Female Hormone Therapy Why Menopause Treatment Is Not the Same for Everyone

Hormone therapy is not a one-size-fits-all treatment for all menopausal patients.

The appropriate method among systemic therapy, local treatment, and non-hormonal management varies depending on the degree of estrogen deficiency, the type of symptoms, the presence or absence of the uterus, and personal medical history. To determine this, a Hormone Level Test and medical history review must precede.

• Hormone therapy is divided into systemic therapy and local therapy depending on the degree of estrogen deficiency and symptoms.

• The possibility of treatment and concomitant medications vary depending on personal medical history, such as the presence or absence of the uterus, and a history of breast cancer or thrombotic diseases.

• As a rule, the treatment method is determined after checking hormone levels such as estrogen and FSH through a blood test.

• If there are no vasomotor symptoms or hormone therapy is difficult, symptoms can be managed with non-hormonal management.

• Even after starting treatment, it is safe to adjust the dosage and method through regular check-ups every three months.

Female hormone therapy refers to treatment that supplements deficient hormones to alleviate symptoms such as hot flashes, sweating, sleep disturbances, and Vaginal Dryness that appear as the secretion of estrogen and progesterone from the ovaries decreases around menopause.

This includes both methods of supplying hormones systemically and methods applied only to local areas. Broadly, non-hormonal approaches that manage symptoms without using hormones are also treated as one aspect of menopausal management.

As menopause approaches, ovarian function declines, and estrogen secretion rapidly decreases.

Since estrogen is a hormone involved in regulating body temperature, maintaining vaginal mucosa, and maintaining bone density, a decrease in its levels can simultaneously lead to symptoms such as hot flashes, sweating, Vaginal Dryness, and decreased bone density.

When such changes are suspected, a hormone test should be performed first, rather than judging based solely on symptoms.

The Korean Society of Menopause's treatment guidelines for menopausal hormone therapy recommend deciding whether to treat after checking estrogen and FSH levels, and explain that in cases of Premature Menopause before age 40 or early menopause before age 45, examination and Consultation are necessary regardless of the presence of symptoms.

Treatment methods also differ depending on the test results.

If systemic symptoms such as hot flashes or sweating are prominent, systemic hormone therapy is considered. If local symptoms such as Vaginal Dryness or urinary discomfort are central, management with local treatment alone is often sufficient.

Since the two methods have different purposes and scopes of application, test results and symptom patterns must be considered together.

Since the type and dosage of hormones that can be used vary depending on whether there is a history of breast cancer, endometrial cancer, or venous thrombosis, and whether the uterus is preserved, a thorough review of medical history must precede the start of treatment.

Those who come to Wooahan Women's Clinic, an obstetrics and gynecology clinic in Gangnam Apgujeong, for Consultation regarding female hormone therapy first go through the Precise Examination & Consultation stage.

Afterward, a single blood test simultaneously analyzes 6 types of hormones, including estrogen and FSH, and if necessary, an AMH test is performed to check ovarian age.

Once the test results are available, the examination items and treatment direction are narrowed down according to the individual's symptoms and medical history, and specific guidance is provided on whether systemic therapy is appropriate or if a local treatment or non-hormonal management approach should be taken.

After starting treatment, regular re-examinations are conducted at the initial, 3-month, and 6-month marks, and hormone dosages are managed by fine-tuning them.

Detailed information on the entire process of menopause treatment can also be found in the article Menopause: When Female Hormone Testing is Necessary.

I am Lee Donghee, the chief director of Wooahan Women's Clinic in Gangnam Apgujeong, an obstetrics and gynecology clinic. I serve as an adjunct professor at Sungkyunkwan University School of Medicine and have been active in academic societies such as the Korean Society of Obstetrics and Gynecology and the Korean Society of Menopause.

We have clinical collaborations with Yonsei University Gangnam Severance Hospital and Asan Medical Center, allowing for safe treatment in conjunction with partner institutions even for patients with complex medical histories.

I also have experience publishing papers related to estrogen changes during the menopausal transition in international academic journals, and I reflect this Clinical Experience in the process of interpreting test results and establishing personalized treatment plans.

As such, these three Methods have different purposes and scopes of application, and non-hormonal management may be combined when hormone use is difficult.

When determining the treatment Method, the presence or absence of the uterus is checked first.

If the uterus is present, combination therapy using both estrogen and progesterone is considered to protect the endometrium. If a hysterectomy has been performed, estrogen monotherapy is reviewed.

For those with a high risk of venous thrombosis or concomitant Metabolic Syndrome, transdermal formulations are prioritized over oral ones. For those with a history of breast cancer or who are uncomfortable with hormone use, we also provide guidance on symptom relief through lifestyle management and non-hormonal medications.

1. Check if you have had a Hormone Level Test (estrogen, FSH) within the last 6 months.

2. Organize any medical history that could affect treatment, such as breast cancer, endometrial cancer, or venous thrombosis.

3. Distinguish for yourself whether your symptoms are systemic symptoms or local symptoms like Vaginal Dryness.

Checking these three things in advance can help you find the most accurate treatment Method for you during Consultation. If you need an accurate diagnosis, please inquire through Consultation.

Q. At what age can hormone therapy be started?

A. It can be started when menopausal symptoms appear, and for Premature Menopause before age 40 or early menopause before age 45, examination and Consultation are recommended regardless of the presence of symptoms.

Q. What items are checked in a hormone test?

A. Estrogen and FSH are basic, and if necessary, related hormones such as AMH are checked together to assess ovarian function.

Q. Is local treatment alone sufficient?

A. If local symptoms such as Vaginal Dryness or urinary discomfort are central, local treatment alone is often sufficient for management. However, if systemic symptoms such as hot flashes are accompanied, systemic therapy is considered together.

Q. Can I receive treatment even if I have a history of breast cancer?

A. If there is a history of breast cancer, hormone therapy may be limited, so non-hormonal management or alternative Methods are prioritized, and safety is confirmed in cooperation with relevant departments if necessary.

Q. How often do I need to visit the clinic once treatment starts?

A. Re-examinations are conducted regularly at the initial, 3-month, and 6-month marks, and thereafter, the check-up cycle is adjusted according to the condition.

Q. Does treatment need to be continued for life?

A. It varies depending on symptoms and individual circumstances. After a certain period of treatment, the duration is re-evaluated based on the degree of symptom relief and test results.

Q. I am concerned about side effects. How are they managed?

A. The dosage and Method are adjusted through regular check-ups. In cases where the risk is high due to medical history, low-dose, transdermal formulations, or local treatment are prioritized from the beginning to reduce the burden.