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Finland scales back hormone use in menopause treatment

The last decade has seen significantly lower doses of oestrogen and progestogen used to treat menopause symptoms.

nainen laittaa hormonilaastarin ihoon.
Patches and gels are gaining ground in the treatment of menopause. Image: AOP

Finnish health care professionals are cutting back on doses of hormones to treat symptoms associated with female menopause.

"For a long time, it was thought that the larger the dose, the greater the risk. But an equal factor explaining the adjustment is that many women's symptoms were found to be relieved just as effectively with lower doses," says Tomi Mikkola, head physician at Helsinki's Women's Hospital.

The most effective treatment for addressing the symptoms of menopause is hormone replacement therapy (HRT), which contains either oestrogen or a mix of oestrogen and progestogen. These are the same hormones a woman's body stops producing when menopause sets in, usually around the age of 50.

"Sales of these hormone medications have gradually decreased in Finland, although we still have the highest overall consumption among the Nordics," says Elina Hemminki, a research professor at the National Institute for Health and Welfare.

Hemminki says that information about the side effects of hormone treatment with relation to other illnesses is still patchy, as it can be dependent on several factors such as the type of medication and the timeframe and duration of treatment. Studies have however linked oestrogen-progestogen HRT to a greater risk of breast cancer.

She says that hormone medication should never be used for longer periods or unnecessarily, as it should be taken to relieve menopause symptoms only.

Women's Hospital doctor Mikkola says the benefits and risks of potential hormone treatment should be weighed carefully with gynaecologists on an individual basis before starting medication. He points out that being overweight presents as much of breast cancer risk as HRT, for example. Likewise, if a patient's family already has a history of cancer, the risk is significantly higher.

Hot flashes and trouble sleeping

HRT tablets ingested orally continue to dominate the market in Finland, but products like hormone patches and gels have become more popular in the last five to ten years. Mikkola says this is because the risk of blood clots has been shown to be much lower with these alternatives.

Päivi Polo, a specialist in obstetrics and gynaecology at the University of Turku, says a new HRT tablet entered the Finnish market this year that combines oestrogen with bazedoxifene, which is not a hormone.

"The bazedoxifene could prove to be safer than progesterone and would therefore lessen the associated risks," she says.

Polo says the most typical menopause symptoms are hot flashes and trouble sleeping. She says many women who are affected wake up several times at night, either sweating or freezing cold.

"Sometimes people don't connect their sleeping disorders with menopause, and they are prescribed sleeping pills. Hormone therapy is however still the primary treatment for dealing with sleep-related menopause symptoms," she says.

Polo says that other symptoms of menopause include dry mucous membranes, joint and muscle pain, and mood swings. For some, the emotional changes can be made manifest as depression, anxiety, listlessness, and burnout.

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