Last Updated December 20th, 2021
What is hormone replacement therapy?
Hormone replacement therapy (HRT) or menopausal hormone therapy (MHT), or sometimes called hormone therapy (HT), is a treatment that helps to relieve symptoms of menopause in women.
Generally, the average age of menopause in women is 50 to 51. However, some women can get early menopause at the age of 35 or 40. During menopause, a woman’s body goes through a lot of hormonal changes. The ovaries no longer produce eggs naturally for reproduction, and she does not get her regular monthly periods.
The female hormones, namely estrogen, and progesterone, may decline rapidly during menopause. As a result, the body may go through several biological changes and may show symptoms like:
- Occasional hot flashes
- Pain during intercourse
- Dryness in the vagina
- Mood swings
- Night sweats.
- Osteoporosis or reduction in bone density
- Lack of concentration
- A reduction in the frequency of periods
- Hair loss
- Problems in urination
- Reduction in breast size
- Difficulty in sleeping
Health benefits of hormone replacement therapy
The benefits of hormone replacement therapy (HRT) include providing relief to perimenopause and menopause symptoms. Benefits include:
- Relief from flashes and vaginal discomfort
- Less pain during sex
- Improves vaginal dryness and itching
- Decreases night sweats
- Prevents bone thinning in osteoporosis
- Reduces risks of heart diseases in women over 40
- HRT is also helpful in treating osteoporosis in women and prevents bone loss
- Reduces the risk of bowel cancer
- Helpful in controlling cardiovascular diseases during menopause
- Improves memory and reduces the risks of dementia
Recent research studies have also shown that hormone replacement therapy can:
- Improve muscle functioning
- Bone density
- Lower the risk of mortality in women after menopause
- Prevents skin aging
Who can have hormone replacement therapy?
Women going through perimenopause (the time before the onset of menopause) and post-menopause symptoms, can undertake a hormone replacement therapy (HRT). However, HRT may not be suitable for a woman with:
- Liver disease
- Uncontrolled high blood pressure
- A woman who has a history of ovarian, endometrial, or breast cancer
- History of blood clotting or thrombosis
- Women with a history of heart disease or strokes
- Vaginal bleeding
- A woman who is pregnant
- Blood clots
- Heart diseases
Types of hormone replacement therapy
Estrogen hormone replacement therapy
Low-dose estrogen therapy is prescribed for women who have undergone hysterectomy (surgery for removal of the uterus) and oophorectomy (surgery to remove both uterus and the ovaries).
Estrogen therapy can be taken in many forms:
Pills are the most common form of estrogen therapy. They are generally taken once in a day in an empty stomach. Estrogen pills are available as combination pills that combine both estrogen and progesterone. Common estrogen pill brands are Estratab, Femtrace, Ogen, Cenestin, etc.
Estrogen patches are worn on the skin of the abdomen, buttocks, or lower back. The patches can be worn for a few days or even a week depending on the dosage of the medicine. Estrogen patches are also available as combination patches that combine both estrogen and progesterone. Common estrogen patch medications include Climara, Alora, Vivelle-Dot, etc. You can also use combined patches like Combipatch or Climara Pro.
Topical creams, gels, and sprays
They are applied directly into the dry and unbroken portions of the skin. The skin absorbs the medication, which then is passed onto the bloodstream. However, you should remember never to apply estrogen creams, and gels on the breasts’ skin as the medicine can have a different reaction. Estradiol is available in both gel and sprays forms. The Evamist spray should be applied on the arm. Other gel creams include Divigel and Estrogel. The Estrasorb cream should be applied on the leg. Estrogen gel, creams, and sprays are generally applied once in a day.
Vaginal estrogen creams and rings
Vaginal estrogen creams are applied directly into the vagina. They are also used by women suffering from dryness, itching, pain, or burning sensation during sexual intercourse. Vaginal creams can be used daily or as directed by the physician. Examples of vaginal creams include Estrace cream, Premarin cream, Ogen cream, et cetera. Patients can also use vaginal rings like Estring and Femring inserted into the upper part of the vagina. They can be replaced every three months.
Vaginal tablets are inserted into the vagina. Vaginal tablets are used daily for the first few weeks. After that, the dosage is reduced to twice a week or as indicated by the physician. Vagifem is a common type of vaginal tablet.
Other forms of therapy
Estrogen and progesterone/progestin combination therapy
This combination therapy is used to treat women for cancer of the uterus lining and the endometrium. Progestin or synthetic progesterone is used for birth control and for treating other symptoms of menopause like dizziness, hot flashes, excessive sweating, et cetera. Patients are advised not to use this medicine during pregnancy or immediately after childbirth. Most doctors prefer progesterone, which is the natural form instead of Progestin because it has no side effects and can also be administered to women with high cholesterol.
Intrauterine progestin application
Low dose intrauterine Progestins are available as IUDs (intrauterine devices) and used for hormone replacement therapy in peri-menopausal and postmenopausal women.
There are herbal supplements that may help in regulating peri and postmenopausal symptoms. However, the FDA does not recommend such treatments, and patients should seek a medical practitioner’s advice before using it.
Bioidentical HRT medications contain the same compounds that are naturally produced by hormones in the body. These medicines are made from extractions from natural plant products. Some bioidentical hormone products are FDA-approved, while others are not. So, one must use them diligently and with prior consultation with the doctor. One of the main plus points of using bioidentical products is that they are manufactured mostly in the form of creams and gels that are applied superficially on the skin and are not ingested directly as oral pills. Thus, these medicines do not pass on to the liver and have fewer side effects.
Side effects of hormone replacement therapy
Like any other treatment, hormone replacement therapy also has specific side effects. The good thing is they generally improve within a few months. However, if the symptoms persist or are severe, you may need to consult a doctor.
Here are a few general side effects:
- Breast tenderness or swelling
- Frequent mood swings
- Indigestion and bloating
- Nauseous feeling
- Swelling in the body
- Pain in the abdomen
- Back pain
- Vaginal bleeding
Many women also complain of weight gain during HRT treatment. However, no evidence has been found that directly links weight gain to the treatment. Some women may experience weight gain during menopause.
Lifestyle changes like stretching exercises or low-fat diet may reduce the symptoms of leg cramps or breast tenderness. Estrogen medicines can be taken with food to reduce bloating and nauseous feelings. Consult a doctor in case your symptoms persist. The doctor may change the medicines or the administered dosage.
Other serious health concerns
Some women may experience serious health effects like blood clots or cancer of the uterus or breasts, but these are extremely rare.
Deep vein thrombosis or clots in the vein
It may also entail pulmonary embolism or blood clots in the lungs. Patients with a family history of blood clots should consult a doctor before undergoing the treatment.
Increased risk of endometrial or uterine cancer
Estrogen hormone replacement therapy may increase the risk of endometrial cancer or uterine cancer in women. This is a reason why many doctors prescribe a combination therapy of estrogen and progestin. Progesterone protects the uterus from endometrial cancer. Doctors usually do a biopsy of the uterus for women undergoing estrogen hormone replacement therapy. Women who have undergone a hysterectomy or removal of the uterus can safely undergo estrogen therapy.
Prolonged use of hormone replacement therapy may increase the risk of breast cancer in women. Women who are undergoing estrogen HRT have a low risk of breast cancers. However, combination therapy of progesterone and estrogen can put patients into an increased risk of breast cancers. Women with a history or family history of breast cancers should inform about the same to the doctors before undergoing the treatment.
Abnormal vaginal bleeding or ‘abnormal bleeding’ may occur in postmenopausal women as a result of HRT. The bleeding may continue for months or even a year. In such cases, the doctor will collect a sample tissue of the endometrial wall and do a biopsy to detect any cancerous growth in the uterus or abnormality. If no abnormalities are found, the doctor generally reduces the medicine dosage to control the vaginal bleeding.
Heart diseases and strokes
Women over 60 undergoing hormone replacement therapy are at increased risk of heart diseases and strokes. In such cases, many doctors suggest skin patches for treatments instead of oral pills.
Oral pills during HRT may cause cholecystitis. This may cause the formation of gallstones or obstruction of the gallbladder ducts, infection, or inflammation. In such cases, the doctor may stop oral pills and instead suggest skin patches. If needed, your doctor may ask you to undergo a gallbladder removal surgery.
When to stop hormone replacement therapy?
Women should undergo hormone replacement therapy as recommended by their doctors. It generally takes a few years until their symptoms subside. However, prolonged therapy may induce symptoms or increase the risk of breast or uterine cancers or other heart diseases.
Is it safe to undergo hormone replacement therapy during pregnancy?
Pregnant women with hormonal imbalances planning to undergo HRT treatment should consult their doctors as the therapy might severely impact their pregnancy and the unborn child. HRT can cause breast and other cancers in women and may cause genital defects in the unborn child.
Lifestyle changes that can improve the symptoms of menopause
Going through menopause can be difficult. Here are some simple lifestyle changes that will help you relieve the symptoms.
Eat healthy food
Avoid spicy food as it may cause hot flushes. Eat foods rich in vitamin D and calcium. Decrease your caffeine, smoking, and alcohol intake.
Manage your weight through moderate regular exercises or yoga. Brisk walks or jogging may help. Practice muscle strengthening exercises to relieve leg cramps.
During menopause, the adrenal glands may become overactive and produce estrogen from time to time. This can result in anxiety, weight gain, or sleep disturbances, which are common in women with menopausal symptoms. Learn to manage stress and anxiety and follow a healthy sleep routine. Meditation can help in your anxiety and night sweats.
Wear light cotton clothes to reduce hot flashes and excessive sweating.
Menopause can cause vaginal dryness and may hinder sexual intercourse. Try using vaginal lubricants to improve sexual activities.
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