Category: Consider treatment options

1-HRT (Hormone replacement)

July 17, 2017 / Rita Galimberti

There is very little question on the fact that hormone replacement therapy is the most effective treatment for menopausal symptoms. The concept is very simple. Your body does not produce oestrogen anymore (or it does at a very reduced rate) and this causes symptoms. To eliminate the symptoms you need to replace the hormones that you are lacking.

HRT is the only treatment that can tackle different parts of your body and help with:

-hot flashes

-night sweats

-vaginal dryness

-sex drive issues

-bone thinning

-urinary incontinence

The problem is that there is a contrasting advice when it comes to taking HRT and may women are confused.

For this reason you need to get proper information and make your own decision in relation to your menopausal treatment.

Again the facts are simple. Breast cancer is a common cancer and affects about 12 women over a 1000 in the over 50’s age group. In the same age group of women who take HRT the incidence is estimated to be 15 over a 1000, so that means 3 extra cases are possibly due to HRT. This mathematics applies to normal women with a normal baseline risk.

Once you have this information you need to assess your current quality of life and decide what you want.

You either keep the symptoms or get treatment. It is important that when you are making the decision you look at all the consequences of estrogen depletion, in particular the vaginal problem which you are more likely to discover a few years later.

Take your time and make an informed decision. If you decide not to take HRT is absolutely fine but you need then to develop an alternative plan in relation to cardiovascular risk prevention and osteoporosis prevention.

2-HRT MYTHS

June 17, 2017 / Rita Galimberti

TAKING HRT WILL DELAY MENOPAUSE

This is one of the commonest myths on menopause and its treatment. Every so often a patient will tell me: “I will have to go through symptoms anyway when I stop the treatment so I might as well do that now and be done with it”

This is really not true.

The duration of menopause symptoms is different and genetically predetermined for each woman.

It can vary from 1 to 10 years and sometimes more and there is no scientific way to know how long symptoms will last for you.

What happens is that if you stop treatment after 4 years and your symptoms were meant to last for three then you will not have them again.

If you stop treatment after 4 years and your symptom will meant to last for 8 then you will still have symptoms when you stop because it is too early for you to stop.

This is something that has created a lot of confusion and brought women to believe that symptoms will return when treatment is stopped.

It is a very personal decision if to start on not treatment but being fearful of having a delayed menopause should not be a factor.

3-WHAT IS IN HRT?

May 14, 2017 / Rita Galimberti / 0 Comments

Your hormonal replacement therapy will contain the following hormones:

-oestrogen

This is the hormone that will improve your symptoms, help your bone density and reduce your cardiovascular risk.

It can be given to you in different forms: as a tablet, as a patch as a gel.

None of these forms is superior to the other.

There are advantages and disadvantages in any of these preparations and the decision is made on careful evaluation of your risk factors and on your preferences as well.

It is important to note that they all have the same effect and one is no better than the other.

The transdermal form have the advantage of not increasing your risk of thrombosis but this might not be relevant for all patients.

-Progesterone

This is needed when patients have a uterus as it protects the womb. It is also still needed in some patients even if the womb is removed for example if they have endometriosis.

It can be given as tablet or a patch

It can be given for some part of the month or on a daily basis.

This is should all be explained to you at the time of your consultation.

-Testosterone

Can be added to treatment. It is mainly used to treat low libido.

It is important to be aware that some women can have negative effect on mood with testosterone.

It also requires accurate dosing and blood levels should be monitored to ensure you are not exceeding the doses.

Libido issues are common in menopause and they are not all solved by adding testosterone. It is important to have a frank conversation on what sexual issues you are experiencing to be able to give you the right help.

Also your vaginal health is very important. For many women the reduction in libido is due to the fact that sex is uncomfortable because of vaginal atrophy

Improving vaginal atrophy is more important that relaying on testosterone only.

4-VAGINAL LASER

April 19, 2017 / Rita Galimberti

Vaginal laser is a new treatment that has completely revolutionised the way we treat vaginal atrophy.

Chronic vaginal dryness and pain at intercourse is a very common problem in menopause. It is the result of the lack of oestrogens which causes changes in the vaginal mucosa. These changes are reversible using oestrogens (HRT) but not all patients want to use them and some patients might have reached the stage at which oestrogens are not just enough.

Using laser to treat this problem in the vagina is a safe way to turn the clock back and make patients comfortable very quickly.

There are two main types of laser: Co2 laser and Er:Yag laser.

Co2 laser cause some mucosa destruction in order to cause regeneration. There have been some concerns with this treatments in relation to scarring and pain.

The non ablative technology used with Er:Yag laser is very different and that is what I recommned.

It uses a selective thermal action which works in the right tissues and it has not been associated with any problems.

We have used this treatment with success and have been very impressed with the changes that this makes for patients.

for more information visit https://femalase.com/renovalase/

5-BIOIDENTICAL HORMONES

March 15, 2017 / Rita Galimberti / 0 Comments

There is a lot of confusion on this issue.

Most of the hormones we use in conventional HRT treatment are identical to what your body will produce . We call them body identical.

However the term bioidentical is used as marketing term by some clinics who use specially compounded preparations . Many claim that these products are better or safer than conventional HRT treatment. Unfortunately these claims are not based on any scientific evidence.

On the contrary these products do not undergo the same checks that conventional products will have to pass in order to be available to patients. That basically means that you have no idea what they contain.

For this reason there are concerns on their safety profile.

They also are far more expensive than conventional HRT as the clinics selling them have a considerable profit margin on the product.

Here is the link to a document produced by the British Menopause society on this issue.

https://thebms.org.uk/publications/consensus-statements/bioidentical-hrt/

6-HOW MUCH HRT DO I NEED?

February 16, 2017 / Rita Galimberti / 0 Comments

Dosages and routes of administration are different for each woman. A full individual assessment is an essential step in prescribing.

During an assessment many factors are taken into consideration:

-age

-risk factors

-severity of symptoms.

The important thing is that current guidelines are very clear on using the lowest dose of HRT that will control your symptoms. Therefore before increasing doses we need to be sure that a symptom is caused by hormonal deficiency and not something else.

It also essential that increasing oestrogen dose is done in parallel to an increased dose of progesterone which is essential to protect the womb from uterine cancer.

The recent trend of prescribing really high doses of oestrogen without any solid evidence has brought the British menopause society to make a statement on the issue:

Read the full statement here:

https://thebms.org.uk/2022/12/bms-statement-hrt-prescribing/

Make sure your medical professional explains all these risks to you when prescribing HRT and your dose is always increased slowly and gradually.

7-DO I NEED TO TAKE SUPPLEMENTS?

February 15, 2017 / Rita Galimberti / 0 Comments

Women affected by menopause symptoms can be very vulnerable. That is why is very easy for marketing companies to target them and offer a vast range of alternative product.

My facebook account is plagued with ads offering the real truth on how to loose weight, sleep and basically solve any problem.

You can spend a lot of money on these products .

Unfortunately there is very little or no scientific evidence on their efficacy.

It is very important that you get proper medical information on menopause as making the wrong choices in the early stages can affect your long term longevity.

VitaminD is probably the only supplement we really need once your diet is good. Look at your diet and at your daily intake of fresh ingredients as your main weapon to age well.

read more on the British Menopause website:

https://thebms.org.uk/publications/consensus-statements/non-hormonal-based-treatments-menopausal-symptoms/