Hormone Replacement Therapy: Difference between revisions

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== Introduction ==
[[File:HRT med.jpeg|thumb|HRT ]]
[[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>


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>


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" />
== Administration ==
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.


== Introduction and description ==
* Oral Estrogen: Any estrogen administered orally increases the risk of a [[Thrombosis|blood clot]].
[[Menopause]] is a physiological change that occurs in women body between the age of 45 and 55<ref name=":2">What is menopause?. National Institute on Aging. U.S. Department of Health and Human Services; 2021. Available from: https://www.nia.nih.gov/health/what-menopause#:~:text=The%20years%20leading%20up%20to,as%20long%20as%2014%20years.</ref>.Phase of [[menopause]] generally last for as less as 7 years or rarely unto 14 years.  This duration is influenced by lifestyle factors and genetics. As the woman enters a pre-menopausal phase, her body usually starts producing lesser estrogen hormone. This comes along with many unpleasant symptoms like hot flashes, vaginal discomfort, etc. <ref name=":2" />
* Transdermal Estrogen: Bypasses the hepatic metabolism and the risk for blood clotting is negated.
* Progestin administration: usually via the oral route.<ref name=":2" />  


Hormone replacement therapy (HRT) is a menopause treatment that relieves symptoms of menopause. It is medication that contains female hormones to replaces or add to 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>It is also known to prevent bone loss in postmenopausal women. However, there are risks associated with Hormone replacement therapy (HRT).
== Indications ==
[[File:AdobeStock 327509111.jpg|center|thumb]]
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]]
[[File:Hormone Replacement Therapy.png|thumb|Hormone Replacement Therapy.]]


== Types of hormone replacement therapy ==
== Safety Issues ==
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 via intra muscular injections or 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 as well. HRT can also be supplemented with testosterone.<ref name=":1" />
[[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" />


* '''Estrogen Therapy:'''<ref name=":3">Johnson TC. Menopause and HRT: Hormone replacement therapy types and side effects. WebMD; 2021. Available from: https://www.webmd.com/menopause/guide/menopause-hormone-therapy</ref>If a woman is having symptoms of menopause after a hysterectomy doctors prescribe a low dose of estrogen in a form of a daily pill or patch. Estrogen is also available in topical form like creams, gels and sprays. Also, vaginal estrogen is also an option where it comes in form of  cream, vaginal ring or vaginal estrogen tablets.
== Benefits ==
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>


* '''Estrogen/Progesterone/Progestin Hormone Therapy:''' <ref name=":3" />This is often called as combination therapy as it uses a combination of estrogen and progesterone. It’s meant for women who still have their uterus. Taking estrogen with progesterone lowers the risk of the cancer of endometrium  which is a known side effect of HRT when taken estrogen alone. Taken in pill form, natural progesterone is a choice made over synthetic  progestin pills as natural progesterone do not have a negative effect on lipids. Intrauterine progestin or Low-dose intrauterine devices (IUD) which is used for pregnancy prevention and bleeding control, is another suggestion by the doctors. IUD is kept inside the patient until perimenopause is complete to help with uneven periods.  
== 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" />


== Indications of hormone replacement therapy ==
Variables to take into consideration include:
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" />
 
===== Symptoms of menopause =====
* Hot flushes
 
* Night sweats with or without awakening.
* vaginal discomfort
* Bone loss
* vaginal dryness
* Thinning of vaginal walls
* vaginal and bladder infections
* Mild urinary incontinence
* Aches and pains in joints and muscles
* Sleep disturbance
* Reduced sex drive
* Mood swings
* Palpitations
* Hair loss
* Abnormal hair growth
 
== Benefits of hormone replacement therapy ==
 
# Relieves hot flashes and night sweats
# Helps better sleep
# Ease vaginal dryness and itching
# Makes sex less painful
# Helps prevent fractures caused by osteoporosis
# Make some women less likely to have heart disease
# Lowers chances of dementia
# Taking HRT around the time of menopause reduces a woman’s risk of developing diabetes
# HRT slightly reduces the risk of colorectal/bowl cancer.
 
{{#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. ==
The largest clinical trial to date, hormone replacement therapy that consisted of an estrogen-progestin (progestin is the synthetic form of progesterone, natural progesterone is a better choice of medication) pill increased the risk of certain serious conditions, including:<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>
 
* Heart disease
 
* Stroke
 
* Blood clots
 
* Breast cancer
 
* Endometrial cancer, if patient takes estrogen without progesterone while still having a uterus.
 
* Venous thrombosis
'''<u>The risks change depending on the following:</u>'''


# 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.  
# 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.  
# Type of hormone therapy: HRT with both estrogen and progesterone is a safer choice, rather than only estrogen.  
# Type of hormone therapy: HRT with both estrogen and progesterone is a safer choice, rather than only estrogen.  
# History: Family and personal medical history of cancer, heart disease, stroke, blood clots, liver disease and osteoporosis play a role in deciding if HRT is a good or bad option for an individual. 
# 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" />
# Patient should take the lowest does of medication that suits them.
# Patient should undergo regular mammograms and pelvic exams.  


== 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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