HRT, which stands for hormone replacement therapy, is exactly as the name implies — a treatment to replenish flagging hormones within the body, specifically during menopause.
Why and When is HRT Used?
HRT is usually administered for women between the ages of 40 to 65, and sometimes earlier, when menopause begins and whose lives are severely affected by menopause. Still, you should always be made aware any potential health hazards.
If you have entered this midlife stage, you may be experiencing some of the many physical and emotional changes, such as menstrual cessation, mood swings, night sweats, sleep problems, and vaginal dryness, to name only a few of the more common disruptions. These are due to the decline of the hormones, estrogen, progesterone, and testosterone.
Estrogen and progesterone are the hormones that keep your reproductive system in good running order throughout life, especially during your childbearing years.
Testosterone contributes to good bone and muscle maintenance, energy, mood, and sexual interest (libido).
What are the Different Blends and Kinds of HRT?
There are several different formats and types:
- Estrogen-alone therapy (ET): This is prescribed for women in a medical menopause who are devoid of both their uterus and ovaries after having a complete hysterectomy.
- Combined estrogen/progesterone therapy (EPT): Both hormones may be needed for women whose uterus and ovaries are still intact, and who are undergoing natural menopause.
- Local estrogen: To be used topically by women experiencing extreme vaginal dryness and vaginal tract issues.
Depending on a woman’s individual needs, HRT comes in several forms:
- Pills
- Transdermal Patches
- Gels
- Vaginal rings
- Creams
- Sprays
- Tablets
Dr. Litrel discusses menopause and hormone therapy in this video.
What Are the Risks Associated with HRT?
In the past, HRT was provided to compensate for hormonal dissipation and to ease the transitional effects of menopause. It made medical sense to replenish the diminishing hormones, thus staving off the unpleasant repercussions this waning had on women.
Mother Nature, unfortunately, did not always agree, and, though HRT helped many women, others had adverse effects such as:
- Cancer of the endometrium: Estrogen alone is given to women in some cases during natural menopause to ward off certain symptoms, leaving them vulnerable to endometrial cancer. This is because menstruation would previously slough off endometrial cells, a process that stops after periods have ceased. This creates a cell buildup along the uterine wall (endometrium) which can lead to cancer.
- Progesterone is needed in tandem with estrogen to prevent this.
Women who have had hysterectomies do not need progesterone because, lacking a uterus, they are no longer susceptible to this particular cancer. - Breast cancer: Studies show there is a slight increase in women developing breast cancer while using HRT. Women receiving estrogen therapy, especially over a period of many years, are at higher risk.
- Venous thromboembolism (VTE): HRT can contribute to the formation of blood clots in the deep veins of the groin, legs. or arms which can subsequently detach and travel into the lungs, leading to pulmonary thrombosis. Risk lessens when HRT is administered in non-oral form.
- Heart Attack: There is a small risk of heart attack associated with use of combined HRT.
- Gall bladder disease: Oral HRT increases risk.
- Unpleasant mood changes and lowered energy: Some forms of HRT, especially when taken orally, can lessen androgen production.
- Stroke.
Dr. Haley discusses bioidentical hormone therapy in this video.
What are the Advantages of HRT?
Hormone replacement therapy can be beneficial for many menopausal symptoms caused by a woman’s natural depletion of estrogen and progesterone. Minor symptoms may be alleviated, such as:
- Hot flashes
- Mood swings
- Night sweats
- Vaginal dryness
- Sleep disturbances
- Dryness leading to painful sex
- Adult acne and other skin disorders
- Urinary tract infections.
More severe complications of menopause can also be mitigated with HRT, such as:
- Osteoporosis
- Elevated cholesterol counts
- Heart disease
- Diabetes
- Risk of fracture
- Colon cancer prevention: Combined estrogen and progesterone therapy appears to lower the risk of developing colon cancer.
Am I a Good Candidate for HRT?
As long as you do not have any risk factors, but find that your symptoms are impacting you negatively, you should discuss if HRT is right for you with your doctor. Additionally, if there is a history of osteoporosis in your family, HRT may be advantageous for you.
There are also many lesser known symptoms attributable to menopause, so you should always be forthcoming about any emotional or physical changes that are occurring during midlife to rule out other disorders. Your health care provider is the best judge of whether HRT can help you. They’ll also decide if you need it short -or long-term.
How Long Can I Take HRT?
Doctors are now initially prescribing HRT in the lowest dose possible, making modifications as necessary until effectiveness is achieved.
All potential risks must be taken into consideration based on thorough disclosure of your symptoms, medical history, family history, and lifestyle. This is vital to insure the best outcome for your individual needs, and whether the benefits outweigh the risks. At one time, it was thought that taking HRT for five years or less posed no danger, but recent findings proved that, depending on the individual, there can be problems even during this short time span. Other women may not be negatively affected at all.
Today, women using HRT are being prescribed lower doses than before. There are also different methods available besides the past standard oral prescriptions. Vigilant and regular monitoring can alert us to any issues that may arise so that you can receive immediate intervention.
Who Should Avoid HRT?
Women with a history of the following issues are cautioned against using HRT:
- Breast cancer
- Liver disease
- Uterine cancer
- Vein, leg, or lung blood clots
- Cardiovascular disease.
Are There Other Options to HRT?
If you wish to avoid HRT, or are not a good candidate for it, there are several other medical and natural remedies you can try.
These include:
- Exercise: Regular exercise strengthens bones, elevates mood and keeps your heart and other organs at peak performance.
- Diet: Many plant-based supplements that contain natural estrogen called phytoestrogen. This can be found in flaxseed, red clover, fenugreek, sesame seeds, beets, lentils, wheat germ, ginseng, carrots, apples, black cohosh, mint, and many other sources. Bioidentical hormone replacement: These plant-derived hormones are molecularly identical to those found in the human body and are often used as alternative for women unable to use HRT.
- Lubricants: Vaginal lubricants can decrease dryness and pain during sex.
- Regular check ups: Annual visits to you doctor are essential for your continued good health.
- Antidepressants: These can lessen mood swings.
To book an appointment to discuss your menopausal issues and obtain information about HRT, call 770.720.7733.
