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Hormone Replacement Therapy

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Amish Patel - NowPatientGreen tick
Updated on 27 Mar 2024

Hormone Replacement Therapy

When menopause occurs in women it can bring about a range of symptoms such as hot flushes and vaginal dryness, due to a decline in the production of oestrogen by the ovaries. Hormone replacement therapy (HRT) is a treatment option used to provide relief from these symptoms, as well as others, to help improve overall quality of life.

Here, we will take a closer look at hormone replacement therapy, its benefits, health risks, and alternatives.

Understanding Hormone Replacement Therapy

HRT is exactly what it says it is. It is the replacement of hormones no longer made by the body. The most common treatment is a combination of estrogen (estradiol, estrone or estriol) and progesterone. Estrogen helps to treat symptoms like hot flashes and vaginal dryness, while progesterone helps to protect against endometrial cancer and osteoporosis. The two main types of HRT are:

  • Systemic HRT: Available as tablets, skin patches, sprays, gels, sprays, and injections. These work throughout the body, relieving hot flashes, vaginal dryness and night sweats
  • Local HRT: Creams, rings, and vaginal tablets, used to treat vaginal symptoms

What are the benefits of Hormone Replacement Therapy?

According to The North American Menopause Society, systemic HRT is the best treatment available for the treatment of symptoms such as hot flushes, vaginal dryness, night sweats, bone loss and urinary tract infections (UTIs). HRT has been shown to improve:

  • Mood changes, insomnia and brain fog
  • Heart disease
  • Osteoporosis, osteoarthritis, and joint pain in postmenopausal women
  • Glucose control in type 2 diabetes
  • Sex drive
  • Overall quality of life

HRT is used to manage vasomotor symptoms, genitourinary syndrome, and the prevention of osteoporosis during menopause.

Risks and considerations

The Women’s Health Initiative has highlighted health conditions that may cause risks when taking HRTs, these include:

  • Heart disease
  • Uncontrolled high blood pressure
  • Stroke
  • Breast cancer
  • Thrombosis
  • Blood clots
  • Liver disease

Risks tend to be higher when HRT treatment is used for longer periods of time. Factors such as age, preferences, and the availability of treatment options should also be considered when choosing treatment.

Administration methods

Oral estrogen is the most common and convenient method of administration. However, patches or gels can bypass the liver avoiding, the risk of blood clotting. Oral progestogens are necessary for use in women with an intact uterus to protect against endometrial cancer. Vaginal treatments, such as creams, rings, or vaginal tablets, can also help to manage localized symptoms.

Side Effects of Hormone Replacement Therapy

Hormone Replacement Therapy may cause certain side effects. The most commonly experienced side effects of HRT may include:

  • Breast tenderness
  • Bloating
  • Mood swings
  • Headaches
  • Vaginal bleeding or irregular spotting

If any side effects are concerning, speak to a healthcare provider for further medical advice.

Alternatives to Hormone Replacement Therapy

Alternatives to HRT include:

  • Avoiding triggers such as caffeine
  • Maintaining a comfortable room temperature
  • Wearing breathable clothing
  • Relaxation techniques such as deep breathing, tai chi, yoga, or meditation
  • Antidepressants
  • Vaginal lubricants or moisturizers

Hormone Replacement Therapy after Hysterectomy

Women who have had a hysterectomy may be prescribed oestrogen-only HRT as there is no need for progesterone to protect against ovarian cancer.

Women under the age of 60 who have had a hysterectomy and take estrogen HRT within 10 years of menopause show a reduced risk of breast cancer.

Hormonal Supplements for men

Men’s hormone levels also naturally decline with age, but testosterone as an “anti-aging treatment” is not recommended due to a lack of evidence. Testosterone supplements may also increase the risk of cardiovascular disease.

Frequently asked questions

What is Hormone Replacement Therapy?

Hormone Replacement Therapy is used to relieve the symptoms of menopause due to hormonal imbalances by replacing hormones no longer naturally produced. HRT will not replace the full amount of hormones produced by a woman before menopause, but provides a smaller percentage.

Is Hormone Replacement Therapy safe?

Hormone Replacement Therapy has been linked to an increased risk of breast cancer and heart disease. However, more recent research has provided a more clear understanding of the risks and benefits of HRT. There are still misconceptions around the safety of HRT, but treatment based on an individuals symptoms, risk factors, and well-being, will provide benefits.

In addition, if HRT is started within 10 years of the last period, it has been shown to reduce the risk of heart disease and bone loss, as well as reduce the risk of diabetes and weight gain.

What are the risks of HRT?

The combined use of estrogen and progestin HRT may slightly increase the risk of breast cancer. The increased risk is however, very low. Also, the synthetic progestin hormones used in past studies are no longer prescribed today, and studies also show that bioidentical hormones do not produce clear increases in breast cancer risk. Alcohol consumption and being overweight, have more of an impact on the risk of breast cancer than HRT. HRT may also increase the risk of blood clots, hence the importance of evaluating risk factors before prescribing HRT.

Should I take Hormone Replacement Therapy?

Hormone Replacement Therapy may not be suitable for everyone. If you have had a stroke, blood clots, heart attack or liver problems, breast or uterine cancers, or unexplained vaginal bleeding, you may be advised not to take HRTs. Speak to a healthcare professional to decide the best treatment option for you.

When is it best to start Hormone Replacement Therapy?

Hormone Replacement Therapy should be started within 10 years of your last period. However, if you have severe menopausal symptoms, you should start treatment earlier, even during perimenopause, while still having regular monthly cycles.

How long can I use Hormone Replacement Therapy?

Guidelines suggest the duration of HRT treatment should be a decision made between you and your healthcare provider. The choice will vary for everyone, but you should have regular checkups, to ensure that your treatment is safe and effective for you.

Conclusion

HRT can significantly improve your quality of life. But you should consider the benefits and risks first. Speak to your doctor to decide what the best treatment is for you. Whether you choose HRT or an alternative method, you will need to be monitored closely to make sure you receive the best ongoing treatment options available.

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