What Is Hormone Replacement Therapy? What is HRT?

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Main Category: Menopause
Also Included In: Women's Health / Gynecology;  Endocrinology
Article Date: 09 Mar 2010 - 0:00 PST

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Hormone replacement therapy, or HRT is given to some women whose estrogen and progesterone levels drop significantly because of the menopause. Estrogen and progesterone are hormones. HRT tops up a woman's levels of essential hormones. HRT may also refer to male hormonal treatment, as well as for individuals who undergo a sex change. This articles focuses entirely on HRT for women whose problem is caused by the menopause.

When estrogen and progesterone levels drop, as they do when the menopause approaches, some women may benefit from artificially boosting their hormone levels to reduce certain menopausal symptoms.

The hormone estrogen stimulates the release of eggs. As soon as a woman's supply of eggs has ended, estrogen levels start to go down. Estrogen helps maintain good bone density, skin temperature and regulating moisture of the vagina. A drop in estrogen levels can cause:

• Vaginal dryness
• Urinary problems
• Thinning hair
• Sleep problems
• Night sweats
• Moodiness
• Lower fertility
• Irregular periods
• Hot flashes (UK: hot flushes)
• Concentration and memory difficulties
• Breasts get smaller
• Accumulation of fat in the abdomen

These sometimes unpleasant symptoms usually go away within two to five years, except for vaginal dryness.

Low estrogen levels may eventually cause osteoporosis after many years.

HRT estrogen comes from pregnant horse urine or plants.

Progesterone's main function is to prepare the woman's womb for possible pregnancies. This hormone also helps protect the endometrium (the lining of the uterus).

Lower progesterone levels do not really cause the woman any immediate discomfort. Experts say her risk of developing endometrial cancer may be higher.

Most women who take HRT for menopausal reasons are given an estrogen/progesterone combination, except for those who have had a hysterectomy, they do not need progesterone.

Put simply, HRT helps a woman control the symptoms of menopause and reduces her risk of developing osteoporosis. The treatment does slightly increase her risk of some cancers and stroke. HRT is not a long-term therapy and should last no longer than five years for the benefits to outweigh known risks.

The patient can start HRT as soon as menopausal symptoms begin. Most women have the menopause at around 52 years of age, according to the National Health Service (NHS), UK. However, ages can range from early forties to well into the sixties. We cannot predict when a woman starts to have her menopause.

In fact, symptoms may sometimes occur before the menopause starts (peri-menopause). In this case the woman's supply of eggs has not finished, they have just dropped significantly, which can trigger a fall in hormone levels. So, the patient may still have regular periods as well as menopausal symptoms.

In most cases women do not need to be tested for menopause, unless they are very young or have abnormal bleeding patterns during menstruation. In such cases, the patient needs to be tested for other conditions with similar symptoms, such as a thyroid problem or cervical cancer.

HRT may not be suitable for women who:

• are pregnant
• have uncontrolled hypertension (high blood pressure). The hypertension needs to be treated first
• have severe migraines
• have a history of thrombosis or blood clots
• have a history of stroke
• have a history of heart disease
• have a history of endometrial, ovarian or breast cancer

Females may become pregnant even after their periods have stopped; those under 50 might remain fertile for up to a couple of years. In such cases, doctors recommend that sexually active women use a condom, diaphragm or some non-hormonal contraceptive.

Three main types of HRT

HRT with only estrogen - those who have had a hysterectomy where their uterus (womb) and ovaries have been removed do not need progesterone, because there is no risk of endometrial cancer.

Cyclical HRT (sequential HRT) - for patients who are still menstruating but have menopausal-like symptoms. The cycles may be monthly, an estrogen plus progestogen dose at the end of the menstrual cycle for 14 days, or a daily dose of estrogen and progestogen for 14 days every 13 weeks.

Continuous HRT - used for post-menopausal patients. They take a continuous combination of estrogen and progestogen.

The doctor may recommend Tibolone, a synthetic hormone that uses both estrogen and progestogen (combined HRT). Tibolone mimics the effects of both hormones.

How does the patient take HRT?

The doctor will try to control menopausal symptoms with the lowest possible dosage - it may occasionally take some time to get it right.

HRT may be taken in the following forms:

• Cream/Gel - it is placed either on the skin or in the vagina if the woman has vaginal dryness
• Tablets
• Skin patch

Patients usually come off HRT gradually - they are weaned off slowly.

Some things the woman can do herself

The following measures may help ease symptoms:

• Consume less caffeine
• Consume less alcohol
• Consume less spicy food
• Don't smoke
• Do exercise regularly
• Wear loose clothing
• Sleep in a well ventilated, cool rom

Some SSRI type antidepressant can help treat hot flashes. Antihypertensive drug, clonidine, may help reduce the symptoms of hot flashes.

Anecdotal accounts say that consuming ginseng, block cohosh, red clover, soya beans and Kava help with menopausal symptoms. Experts say scientific studies are needed to confirm this.

Sources: National Health Service (NHS), UK, National Institutes of Health (NIH), USA, Medical News Today archives

Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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