The development of the pharmaceutical industry provides various forms of taking estrogen preparations – oral tablets, transdermal patches, vaginal gels or rings, subcutaneous applicators, and also intramuscular depot forms. The diversity shows that there is no single and stereotyped “best” option for hormone therapy in menopausal women. Rather, it shows the important role for the doctor to tailor therapy to the hormone and to the individual needs of each woman. Despite the growing concern about possible side effects and the demand for non-hormonal treatment, estrogen therapy (with or without progestin) remains the most effective treatment for menopause. It should be known, however, that hormone therapy is used to combat the symptoms associated with menopause and is not indicated for disease prevention. Which form should I choose? Oral estrogen tablets are absorbed by the body, passing through the lining of the digestive system and reaching the liver. There, a large part of the active ingredient is neutralized. In addition, the metabolization of synthetic estrogens taken orally leads to changes in the functions of the liver – lipoproteins, cholesterol and triglycerides in the blood increase. The effects of transdermal patches are minor compared to those of the tablet form. Transdermal estrogens do not affect the lipid profile, do not increase the activity of clotting factors and have a stable concentration in the blood that is not affected by smoking as with oral forms. This suggests that transdermal hormone therapy is the more reasonable choice for menopausal female smokers, in whom the risk of venous thrombosis is minimal. Depending on the manufacturer, the patch is changed every 1 or 2 weeks. Transdermal therapy, however, is more expensive. Therefore, it is offered to those women who will experience the greatest benefit – those at risk of venous thrombosis, women with malabsorption (impaired absorption of substances from the digestive system), with hypertriglyceridemia and with obesity and metabolic syndrome. Progestins Progesterones as hormonal substances also have their place in hormone therapy in menopausal women. Progestins can be used as a stand-alone therapy to control menopausal symptoms, but are most often combined with an estrogen component. Estrogens alone are associated with endometrial hyperplasia or an increased risk of endometrial carcinoma, and their combination with a progestin product reduces this risk. Thus, menopausal women are usually offered combined hormonal therapy with an estrogen and progestin preparation, unless they have undergone a hysterectomy (removal of the uterus). Then endometrial protection from progestin is not necessary. NEWS_MORE_BOX There are two types of combination therapy – cyclical and continuous. Cyclical means that there is a period of 5-7 days that are free from taking hormones.With this method of treatment, the effectiveness of progestin for protection from the uterus is greatest. The downside of this method is that sometimes genital bleeding may be present on days free of therapy. An alternative to cyclic progestin intake in menopause is its long-term use. He has no cyclic genital bleeding. The most modern way of hormonal therapy at the moment is the insertion of an IUD with levonorgestrel (progestin), which for a long time and locally releases the hormone and thus protects the uterine mucosa, together with systemic cyclic intake of an estrogen preparation. This also avoids bleeding. It should not be forgotten that therapy can lead to some side effects such as headache, chest pain, nausea, bloating, swelling. Therefore, it is important to initially titrate (gradually increase) the dose of hormonal preparations until the effect of the treatment is achieved. Continuation of vaso-motor symptoms (hot flashes, sweating, palpitations) and vaginal dryness mean that the dose should be increased, and chest pains and discharge from the nipple are a signal to reduce the dose of the hormonal preparation.