What is Hormone replacement therapy? what is HRT for women?

What is Hormone replacement therapy?

What is Hormone replacement therapy? Well, It is a replacement therapy in which natural body reproductive hormones are given externally to humans, insufficiency of body production of these reproductive hormones. This therapy is mainly given to women as a treatment for menopausal symptoms. It is also known as HRT.

HRT full form is Hormone replacement therapy. The therapy is based on the treatment to prevent discomfort caused by diminished circulating estrogen and progesterone hormone, by use of one or more of a group of medications designed to artifically boost reproductive hormone levels.

Hormone therapy or Hormonal replacement therapy is a popular treatment for menopausal symptoms, it has many benefits and risks for breast cancer, endometrial cancer, and cardiovascular disease, here we can understand all about hormonal therapy.

What are the Hormones used in HRT?

There are different hormone therapies, but most popularly it is used in the treatment of menopausal systems, for menopausal systems reproductive hormones are used as a therapy. The HRT is the replacement of reproductive hormones that a woman’s body fails to make after menopause. The hormones used in HRT are

• Estrogen
• Progesterone
• Testosterone

What is Estrogen hormone therapy?

There are numerous Estrogen therapies in which original ovarian estrogen mimic components are used like estradiol, 17 beta-estradiol, estriol, estrone, and conjugated equine estrogen (CEE). The mimic components are not identical in their effects on the human body but are made according to guidelines given by the Food and Drug Administration.

Estrogen therapy is used to reduce vasomotor symptoms (hot flashes and night sweats).

CEE is the most commonly prescribed estrogen in the United States.

What is progesterone Hormone therapy?

Progesterone hormone therapy involves the use of one or more of a group of medications designed to artificially boost progesterone levels, a progesterone-like substance also known as progestin. Progestin drugs have also been successfully used to treat hot flashes.

Megestrol acetate (Megace) is sometimes prescribed over the short term to help relieve hot flashes. Another form of progesterone, medroxyprogesterone acetate (Depo-Provera) administered by injection, can also sometimes be useful in treating hot flashes, but may also lead to weight gain as well as bone loss.

What is Testosterone hormone therapy?

Testosterone is an androgen group hormone or a steroid hormone? Which stimulates the development of male secondary sexual characteristics. It has both anabolic and androgenic effects. So anabolic effects are linked to muscle mass and bone density, Growth and maturation,

Androgenic effects are linked to the sex organs. In terms of fertility, Erections libido. And the male sexual response. Now there are several benefits of testosterone.

• The first benefit of testosterone that is under-studied under-reported is Testosterone has a cardioprotective role. So patients with low testosterone have a higher incidence of major adverse cardiac events such as myocardial and function stroke.
• Testosterone is very important for lean body mass. It helps in controlling weight. Increasing the energy and gaining protein, Gaining the muscle mass.
• It helps you stronger bones. Testosterone replacement helps Patients with osteopenia, so testosterone Will help in maintaining Stronger bones
• Then the sexual benefits of testosterone in terms of better libido, Erectile dysfunction, And testosterone can help you.
• It helps in diabetes control. It is a mood elevator. It prevents depression.
• There are long-term studies that say that low testosterone leads to Alzheimer’s and problems with memory.

Why there is a need for Estrogen and Progesterone Hormone replacement therapy?

The estrogen and progesterone hormone therapy is needed for that we have to understand Estrogen and progesterone work in our body. You are reading a blog post about “What is Hormone replacement therapy?”

Estrogen

It is used by the body to stimulate the release of ovarian eggs in the reproductive phase, once there are no eggs to release, the level of estrogen in the body will begin to fall. The estrogen helps to regulate many other bodily functions, including bone density, skin temperature, and moisture of the vagina. The drop in the level of estrogen causes symptoms associated with menopause, to treat these symptoms we need estrogen hormone therapy.

Progesterone

The main function of progesterone is to prepare the womb for pregnancy in reproductive women. Progesterone helps to protect the endometrium. The decrease in the natural level of progesterone affects and causes symptoms like sleep disturbance, mood instability, and dysfunctional uterine bleeding. These symptoms are managed by hormone therapy.

What are the types of HRT?

There are three main types of HRT

• Estrogen only HRT
• Cyclic HRT
• Continuous HRT

Estrogen only HRT

In this only estrogen artificial hormones are prescribed to women. It is usually recommended for women who have had their wombs and ovaries removed by hysterectomy. In women with hysterectomy, only estrogen HRT is used.

Cyclic HRT

The cyclic HRT also known as sequential HRT, is recommended for women who are experiencing menopausal symptoms but are still having periods. There are two types of cyclic HRT, monthly HRT and three monthly HRT.

Monthly HRT

In this daily dose of estrogen is given and the progesterone is given at the end of the menstrual cycle for 14 days every month. The monthly HRT is normally recommended for women who are having regular periods. The women will continue to have monthly periods until menopause causing them to stop.

Three monthly HRT

In this, the estrogen is given as a daily dose. The progesterone is given for 14 days, every 3 months. It is recommended for women with experiencing menopausal symptoms but having irregular periods.

Continuous HRT

In this type of Hormone replacement therapy both estrogen and progesterone are given in combination and given in a continuous regimen. Continuous hormone replacement therapy is recommended for women having post-menopausal symptoms.

How is Hormone replacement therapy given?

Hormone replacement therapy is delivered to the body by different routes, and each route of administration has unique benefits. The HRT administration routes are.

• oral route
• Transdermal route
• Intrauterine route
• Intravaginal routes

Oral route

oral route is the route of administration by which the hormones are given to women in the form of an oral tablet. Oral contraceptive pills are also a form of HRT and are prescribed for women in perimenopause to treat irregular vaginal bleeding.

Transdermal route

The hormone replacement therapy can be given to women by a transdermal route through combined estrogen and progesterone skin patches, through cream.You are reading a blog post about “What is Hormone replacement therapy?”

Intrauterine route

Intrauterine route – the intrauterine route means within the uterus, in this the hormones are released by intrauterine device ( Mirena). This route is sometimes painful, and not usually used.

Intravaginal route

Intravaginal route – In the intravaginal route vaginal tablets and vaginal cream are used. In this women have to place tablets in the vaginal canal after 3-5 min tablets dissolve and are absorbed by vaginal tissue, the same procedure for vaginal cream. This method gives relief to women from vaginal dryness, vaginal irritability, and dyspareunia.

What are the benefits of Hormone replacement therapy?

The HRT works on reducing discomfort due to menopause, which means it gives benefits to people, the benefit depends on each condition, but the common benefits that every woman experiences after HRT and during HRT are

• Helps in soothing vaginal dryness and irritability.
• Reduces strokes of night sweats, palpitations, and hot flashes.
• Stabilize mood changes.
• regulate the menstrual cycle in the case of women who are experiencing menopausal symptoms but are still having periods.
• Reduces the risk of fracture.
• Improves sex desire.
• Improves sleep, muscle aches, and pains.
• It also improves the quality of life in symptomatic women.
• Estrogen therapy helps women to look fresh and younger.

How well does HRT work?

HRT is currently the most effective treatment for troublesome vasomotor symptoms (hot flashes, night sweats). A systematic review showed a significant mean reduction in the frequency of hot flushes by 87% compared with placebo.

Large randomized controlled trials have confirmed that HRT also significantly reduces fracture results. HRT (estrogen alone and combined ) shows significant absolute benefits for the treatment of vasomotor symptoms, vaginal dryness, and fracture reduction.

What are the Risks of Hormone replacement therapy?

Every treatment has a good side and a bad side, the estimated risks associated with HRT use in postmenopausal women aged 50-59 years or less than 10 years after menopause. The background risk of most adverse events linked with HRT increases with age, and risks will differ according to age and current health status.

The principal risks of HRT are thromboembolic disease (venous thromboembolism and pulmonary embolism), strokes(cardiovascular disease), breast cancer, endometrial cancer, and gallbladder disease.

Who can take HRT and at what age?

In general healthcare providers prescribe HRT for women going through menopause and who have already gone through it ( as postmenopausal). In women with certain conditions like, in the case of women where women’s bodies do not make normal levels of the hormones because of medical problems, such as premature ovarian failure.

Current guidelines recommend that HRT be given to women aged less than 40 in case of premature menopause, and women in their 50s. HRT at the age of 60 and after is not recommended because of increased risk. HRT is recommended when menopause occurs in women younger than 45 years until age 50 who do not have any other conditions.

How safe is HRT?

The studies show that for most symptomatic women, the use of HRT less than 5 years is safe and effective. HRT is contraindicated in some women and may lead to adverse outcomes. The background risk of most adverse events linked with HRT increases with age.

The risk will differ according to age and current health status. The low dose of HRT gives effective benefits but needs close monitoring. The high dose and misuse of HRT may lead to adverse effects.

How cost-effective is HRT?

HRT is a treatment for menopausal symptoms, which makes cost-effectiveness difficult to measure. The study of quality of life years gained in the United Kingdom and the USA has used data from the Women’s Health Initiative study and considers that there are some adverse effects of HRT over five years of HRT use.

HRT is cost-effective in all women compared with no treatment but the cost-effectiveness was greater in those with severe vasomotor symptoms.

How is before HRT monitoring done?

The before monitoring of HRT is done by checking health condition and severity of symptoms as

• Consider women with a low risk of cardiovascular disease.
• Consider women with premenopausal symptoms or recent postmenopausal symptoms.
• Consider the severity of menopause and the nature of menopause.
• The women’s age and health status are also considered.
• Consider HRT in those women who have a high risk of osteoporosis and have no contraindications.
• Individualized discussion with women about their wish for treatment, benefits, and risks of HRT.
• breast and cervical screening is done for any risk of breast and endometrial cancer.
• Check for any allergies or previous allergies.

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How is HRT given?

The HRT is started after all monitoring of previous medical history, and present medical condition of women. Consent is taken before starting the treatment as all benefits and risks are discussed with the patient before the start of HRT

• The HRT is started with the lowest effective dose, to minimize duration to control troublesome symptoms.
• In the case of perimenopausal women combined oral contraceptives can be given, to reduce vasomotor symptoms.
• In some cases, oral HRT may contain the risk of blood clotting, in this transdermal patch is used.
• The dose of HRT gradually increases after 4-6 weeks, if the vasomotor symptoms persist in the patient.

How Hormone replacement therapy/ HRT is monitored?

The effectiveness of HRT after administration is monitored by reviewing the patient’s menopausal symptoms, blood tests to check the level of estrogen and progesterone in the body, and review for screening tests such as mammography and cervical smear.

Check the patient’s heart status to check the risk of cardiovascular disease. Ask the patient about breast tenderness symptoms, and other dysfunctions of body activity after the start of HRT. Ask the patient after the start of HRT to feel some relaxation from vaginal irritations and vaginal dryness. Monitoring of patient sleep and mental health is done.

Who should not take HRT?

Women having certain conditions should not take HRT

• The woman with previous medical history of any allergy.
• The women taking chemotherapy or radiation therapy.
• Previous exposure to toxic chemicals.
• Overweight women (increased risk of heart problems)
• Women having a medical history of blood clot disease.
• Having a history of heart disease, and kidney disease.
• Any risk of breast cancer, cervical tumor, or cervical cyst.
• Women over 60 years of age.

Is HRT can cause Heart stroke?

There are many reasons for having a heart stroke, in some cases, HRT can result in a risk of heart stroke. The HRT increases the risk of Heart stroke, the risk increases with age and is seen more in women greater than 60 years of age. The risk of stroke may be lower with transdermal HRT at a lesser quantity of dose. The women with a previous history of heart issues and are at increased risk of heart disease HRT is not recommended. 

Is HRT can result in Cancer?

The studies show that there is a risk of using HRT, it may result in cancer of breast and endometrial cancer.

• The combined HRT can increase the risk of a breast cancer diagnosis or breast cancer mortality. The Women’s Health Initiative study reported an excess breast cancer risk attributed to a combined HRT of 8 per 10000 women a year after four to five years of use. This may result in about 0.1% increase in breast cancer. HRT also increases breast density and the risk of abnormal mammography.
• In women with no hysterectomy ( intact uterus), may lead to endometrial hyperplasia and an increased risk of endometrial cancer.

Is Testosterone also used in HRT?

Testosterone is a reproductive hormone, present in males at a high level, and also present in females at a low level, as some studies show the use of testosterone in HRT to maintain sexual libido ( as after menopause disturbed level of testosterone may result in less desire of sex) in women after menopause, but testosterone hormone having certain effects on body as the influence of testosterone the women body may experience increases facial hairs.