Hormone Replacement Therapy: Difference between revisions

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== Introduction ==
== Introduction ==
[[Menopause]] is a physiological change that occurs in women around the age of 51. Hormone replacement therapy (HRT) combines estrogen with a progestogen to protect the endometrium in women who still have their uterus. <ref name=":1">Hickey M, Elliott J, Davison SL. Hormone replacement therapy. Bmj. 2012 Feb 16;344.</ref>Hormone replacement therapy (HRT) is a menopause treatment that relieves symptoms. As you approach menopause, it replaces hormones that are at a lower level.<ref name=":0">Sullivan SD, Sarrel PM, Nelson LM. Hormone replacement therapy in young women with primary ovarian insufficiency and early menopause. Fertility and sterility. 2016 Dec 1;106(7):1588-99.</ref>
[[File:HRT med.jpeg|thumb|HRT ]]
[[File:AdobeStock 327509111.jpg|center|thumb]]
[[Hormones|Hormone]] replacement therapy (HRT) is a treatment that relieves symptoms of [[menopause]], by supplementing the hormones that are at a lower level.<ref name=":1">Hickey M, Elliott J, Davison SL. Hormone replacement therapy. Bmj. 2012 Feb 16;344.</ref><ref name=":0">Sullivan SD, Sarrel PM, Nelson LM. Hormone replacement therapy in young women with primary ovarian insufficiency and early menopause. Fertility and sterility. 2016 Dec 1;106(7):1588-99.</ref> Conventional HRT includes an [[estrogen]] and progesterone component to mimic hormones created by the human ovary.<ref name=":2">Harper-Harrison G, Shanahan MM. Hormone Replacement Therapy. InStatPearls [Internet] 2022 Feb 17. StatPearls Publishing. Available:https://www.ncbi.nlm.nih.gov/books/NBK493191/ (accessed 21.12.2022)</ref>
[[File:Hormone Replacement Therapy.png|thumb|Hormone Replacement Therapy.]]


== Types of hormone replacement therapy ==
Since the 2002 Women’s Health Initiative (WHI) trials, the risks of HRT are low for healthy women less than age 60 or within ten years from menopause, has been found to be low.  For women experiencing troublesome vasomotor symptoms, it can be a good solution. HRT also has a role in preventing [[osteoporosis]] in appropriate populations.<ref name=":3">Mehta J, Kling JM, Manson JE. Risks, benefits, and treatment modalities of menopausal hormone therapy: current concepts. Frontiers in Endocrinology. 2021 Mar 26;12:564781. Available: https://www.frontiersin.org/articles/10.3389/fendo.2021.564781/full<nowiki/>(accessed 21.12.2022)</ref>
Hormone replacement therapy (HRT) - most women take a combination of estrogen, progestogen, and estrogen alone.<ref name=":0" /> Oral, intravaginal, or transdermal estrogen (oestradiol, oestradiol 17, oestrone, or conjugated equine estrogen) The progestogen can be taken orally, applied topically, or administered through an intrauterine device . Estrogen is used daily in HRT regimens, with progestogen added sequentially (cyclic regimen) or daily (continuous combined regimen) as needed. Tibolone is a synthetic steroid that has estrogenic, androgenic, and progestogenic effects and can be taken as HRT. HRT can be supplemented with testosterone.<ref name=":1" />


* Progestins
HRT should only be for a few years, and close monitoring is required. When symptoms of menopause are mild, then education should be provided about the benefits and harm of these hormones.<ref name=":2" />
* Tibolone
== Administration ==
* Testosterone
There are many estrogen and progestogen choices that can be administrated orally or transdermally either through cream, patch, vaginal inserts, or subdermal pellets. Each route of administration has unique benefits and risks.
* Dehydroepiandrosterone
* Custom Compounding


== Indications of hormone replacement therapy ==
* Oral Estrogen: Any estrogen administered orally increases the risk of a [[Thrombosis|blood clot]].
The presence of bothersome vasomotor symptoms is the main indication for HRT. Vasomotor symptoms are common during the menopause transition and affect about 80% of women, and are severe in about 20% of these women. The duration of these symptoms varies, with a median of four years, but may continue for as many as 12 years in about 10% of women. HRT may be indicated when menopausal symptoms are adversely affecting [[Quality of Life|quality of life]].<ref name=":1" />
* Transdermal Estrogen: Bypasses the hepatic metabolism and the risk for blood clotting is negated.
* Progestin administration: usually via the oral route.<ref name=":2" />  


===== vasomotor symptoms =====
== Indications ==
The presence of bothersome vasomotor symptoms is the main indication for HRT. Vasomotor symptoms are common during the menopause transition and affect about 80% of women, and are severe in about 20% of these women. The duration of these symptoms varies, with a median of 4 to 7 years, but may continue for as many as 12  to 14 years in about 10% of women. HRT may be indicated when menopausal symptoms are adversely affecting [[Quality of Life|quality of life]].<ref name=":1" /> For Symptoms of menopause see [[Menopause|here]]


* Hot flushes
== Safety Issues ==
[[File:Hot flashes with placebo and different doses of oral estradiol in menopausal women.png|thumb|556x556px|Hot flashes with placebo or drug|alt=]]
We know now that the safety of HRT depends on a woman’s age and length of time since menopause. As such the benefits tend to outweigh the risks in healthy women less than age 60 or within ten years from menopause. There are various types, formulations and routes of HRT available to women so that their healthcare practitioner can fashion their treatment to manage their symptoms.<ref name=":3" />


* Night sweats
== Benefits ==
* with or without awakening.
HRT is often helpful in relieving hot flushes and night sweats. Mood, [[Sleep Deprivation and Sleep Disorders|sleep]] and sex drive problems may also improve, as may joint aches, vaginal dryness and [[Urinary Incontinence|incontinence]] that some women experience.<ref name=":5">Health direct HRT Available:https://www.healthdirect.gov.au/hormone-replacement-therapy (accessed 22.12.2022)</ref>


== Benefits of hormone replacement therapy ==
== Risks ==
The main risk with MHT is that some types lead to a slightly increased risk of developing [[Breast Cancer|breast cancer]] or [[thrombosis]]. On the other hand, it can be preventative for other conditions such as osteoporosis, [[Coronary Artery Disease (CAD)|heart disease]], [[diabetes]] and some types of cancers.<ref name=":5" />


# Menopausal symptoms: HRT is widely used for the established indications of menopausal symptoms.
Variables to take into consideration include:
# Osteoporotic fractures: an older population with severe osteoporosis might have enjoyed greater protection from fractures with HRT. Some studies also found that the use of HRT reduces vertebral and hip fractures.
# Cardiovascular Disease: HRT is used for high cholesterol levels and for coronary heart disease. Hence, for primary prevention of cardiovascular disease.
# Women who use HRT have a significantly lower risk of disease and death than women who do not.
# Breast cancer: The risk of metastases among breast cancer patients who had used HRT was significantly decreased; this suggests that these cancers were localized to the breast and potentially had a better prognosis.
# Colorectal cancer: Studies suggest that estrogen reduces the risk of colorectal cancer. other studies found out that HRT brings about protection of colorectal cancer with increased in duration of use.
# Brain: some studies have found out that may have effect on the brain. A beneficial effect on verbal memory, vigilance, motor speed, and reasoning on symptomatic women.
{{#ev:youtube|watch?v=Bin4GEf7-TI}}<ref>Benefit of Hormone Replacement Therapy Available from https://www.youtube.com/watch?reload=9&app=desktop&v=Bin4GEf7-TI Accessed on 31/05/2022 </ref>


== Risks of hormone replacement therapy. ==
# Age: Women who start treatment earlier as symptoms appear are at low risk of side effects where as women who start HRT later for example 10 years after menopause are at the higher risk of developing side effects.
Harms of HRT include coronary heart disease, stroke, and thromboembolism (especially during early use). The risk of breast cancer and cholecystitis increases with longer use.<ref>Grimes DA, Lobo RA. Perspectives on the Women’s Health Initiative trial of hormone replacement therapy. Obstetrics & Gynecology. 2002 Dec 1;100(6):1344-53.</ref>
# Type of hormone therapy: HRT with both estrogen and progesterone is a safer choice, rather than only estrogen.  
# May not be appropriate if medical history of: breast cancer; [[Endometrial Cancer|endometrial cancer]]; other cancers that are dependent on hormones; undiagnosed vaginal bleeding; untreated uterine lining thickening; raised risk of thrombosis; coronary artery disease, [[stroke]] or [[dementia]]; [[Deep Vein Thrombosis|DVT]]<nowiki/>s; untreated [[Hypertension|high blood pressure]].<ref name=":5" />


== References ==
== References ==
<references />
<references />
[[Category:Womens Health]]
[[Category:Womens Health]]

Latest revision as of 13:17, 21 December 2022

Original Editor - Habibu salisu Badamasi

Top Contributors - Habibu Salisu Badamasi, Lucinda hampton and Niha Mulla

Introduction[edit | edit source]

HRT

Hormone replacement therapy (HRT) is a treatment that relieves symptoms of menopause, by supplementing the hormones that are at a lower level.[1][2] Conventional HRT includes an estrogen and progesterone component to mimic hormones created by the human ovary.[3]

Since the 2002 Women’s Health Initiative (WHI) trials, the risks of HRT are low for healthy women less than age 60 or within ten years from menopause, has been found to be low. For women experiencing troublesome vasomotor symptoms, it can be a good solution. HRT also has a role in preventing osteoporosis in appropriate populations.[4]

HRT should only be for a few years, and close monitoring is required. When symptoms of menopause are mild, then education should be provided about the benefits and harm of these hormones.[3]

Administration[edit | edit source]

There are many estrogen and progestogen choices that can be administrated orally or transdermally either through cream, patch, vaginal inserts, or subdermal pellets. Each route of administration has unique benefits and risks.

  • Oral Estrogen: Any estrogen administered orally increases the risk of a blood clot.
  • Transdermal Estrogen: Bypasses the hepatic metabolism and the risk for blood clotting is negated.
  • Progestin administration: usually via the oral route.[3]

Indications[edit | edit source]

The presence of bothersome vasomotor symptoms is the main indication for HRT. Vasomotor symptoms are common during the menopause transition and affect about 80% of women, and are severe in about 20% of these women. The duration of these symptoms varies, with a median of 4 to 7 years, but may continue for as many as 12 to 14 years in about 10% of women. HRT may be indicated when menopausal symptoms are adversely affecting quality of life.[1] For Symptoms of menopause see here

Safety Issues[edit | edit source]

Hot flashes with placebo or drug

We know now that the safety of HRT depends on a woman’s age and length of time since menopause. As such the benefits tend to outweigh the risks in healthy women less than age 60 or within ten years from menopause. There are various types, formulations and routes of HRT available to women so that their healthcare practitioner can fashion their treatment to manage their symptoms.[4]

Benefits[edit | edit source]

HRT is often helpful in relieving hot flushes and night sweats. Mood, sleep and sex drive problems may also improve, as may joint aches, vaginal dryness and incontinence that some women experience.[5]

Risks[edit | edit source]

The main risk with MHT is that some types lead to a slightly increased risk of developing breast cancer or thrombosis. On the other hand, it can be preventative for other conditions such as osteoporosis, heart disease, diabetes and some types of cancers.[5]

Variables to take into consideration include:

  1. Age: Women who start treatment earlier as symptoms appear are at low risk of side effects where as women who start HRT later for example 10 years after menopause are at the higher risk of developing side effects.
  2. Type of hormone therapy: HRT with both estrogen and progesterone is a safer choice, rather than only estrogen.
  3. May not be appropriate if medical history of: breast cancer; endometrial cancer; other cancers that are dependent on hormones; undiagnosed vaginal bleeding; untreated uterine lining thickening; raised risk of thrombosis; coronary artery disease, stroke or dementia; DVTs; untreated high blood pressure.[5]

References[edit | edit source]

  1. ↑ 1.0 1.1 Hickey M, Elliott J, Davison SL. Hormone replacement therapy. Bmj. 2012 Feb 16;344.
  2. ↑ Sullivan SD, Sarrel PM, Nelson LM. Hormone replacement therapy in young women with primary ovarian insufficiency and early menopause. Fertility and sterility. 2016 Dec 1;106(7):1588-99.
  3. ↑ 3.0 3.1 3.2 Harper-Harrison G, Shanahan MM. Hormone Replacement Therapy. InStatPearls [Internet] 2022 Feb 17. StatPearls Publishing. Available:https://www.ncbi.nlm.nih.gov/books/NBK493191/ (accessed 21.12.2022)
  4. ↑ 4.0 4.1 Mehta J, Kling JM, Manson JE. Risks, benefits, and treatment modalities of menopausal hormone therapy: current concepts. Frontiers in Endocrinology. 2021 Mar 26;12:564781. Available: https://www.frontiersin.org/articles/10.3389/fendo.2021.564781/full(accessed 21.12.2022)
  5. ↑ 5.0 5.1 5.2 Health direct HRT Available:https://www.healthdirect.gov.au/hormone-replacement-therapy (accessed 22.12.2022)
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