Development (OECD) countries, South Korea's life expectancy is predicted to rank first in the world by 2030, with the life expectancy for women reaching 90.82 years. For the treatment of moderate or severe vaginal atrophy, both systemic and topical estrogens are effective. It can also be a time of increased anxiety and stress, as they navigate the changes in their bodies and lives. Moreover, in South Korea, the number of ovarian cancer patients shows a trend of continuous increase (change of location) [116]. The incidence rate of femur fracture increased from 99.6 cases per 100,000 in men and 209.9 cases per 100,000 in women in 2008 to 110.5 cases per 100,000 in men and 243.1 cases per 100,000 in women in 2012 from the data from National Health Insurance Service [167]. The occurrence rate in American women is 126.4 cases per 100,000 people, whereas the mortality rate due to breast cancer is 20 cases per 100,000 people. However, there has been no large-scale prospective study with the purpose of examining the occurrence of cardiovascular disorder related to tibolone. However, hormonal changes and vasomotor symptoms can lead to new depressive symptoms and the risk of developing depression could increase during menopausal transition or early menopause [149,150]. It varies among individuals and is a period that often includes vasomotor symptoms such as hot flushes alongside frequent or excessive menstruation. 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