FAQ

FAQ

Here is a FAQ guide to support your conversations with patients and address their concerns regarding the menopause and HRT.

  • 1) What is menopause?

    Menopause is the time in a woman’s life when menstrual periods permanently stop, as she reaches the end of her natural reproductive life. Natural menopause occurs when the ovaries inherently begin decreasing their production of the sex hormones estrogen and progesterone. Menopause can also be induced by the surgical removal of both ovaries. The definitive cessation of menstruation is preceded by several months to several years of irregular menstrual cycles which is called peri-menopause. Menopause is a retrospective clinical diagnosis, as the final menstrual period can only be defined if followed by 12 months of amenorrhoea.1

  • 2) When does menopause start?

    The menopause is a natural part of ageing that usually occurs between 45 and 55 years of age, as a woman's estrogen levels decline. In the UK, the average age for a woman to reach the menopause is 51.2

  • 3) How does the menopause impact short and long term health?

    In the short term, the decrease in production of your sex hormones estrogen and progesterone is responsible for many physiological changes which can manifest by troublesome physical symptoms such as headaches, vaginal dryness, muscle pain, joint stiffness, etc. In the longer term, menopause can be associated with an increased risk of cardiovascular disease and osteoporosis as the lack of hormones induces a loss of bone density.1

  • 4) What impact does menopause have on quality of life?

    Because of its rather troublesome and distressing symptoms, menopause can potentially have a strong impact the quality of life including physical health, relationships, hobbies and even work life. For example, hot flushes can disrupt sleep and make women feel tired, vaginal symptoms can affect libido and sex life, forgetfulness and loss of concentration can make work life difficult.11,14

  • 5) What are the most common symptoms of menopause?

    There are both physical and psychological manifestations of the menopause. Symptoms include hot flushes, night sweats, insomnia, reduced libido, vaginal dryness, headaches, mood changes, irritability, anxiety, palpitations, joint stiffness, aches and pains, reduced muscle mass, recurrent urinary tract infections, low mood, weight gain, skin changes (dryness, elasticity), difficulty with memory and concentration.1,11,14

  • 6) Do all women suffer from menopausal symptoms?

    Every woman experiences menopause in their own way. Although most women experience physical or psychological symptoms, some women don’t have any apparent symptoms.1 In a survey by the BMS (British Menopause Society), 79% of women surveyed experienced hot flushes and 70% experienced night sweats.11

  • 7) How long do menopausal symptoms last?

    The duration of menopausal symptoms varies from one woman to another. Symptoms are thought to last for a median duration of 4 years, however, 10% of women may continue to experience symptoms for as long as 12 years following the last menstrual period.15

  • 8) What is HRT and how does it work?

    HRT (hormonal replacement therapy) aims to relieve symptoms caused by lower levels of female hormones during the menopause. Hormonal treatment of menopause usually involves the use of a daily estrogen alone or in combination with a progestogen taken daily or sequentially. It works by restoring the levels of sex hormones in your body.

  • 9) Who is HRT intended for?

    Not all women have indications for HRT (hormonal replacement therapy). HRT is indicated for the treatment of estrogen deficiency symptoms in menopausal women, such as vasomotor symptoms, and others which may significantly impact their quality of life. HRT should not be recommended without a clear indication and should be individualised, and also adapted over time. HRT should not be initiated in women over the age of 70 years old, or women with history of breast, ovarian or uterine cancer, history of blood clots, liver disease or untreated high blood pressure.1

  • 11) When should HRT be initiated?

    In women who have an indication for HRT (hormonal replacement therapy), it is recommended to start as early as possible. A higher benefit risk balance is achievable if treatment is initiated in proximity to the start of menopause.4 Timely initiation of treatment is important. In the age group 50-60 years or within 10 years after menopause, the benefit of HRT is more likely to outweigh the risk.1

  • 12) What are the benefits of HRT?

    Risks and benefits of HRT (hormonal replacement therapy) differ depending on age of women and menopausal state. The short- and long-term benefits of HRT are:5

    • Relief of hot flushes and night sweats5
    • Alleviate urinary and vaginal symptoms5
    • Prevention of osteoporosis in postmenopausal women at high risk of future fractures who are intolerant of, or contraindicated for, other medicinal products approved for the prevention of osteoporosis12,13
    • HRT may improve joint and muscle pain, mood swings, sleep disturbances and sexual function1
    • Women aged younger than 60 years or who are within 10 years of menopause onset, might experience more benefits associated with HRT1
  • 13) What are the risks of HRT?

    Risks and benefits of HRT (hormonal replacement therapy) differ depending on the age of women, but also on the type of treatment and regimen.6 It is important to have at least one consultation annually to assess the efficacy and tolerability of treatment, and to evaluate the individual's benefit and risk balance. Risks of HRT can include an increased risk of:10

    • Breast Cancer
    • Venous thromboembolic disease
    • Stroke

    In order to minimise the individual risks and optimize the benefits, the treatment type, dosage, route of administration and duration of use should be adapted according to the symptoms and history.

  • 14) What is the association between HRT and cardiovascular disease risk?

    A study that followed women for 18 years found that, overall, the use of HRT for 5 to 7 years was not associated with an increased risk of all-cause, cardiovascular, or cancer mortality among postmenopausal women7 The NICE guideline (NG23) states that HRT does not increase cardiovascular disease risk when started in women aged under 60 years.10

  • 15) What are the contraindications for HRT?

    HRT (hormonal replacement therapy) is not recommended to be initiated in women after 70 years of age. Women with history of breast, ovarian or uterine cancer, history of blood clots, liver disease or untreated high blood pressure should discuss with a doctor to determine the appropriate treatment options.1,8

  • 16) What are the side effects of HRT?

    Side effects of HRT (hormonal replacement therapy) may include e.g. breast tenderness, bloating, fluid retention, headaches, mood swings and nausea. In case of bothersome side effects, reducing the dose of estrogen, changing the type of progestogen or altering the route of administration can be trialed.16

  • 17) When should a woman stop taking HRT?

    According to the IMS 2016 recommendations, there are no reasons to place a mandatory limitation on the duration of HRT (hormonal replacement therapy), provided that it is consistent with treatment goals. The dosage should be titrated to the lowest effective dose. Whether or not to continue therapy should be decided at the discretion of the well-informed woman and her health professional, dependent upon the specific goals and an objective estimation of ongoing individual benefits and risks.1

  • References

    1. 1) Baber RJ, Panay N, Fenton A; IMS Writing Group. 2016 IMS recommendations on women’s midlife health and menopause hormone therapy. Climacteric 2016; 19(2):109-50.
    2. 2) NHS. Menopause. Available at: https://www.nhs.uk/conditions/menopause/ (Accessed on: January 2021).
    3. 3) Hamoda H, et al. The British Menopause Society & Women's Health Concern 2020 recommendations on hormone replacement therapy in menopausal women. Post Reprod Health. 2020;26(4):181-209.
    4. 4) Hodis HN, Collins P, Mack WJ, et al. The window of opportunity for coronary heart disease prevention with hormone therapy: past, present and future in perspective. Climacteric 2012; 15(3):217-28.
    5. 5) Armeni E, Lambrinoudaki I, Ceausu I, et al. Maintaining postreproductive health: a care pathway from the European Menopause and Andropause Society (EMAS). Maturitas 2016; 89:63-72.
    6. 6) The NAMS 2017 Hormone Therapy Position Statement Advisory Panel. Menopause 2017; 24(7):728-53. *Treatment duration during intervention phase: CEE alone for a median of 7.2 years; CEE + MPA for a median of 5.6 years.
    7. 7) Manson JE, Aragaki AK, Rossouw JE, et al. Menopausal Hormone Therapy and Long-term All-Cause. and Cause-Specific Mortality. The Women’s Health Initiative Randomized Trials. JAMA 2017; 318(10):927-38.
    8. 8) NHS Choices. https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/. Accessed January 2021.
    9. 9) Sood R, Faubion SS, Kuhle CL, et al. Prescribing menopausal hormone therapy: an evidence-based approach. Int J Women's Health 2014; 6:47-57.
    10. 10) NICE. Menopause: diagnosis and management. NG23. Available at: www.nice.org.uk/guidance/ng23 (accessed January 2021).
    11. 11) The British Menopause Society, National Survey 2016. Accessed from: https://thebms.org.uk/publications/tools-for-clinicians/. Last accessed January 2021.
    12. 12) Femoston® 1mg/10mg Summary of Product Characteristics.
    13. 13) Femoston® 2mg/10mg Summary of Product Characteristics.
    14. 14) https://thebms.org.uk/wp-content/uploads/2016/05/FINAL_BMS-2016-Annual-Conference_Press-Release_060516.pdf.
    15. 15) Potili MC, et al. Revisiting the Duration of Vasomotor Symptoms of Menopause: A Meta-Analysis. J Gen Intern Med. 2008 Sep; 23(9): 1507–1513.
    16. 16) British Menopause Society, Tool for Clinicians: HRT Guide. Available at https://thebms.org.uk/publications/tools-for-clinicians/.

Femoston®

Femoston is a combination of 17β estradiol and dydrogesterone, which is indicated for postmenopausal women at least 6 months since last menses to provide relief from vasomotor symptoms.

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