Menopause is far from a uniform experience. While many women face similar challenges during the menopausal transition, the underlying hormonal shifts vary significantly from person to person. For years, menopausal hormone therapy (MHT) has been used to manage these transitions, but there is a growing shift toward a more personalized approach. Rather than a standard prescription, experts are now emphasizing the importance of a woman’s specific androgen status to optimize treatment outcomes.
The Shift Toward Personalized MHT
For a long time, the primary focus of hormone therapy has been the correction of oestrogen deficiency. Though, the hormonal landscape of menopause involves more than just oestrogen. Androgens—such as testosterone—play a critical role in overall well-being, mood, and physical health during the menopausal transition.
A personalized approach to MHT selection involves assessing a woman’s unique hormonal profile before deciding on a treatment plan. This ensures that the therapy doesn’t just replace a missing hormone but restores a healthy, individualized hormone balance.
The Role of Androgen Status and SHBG
To personalize therapy, clinicians appear at more than just total hormone levels. A key factor in this process is Sex Hormone-Binding Globulin (SHBG). SHBG is a protein that binds to hormones like testosterone and oestradiol, regulating how much of these hormones are “free” and active in the body.
When SHBG levels fluctuate, the amount of available androgen changes, even if the total amount of testosterone in the blood remains the same. By analyzing androgen status alongside SHBG levels, healthcare providers can better understand why some women experience more severe symptoms than others and how they will likely respond to specific MHT combinations.
Tailoring Treatment: Oestradiol and Dydrogesterone
Recent medical discourse, including research presented by Svetlana O. Dubrovina of Rostov State Medical University at the ISGE Congress, highlights the importance of selecting specific hormone combinations based on these individual markers.
The use of oestradiol (to address oestrogen deficiency) and dydrogesterone (a progestogen used to protect the uterine lining) can be adjusted based on the patient’s androgen status. This targeted selection helps in achieving a more precise hormone balance, potentially reducing side effects and improving the efficacy of the therapy.
Key Takeaways: Personalized MHT
- Beyond Oestrogen: Effective MHT isn’t just about replacing oestrogen; it requires balancing androgens as well.
- The SHBG Factor: Measuring Sex Hormone-Binding Globulin is essential to determine the amount of active, free hormones in the system.
- Customized Selection: The choice of medications, such as oestradiol and dydrogesterone, should be informed by the woman’s specific androgen status.
- Goal of Therapy: The ultimate aim is a personalized hormone balance that addresses the individual’s unique physiological needs.
Why Personalization Matters
When MHT is applied as a “one size fits all” solution, some women may uncover their symptoms persist, while others may experience unnecessary side effects. By integrating androgen status into the selection process, clinicians can:
- Improve the management of symptoms associated with the menopausal transition.
- Avoid over-treatment or under-treatment of specific hormones.
- Create a more sustainable long-term wellness plan for the patient.
Frequently Asked Questions
What is “androgen status” in the context of menopause?
Androgen status refers to the levels and activity of male-type hormones (which women also produce) in the body, specifically testosterone. These hormones influence muscle mass, bone density, and libido during menopause.
Why is dydrogesterone used in MHT?
In women who still have a uterus, oestrogen therapy must be paired with a progestogen, like dydrogesterone, to prevent the overgrowth of the uterine lining (endometrial hyperplasia).
How is a personalized approach different from standard MHT?
Standard MHT often follows general guidelines based on age or symptom severity. A personalized approach uses specific blood markers—like androgen levels and SHBG—to tailor the type and dose of hormones to the individual woman.
Looking Ahead
The move toward precision medicine is reaching reproductive health. As our understanding of the interplay between oestrogens, androgens, and binding proteins like SHBG grows, the “standard” approach to menopause is evolving. The future of MHT lies in highly individualized protocols that treat the woman, not just the symptoms, ensuring a healthier and more balanced transition into postmenopause.