Hormone Replacement Therapy – is it the Best Option Available?

Introduction

Menopause is that time in a woman’s life when her periods stop as a part of aging. During and before menopause, the hormonal levels in the body can increase or decrease, causing hormonal imbalance. The imbalance can lead to symptoms like hot flashes, vaginal dryness, and night sweats. For some women these symptoms associated with the hormonal changes come and go away on their own, while some women take hormone replacement therapy (HRT) also known as, menopausal hormone therapy, to get rid of the symptoms. Hormone replacement therapy also helps in preventing the onset of osteoporosis in menopausal women. There are different types of HRT and it can be taken in various forms.

What is Hormone Replacement Therapy?

Hormone replacement therapy helps to balance the estrogen and progesterone levels in the woman’s body, especially around the time of menopause when women tend to experience hormonal imbalance. Hormone replacement therapy (HRT), also known as hormone therapy (HT) or menopausal hormone therapy (MHT) helps to relieve the woman from the symptoms associated with hormonal imbalance like sweating, hot flashes and more. The risk of osteoporosis is also reduced with the HRT. This treatment can be used for males also and for people who wish to change their sex.

Types of Hormone Replacement Therapy

There are different types of hormone replacement therapy available today. If you wish to take HRT, you must consult your general physician and ask him about the various types of HRT that can be suggested to you. There are alternatives to this therapy as well. Your physician will know what is best for you.

The work of HRT is to replace the hormones which are not produced by the woman’s body anymore because of aging and menopause. The main hormones used in HRT are:

• Progesterone– Artificially created, synthetic version of the hormone progesterone is used in HRT, namely, levonorgestrel, norethisterone, medroxyprogesterone, and dydrogesterone.
• Oestrogen– Estradiol, estriol, and estrone are some of the types that are used in HRT for this hormone.

Depending upon the woman’s hormonal levels, she might have to take both the hormones or estrogen only. Most women prefer taking combined HRT as taking just estrogen can increase the risk of developing womb cancer. But, when the woman takes progesterone along with estrogen, the risk of developing endometrial (womb) cancer is reduced.

There are different ways in which the different types of HRT can be taken like below:

Tablets– Tablets can be taken only once a day, which is one of the most common ways of taking HRT. Oestrogen-only and combined HRT tablets, both being available make it one of the simplest ways of taking HRT. But there are risks of HRT like blood clots that are more common when HRT is taken in the form of tablets.

Vaginal estrogen– The HRT is also available in the form of a cream or ring that is inserted in the vagina, which helps in relieving symptoms like vaginal dryness. This is one of the safest methods as it does not carry the risks of HRT and does not require taking progesterone along with it.

Implants– HRT can be taken with the help of small implants that are inserted under the individual’s skin, while it is numbed with local anesthetics. This implant is not a very common way of taking HRT, but, is very convenient when you do not wish to take it on a regular basis. The implants release the estrogen eventually and can stay active and in place for several months before they need to be replaced.

Skin Patches– It is also a common and effective way to take HRT. The patches need to be stuck to your skin and replaced every few days. Both estrogen-only and combined HRT patches are available. The patches also reduce the risk of experiencing the common side effects of HRT, like indigestion.

Oestrogen Gel– The gel is another popular way of taking HRT. The estrogen gel can be applied to the skin once every day which works effectively and also reduces the risks of blood clots, unlike, tablets. But, in the case of the womb still being present, the woman would require to take progesterone separately, to reduce the risks of developing womb cancer.

Benefits of HRT 

There are a number of benefits of HRT like:

• HRT has been found to be the best effective treatment procedure for reducing vasomotor symptoms. The symptoms get better within four weeks of beginning the treatment while the maximum benefit is earned within three months.
• It helps in reducing the frequency of hot flashes by 18th week (approx) from the starting of the treatment.
• HRT also helps in enhancing sleep and reducing muscle pain which ultimately results in an improved quality of life for symptomatic women.
• HRT can be helpful to alleviate low mood which happens due to menopause in aging women.
• HRT improves sexual function as it reduces vaginal dryness and helps to maintain a healthy lifestyle.
• The symptoms related to vaginal atrophy are also improved with the help of HRT.
• HRT helps to relieve the symptoms of frequent urination by working on the bladder and urethral epithelium.
• The urinary symptoms in menopausal women are improved with the intake of topical estrogen.
• HRT is overall good for the vaginal symptoms; it improves epithelial maturation and maintains the vaginal pH level.
• Oestrogens taken via HRT can increase bone mineral density and also help to prevent osteoporotic fractures in women.
• The quality of bone protection that HRT will offer to the women depends upon the dosage. But low dosage of estrogen will also give quite some protection to the bones. Women who take HRT have a decreased incidence of bone fractures when taken for a long time.
• HRT can also help in reducing the occurrence of cardiovascular disease in the women who take it.
• Oestrogen has positive effects like it increases the HDL-cholesterol levels and decreases the LDL-cholesterol levels.
• Women who have migraine symptoms often tend to suffer more during their menopause. The symptoms can be improved by balancing the hormonal fluctuations that are attributable to the migraine symptoms with HRT.
• In women who take HRT, there is a reduction of the risk of Alzheimer’s disease for a long period of time.

Who is it for?

Almost every woman can take Hormone Replacement Therapy when they experience symptoms of hormonal fluctuations, especially during or before their menopause. Other than that, women with certain conditions cannot take HRT like:

• Women who have a history of blood clots.
• Women with high blood pressure which need to be controlled before she can start taking Hormone Replacement Therapy.
• If the individual has liver disease.
• If the woman has a history of womb cancer, ovarian cancer or breast cancer.
• The woman is pregnant. It is possible to get pregnant even if the woman is taking HRT. But using contraception is necessary as per the doctor’s suggestion.

Under the above-mentioned cases, alternatives to HRT can be suggested to the individual.

How does HRT work?

Hormone Replacement Therapy is helpful in reducing the symptoms of menopause in women. When women are in their mid-40s or 50s, the hormones start fluctuating in their bodies. The estrogen and progesterone levels start to decrease while the menstrual cycle gets disrupted. This period, when the woman has lesser periods and almost none for a year due to the decreased hormonal levels in her body, is known as menopause. Menopause has symptoms such as sleeplessness, hot flashes, and vaginal irritation. Some women may experience mild symptoms while others might experience severe ones, which is when they need HRT. Hormone Replacement Therapy helps to improve these symptoms and bring a balance in their hormonal levels. HRT can be estrogen only (ET) or a combination of both estrogen and progesterone (EPT). They come in different forms like pills, injections, creams and skin patches. They can also be found in the form of vaginal rings and vaginal creams.

Hormone Replacement Therapy has the best effect in improving the symptoms of menopause and also enhancing the lifestyle of the woman. Taking HRT might also have some health risks which must be considered before taking the therapy. To minimize the risks, a low dosage of HRT must be considered at the start and taken for a short period of time, while the physician would check on the improvements and act accordingly. Hormones play a vital role in maintaining a healthy body and Hormone Replacement Therapy helps to improve the hormonal fluctuations which offer a lot of health benefits with fewer risks.

Downsides of Hormone Replacement Therapy

There are certain downsides to taking HRT and the main risk of taking HRT are thromboembolic disease, breast cancer, endometrial cancer, gallbladder disease and stroke. There has been a controversy regarding the severe risks that the therapy might have on the women taking it. But studies have shown that women with the symptoms of menopause have experienced more benefits than the risks when they took HRT.

Venous thromboembolism (VTE): The risk of VTE gets increased to three times when HRT is taken orally and the risk also increases with several other factors like obesity, smoking, immobility, and aging. Factors like the type of HRT and delivery system of both the estrogen and progesterone affect the risk of thromboembolic disease. However, the risk of VTE is low in women who are under sixty years old.

Breast Cancer: Combined HRT has been known to increase the risk of breast cancer which is also a rare thing. Only 1 in 1,000 women each year is at the risk of getting breast cancer from taking HRT. The risk is increased in lean women. In women with a previous hysterectomy, evidence has shown estrogen, when taken, alone reduces the risk of breast cancer and deaths from the same. Combined HRT increases the overall breast density which could be harmful.

Endometrial Cancer: Oestrogen-only HRT is known to increase the risk of endometrial cancer in women with a uterus. The risk can be lowered by taking combined HRT continuously after a year.

Ovarian Cancer: The data on the role of HRT in increasing the risks of ovarian cancer is conflicting. However, one analysis has shown that  1 in 1,000 women is affected by the risk.

Stroke: There is a small risk of stroke in women who take combined or estrogen-only HRT orally. Lowest dosage is preferred for the start as the risk of stroke depends upon the dosage also. Tibolone increases the risk in women above 60 years.

How to Reduce the Risks of HRT?

Menopause symptoms can be very difficult to deal with. The hormonal fluctuations at that time can lead to a decreased quality of lifestyle for some women. Women suffering from these symptoms can rely on HRT to improve their lives. But the risks of HRT must also be considered along with the benefits that it offers. When you are having severe hot flashes or other symptoms of menopause, you might want to consider taking HRT. Under such circumstances, you must talk to your doctor about your symptoms and how severe they are. Tell your doctor about any condition that you have, which could influence the risk of taking HRT. Know from your doctor about how you can reduce the risks of breast cancer, endometrial cancer, and other risks while you take HRT. Discuss the advantages and disadvantages of taking the different types of HRT with your doctor. Research well about the estrogen-only HRT and the combined HRT before you start taking them. When you finally decide to take HRT, ask the doctor to prescribe you low dosage in the beginning and keep a check on the improvement and any side effects, if you notice. Take the HRT for the shortest period of time to reduce the risks of HRT.

Who should not opt for HRT?

Women with a history of breast cancer, ovarian cancer, blood clots, stroke, liver disease, endometrial cancer, or sudden vaginal bleedings must not take HRT. You do not need to take HRT if your symptoms of menopause are mild or your menopause has started after the age of 45. Talk to your doctor about the alternatives to reduce the symptoms you are experiencing or whatever the problem is. Get diagnosed properly for your condition and the doctor will suggest you other medications for treating your condition accordingly.

Is Hormone Replacement Therapy right for you?

The therapy that helps to improve the symptoms of menopause has other benefits like it prevents bone loss and decreases the risk of fracture in postmenopausal women. Along with the benefit, there are certain risks that you need to keep in mind. The risks depend upon factors like the dose and the time period of taking HRT. To know if the therapy is right for you, you need to see a doctor and get diagnosed with the conditions that could increase the risk of HRT. This would help you to understand if the benefits are worth more than the risks that the treatment entails. If you have any history of blood clots, stroke, heart disease etc. you must not take HRT; instead, go for its alternatives to reduce the risks.

HRT is right for you if you do not have conditions which influence the risk of HRT and you experience severe symptoms of menopause or have lost bone mass. You can also take HRT if you stopped having your periods before the age of 40.

Can HRT Replace Contraception?

HRT must not be confused as a contraceptive and a woman is potentially fertile even after two years from her last periods when she is under 50 years old and for a year if she is more than 50 years old. Many women consider estrogen HRT and IUS as a great combination. While a woman chooses to take combined HRT, she can also take the progesterone-only HRT along with it. Thus, HRT cannot replace contraception generally but with women above 50 years of age are not prescribed oral contraceptive pills but can take HRT in dosage, as prescribed by their physician.

Can HRT be used for a long period?

The duration, dosage, and regimen of HRT cannot be generalized. It differs from one individual to the other. There is no maximum duration for women to take HRT. An individualized approach to diagnose, investigate and treat the symptoms of menopause accordingly is very important to reduce risks. Women who have continuous symptoms of menopause have achieved more benefits from HRT than the risks. The treatment duration needs to be based on the individual patient’s risk profile as well as proper diagnosis and examination. When the woman is above 65 years old, systemic HRT must not be stopped at once, but, checked with the risk profile and the individual’s preference.

Alternative Solutions to HRT

There are alternatives to HRT also which can be helpful to people who want to avoid the risks associated with HRT or have conditions that do not allow them to take HRT. As shown by several studies, some prescribed medications can reduce the hot flushes and sweats. Herbal medications like black cohosh can be used to reduce hot flashes and sweating. Vaginal dryness can be reduced by the application of vaginal moisturizers available in the market, which can be used on a regular basis.

There are not many alternatives to HRT which have proved to be an effective alternative when they are compared with placebo treatments in the research institutes. Discussing with a doctor about the alternatives can help you to get the right alternative for yourself.

Conclusion

If you cannot decide whether you should take HRT or not, talk to your doctor and research well before deciding on this. Look for alternatives that are safe and try to take them instead as per your doctor’s suggestion. Taking low dosage of HRT can also help in improving the symptoms and lower the risks of taking it. Keep going to the clinic for regular check-ups when you are taking HRT.