Summary
Dr. Caoimhe Hartley discusses perimenopause, menopause, and the symptoms women may experience during this time. She explains the impact of hormonal fluctuations on endometriosis and the importance of managing symptoms during perimenopause. Dr. Hartley also explores various treatment options for perimenopause and postmenopause, including hormone replacement therapy (HRT) and the use of testosterone. She emphasises the need for individualised care and risk assessment when considering HRT. Additionally, Dr. Hartley highlights the importance of lifestyle factors in managing menopausal symptoms and reducing overall health risks. This conversation covers various topics related to hormone replacement therapy (HRT) and the management of menopausal symptoms. It explores individualised approaches to HRT, the importance of long consultations and patient advocacy, options for managing menopausal bleeding, non-hormonal medications for heavy bleeding, different hormonal options for bleeding control, the use of Tibolone as an alternative hormone therapy, the safety of vaginal oestrogens in breast cancer patients, and the myth of hormone balancing.
Takeaways
Hormone replacement therapy (HRT) should be individualised based on a person's symptoms, risk factors, and preferences. It is not a one-size-fits-all approach.
Long consultations and patient advocacy are crucial in providing comprehensive care for menopausal patients. Patients should be well-informed and actively involved in their treatment decisions.
There are various options for managing pre and perimenopausal bleeding, including non-hormonal medications like tranexamic acid, as well as hormonal options.
Tibolone is a synthetic steroid that can be used as an alternative hormone therapy. It has similar benefits to other forms of HRT and is considered safe for most women. It was studied as addback HRT for use with GnRHa like Zoladex.
Aromatase inhibitors are commonly used in post-breast cancer treatments and infertility. They can be effective but may cause significant side effects. Some patients with endometriosis have used them for symptom control.
Vaginal oestrogens are safe and effective for managing vaginal dryness and other genitourinary symptoms in women. They do not increase the risk of breast cancer.
Resources
Dr Caoimhe Hartley - Menopause Health https://www.menopausehealth.ie/
Chapters
00:00 Introduction and Background
03:32 Perimenopause and Menopause
06:50 Perimenopausal Symptoms and Endometriosis
15:06 Treatment Options for Perimenopause and Postmenopause
20:17 Managing Symptoms in Hysterectomy Patients
22:48 The Use of Testosterone in Menopause
27:44 Alternative Options for Women Not Taking HRT
34:51 Risks and Side Effects of HRT
40:23 Individualised Risk Assessment
41:13 Individualised Hormone Replacement Therapy (HRT)
42:02 Long Consultations and Patient Advocacy
43:14 Managing Menopausal Bleeding
44:19 Non-Hormonal Medications for Heavy Bleeding
44:49 Hormonal Options for Bleeding Control
45:46 Tibolone as an Alternative Hormone Therapy
48:36 Aromatase Inhibitors in Endometriosis Treatment
50:53 Vaginal Oestrogens and Breast Cancer
54:46 The Myth of Hormone Balancing