Hormone Replacement Therapy

Original Editor - Habibu salisu Badamasi

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

Introduction and description

Menopause is a physiological change that occurs in women body between the age of 45 and 55.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.

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.It is also known to prevent bone loss in postmenopausal women. However, there are risks associated with Hormone replacement therapy (HRT).

Hormone Replacement Therapy.

Types of hormone replacement therapy

Hormone replacement therapy (HRT) - most women take a combination of estrogen, progestogen, and estrogen alone. 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.

• Estrogen Therapy: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.

• Estrogen/Progesterone/Progestin Hormone Therapy: 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.

Indications of hormone replacement therapy

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.

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

1. Relieves hot flashes and night sweats
2. Helps better sleep
3. Ease vaginal dryness and itching
4. Makes sex less painful
5. Helps prevent fractures caused by osteoporosis
6. Make some women less likely to have heart disease
7. Lowers chances of dementia
8. Taking HRT around the time of menopause reduces a woman’s risk of developing diabetes
9. HRT slightly reduces the risk of colorectal/bowl cancer.

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:

• Heart disease

• Stroke

• Blood clots

• Breast cancer

• Endometrial cancer, if patient takes estrogen without progesterone while still having a uterus.

• Venous thrombosis

The risks change depending on the following:

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. 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.
4. Patient should take the lowest does of medication that suits them.
5. Patient should undergo regular mammograms and pelvic exams.