Hormone replacement therapy, or HRT is prescribed for women whose progesterone and estrogen levels drop significantly, usually due to the menopause. Progesterone and estrogen are hormones. HRT raises a woman's levels of vital hormones. HRT may refer to male hormonal treatment, it is also prescribed for people who undergo a sex change.
There are three main types of HRT for women:
- Estrogen-only HRT - prescribed for women who have had a hysterectomy (uterus and ovaries removed).
- Cyclical (sequential) HRT - prescribed for women who have menopausal-like symptoms but are still menstruating. Cycles may be monthly, with an estrogen + progestogen dose at the end of the menstrual cycle for two weeks, or a daily dose for two weeks every 13 weeks
- Continuous HRT - prescribed for post-menopausal women. Continuous estrogen plus progestogen is administered
HRT once seen as the "elixir of youth"Eleven years ago HRT was referred to as the "elixir of youth". This gradually changed as serious and potentially fatal side effects were found, including a higher risk of breast cancer, ovarian cancer and other diseases, and HRT became advisable only in certain circumstances.
Even since the findings from the WHI (Women's Health Initiative) Trial in 2002, HRT has been mired in confusion and controversy. In fact, HRT's risks received so much attention that its benefits have been mostly forgotten.
In the WHI estrogen and progestogen study, a small increase in breast cancer risk was found after five years of HRT usage - the increase was of about 1 extra case per 1,000 women per year. The WHI estrogen-alone trial found a small but statistically significant reduction in breast cancer risk. The Million Women Study also raised concerns regarding breast cancer risk for women on long-term HRT.
Recently, the WHI and MWS studies have been criticized, with experts saying there were key flaws which limit the ability of the studies to establish a causal link between HRT and breast cancer.
A panel of experts, including endocrinologists, gynecologists and other health care professionals and scientists have carefully considered, researched and re-assessed the WHI and MWS studies, as well as other trials and studies. The new guidelines offer doctors a detailed review of the available evidence to help them make the best possible clinical decisions, as well as providing women with more balanced, impartial and accurate HRT treatments for menopausal females.
The aim of the HRT recommendations is to complement the BMS Observations and Recommendations on Menopause. These new guidelines detail key recommendations explaining how women can optimize their transition into menopause and beyond.
Nick Panay, Chair of The British Menopause Society and lead author of the recommendations, said:
"Our aim is to provide helpful and pragmatic guidelines for health professionals involved in prescribing HRT and for women considering or currently using HRT. With these updated recommendations, it is hoped that HRT will once again be used appropriately and provide benefits for many women in their menopause."
The following key points are included in the new guidelines:
- Whether to use HRT is an individual decision. Each woman should have received sufficient information from her health care professional so that she can make a fully informed choice
- The dosage of HRT, as well as the overall regimen and duration should be calculated on an individual bases.
- Every woman on HRT should have her treatment evaluated for pros and cons annually
- There should be no arbitrary limits on the duration of HRT usage. "If symptoms persist, the benefits of hormone therapy usually outweigh the risks."
- If HRT is to be used, patients and health care professionals are reminded that there is a favorable benefit/risk profile if it is prescribed before the age of 60
- Women with premature ovarian insufficiency should use HRT at least until the average age of the menopause
- When older patients are prescribed HRT (over 60), doses should be lower at first, and preferably with a transdermal route of administration
- As people are living longer and will probably continue to do so, R&D on HRT should focus on maximizing benefits and minimizing risks and side effects. "This will optimize quality of life and facilitate the primary prevention of long-term conditions which create a personal, social and economic burden."