Hormone replacement therapy

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  • What is hormone replacement therapy?

    Hormone replacement therapy is the use of hormones, synthetic or natural, to treat a woman who is lacking them. It is often prescribed to women at the time of menopause. Menopause is the stage in a woman’s life when menstruation stops permanently. This means she is no longer able to have children. Menopause usually occurs between the ages 40 to 55 years. Although it is a natural event in a woman’s life, it may also occur when a woman has both of her ovaries and uterus removed by an operation. Hormone replacement therapy consists of giving either oestrogen alone or oestrogen and progesterone together.

  • What happens during menopause?

    When women go through menopause, the level of the female hormone oestrogen in the body goes down. Low levels of oestrogen produce the symptoms of menopause such as: Hot flashes or hot flushes, which is a sensation of sudden flushing and sweating. Night sweats Mood changes Difficulty in sleeping Vaginal dryness Painful intercourse Urinary symptoms like increased frequency Hormone replacement therapy is often given to women in menopause to reduce these uncomfortable symptoms.

  • When is it given?

    HRT not only helps to reduce the symptoms of menopause but also reduces the risk of osteoporosis or weakening of bones. When to start HRT depends totally on the individual’s health status, but is best initiated  in women before 60 years of age.

  • How is it given?

    Estrogen is most commonly prescribed in pill form. Vaginal oestrogen creams are sometimes prescribed to relieve vaginal dryness and thinning of the vaginal walls. Estrogen gels/patches can also be used as they can be absorbed through the skin. Natural estrogens are used in HRT  and is about five to seven times less powerful than the amount used in birth control pills. As a result, many of the risks associated with oestrogen in birth control pills are not applicable to women on HRT. The progestin – a synthetic compound similar to the hormone progesterone, is given in combination with oestrogen, as taking oestrogen alone increases the risk of endometrial cancer. However, women who have undergone hysterectomy can take oestrogen alone and do not have to combine it with progestin. Androgens, such as methyltestosterone, may be added to standard hormone replacement therapy in an effort to improve libido.

  • What are the benefits of HRT?

    Hormone replacement therapy is used for two reasons: treatment of menopausal symptoms and other medical benefits. It effectively treats hot flushes, night sweats, sleep disturbances and other symptoms related to the menopause. It is also effective in the management of symptoms related to degenerative changes in the vagina or urinary tract. It helps maintain skin thickness and elasticity, and prevents wrinkles. HRT and osteoporosis – Hormone replacement therapy helps in the prevention and treatment of osteoporosis. Osteoporosis is a condition in which there is reduction in the quality and quantity of bone by the loss of both mineral and protein content. Oestrogen prevents the accelerated loss of bone associated with menopause, maintains bone density and reduces the risk of hip fracture by up to 50 %. The risk of vertebral fractures may be decreased as much as 90%, depending upon when HRT was initiated. The protective effect of HRT lasts as long as the treatment is continued. Women who take HRT after menopause, but then stop after few years, have the same risk of fractures as those who have never taken the treatment. However non- hormonal treatments for prevention of osteoporosis are available and a estrogens need not be started only for osteoporosis management. Oestrogen also plays a role in the improvement of certain aspects of memory in women undergoing surgical menopause.

  • What are the risks of HRT?

    Despite the known and possible benefits of HRT, the majority of women do not take it as it appears to increase the risk of breast and uterine cancer for women who have undergone hormone replacement therapy for more than 10 years. There are no increased risks of breast cancer or uterine cancer when HRT is used for a shorter period of time ( less than 5 years) There are certain conditions in which the therapy has been contraindicated and HRT is only taken after detailed discussion on various aspects. These conditions include: Breast or uterine cancer History of blood clots Long-term or a recent liver disease Unexplained, abnormal vaginal bleeding Endometriosis Other conditions that can be managed safely with adjustments in dosage and the form of therapy are: Migraine Gallbladder disease Diabetes Uterine fibroids Seizures.

  • What are the side effects?

    There are some side effects that can occur with HRT in varying frequencies. These include bleeding, weight gain, breast tenderness, headaches, mood swings and skin irritation. Most of these can be improved or corrected by making changes in medications and dosage.