Symptoms & complaints

The decline in oestrogen is responsible for the most frequent menopausal symptoms such as hot flushes, a sudden quickening of the heart beat, and sleep disorders. The lack of oestrogen also leads to nervousness and irritability, problems with concentration, depressive mood, anxiety, loss of self-confidence and sexual appetite. More than 70% of women suffer from mild to moderate or severe hot flushes.1 Due to deficiency in oestrogen, the skin and mucous membranes, e.g. vaginal epithelium, lose their elasticity and moistness, and are not as well supplied with blood. This results in dryness of mucous membranes, e.g. of the eyes, mouth and nose, but also frequently of the urinary tract and the vagina. Many women in their menopausal years suffer substantially from vaginal dryness and recurring urinary tract infections, but very few understand that this is a direct consequence of the hormonal change in their bodies. Because of symptoms such as vaginal soreness and itching, sexual intercourse is often extremely painful and therefore many women consequently avoid sexual activity.

Osteoporosis

Osteoporosis occurs when the bones lose their mineral density due to decreasing oestrogen levels in the female body and thus a consequence of the menopause. They become thin and tend to fracture.  Therefore, about 80% of patients with osteoporosis are women.2 According to the World Health Organization 1% loss of bone mass per year is accepted as within the normal range of the ageing process of the body, but about one third of women suffer a bone loss of up to 5% per year. The World Health Organisation classifies osteoporosis as one of the ten most important diseases.3 In Europe, one out of three women over the age of 80 develops a hip fracture caused by osteoporosis.2 The number of hip fractures worldwide due to osteoporosis is expected to rise three-fold by the middle of the next century, from 1.7 million in 1990 to 6.3. million by 2050.3

Hormone replacement therapy is one of the options used for the prevention of bone loss and subsequently for the reduction of osteoporosis incidence and related fractures. Various progestogens such as norethisterone acetate (NETA) even can increase the effect of oestrogen on bone.

Vaginal dryness

Vaginal dryness is a critical issue for many women in their menopause. Common symptoms are itching, soreness, irritation and pain during sexual intercourse (dyspareunia). The resulting loss of libido or female sexual dysfunction (FSD) is a major problem for women over the age of 45. Most women do not know that vaginal dryness – the medical term for it is “atrophic vaginitis” – occurs due to the decreasing oestrogen levels during menopause. This growing oestrogen deficiency is responsible for a loss of elasticity of the vaginal mucous membranes, leading to the painful symptoms and often even to recurring urinary tract infections.

Often women don’t like to address the subject of vaginal dryness and related sexual problems with their doctor. In contrast to the issue of erectile dysfunction in men, the sexual well-being of women can still be taboo. Frequently it is not well understood and dismissed as a mere psychological problem. However, women do not have to live with it: vaginal dryness can be treated with local estrogens. In a European attitudinal study, the local oestrogen preparation Vagifem® emerged as the most recommended or prescribed local estrogen therapy.1 It consists of an oestrogen tablet that is administered locally via an applicator and is thus easily dosed and applied. It is better accepted and supports better compliance than other application forms. A clinical study showed that after only 12 weeks of treatment more than 90% of the participating women had none or only mild symptoms of vaginal dryness.4

In women who have predominantly vaginal symptoms of oestrogen deficiency local treatment with low dose oestrogens should be preferred.

Duration of treatment

The authorities and experts recommend using HRT at the lowest dose for the shortest duration of time consistent with the woman’s individual needs and balancing risk versus benefits.

The appropriate indication, dose and type of HRT should be re-evaluated periodically, but not less than annually.