What Are The Signs That You Need Hormone Replacement Therapy
As with any potential treatment options, there are particular signs and symptoms indicative of what kind of treatment you need. If you are wondering what the signs are that you need hormone replacement therapy, below we present a list of symptoms that are usually recognized as potential reasons to start taking HRT.
- Issues with the urinary tract
- Itching and burning in the vaginal area
All of these signs should be discussed with your chosen doctor, especially if you are going through menopause, before deciding to start hormone replacement therapy for menopause.
Ht Indications Contraindications And Adverse Effects/risks
Indications for hormone therapy can be symptomatic or preventive. However, the application of HT to prevent sequelae of menopause is controversial, although some consensus has been reached regarding the use of HT to relieve symptoms.
The following are common clinical indications for prescribing HT:
To relieve vasomotor symptoms
To improve urogenital symptoms
To prevent osteoporosis
No absolute contraindications of HT have been established. However, relative contraindications exist in certain clinical situations, such as patients with the following findings:
A history of breast cancer*
A history of endometrial cancer*
* Note that many clinicians do not prescribe HT for women with a previous history of breast or endometrial cancer.
Adverse effects and risks
Possible transient adverse effects are as follows:
Bloating, weight gain , fluid retention
Potential risks of HT in postmenopausal women include the following:
Breast cancer: Use of combined HT study results inconsistent, but emerging consensus of slightly increased risk for breast cancer similar to that associated with natural late menopausecomes into effect after at least 5 years of continuous HT
Endometrial cancer and uterine hyperplasia and cancer: Use of HT based on unopposed estrogen
Thromboembolism: Use of combined or estrogen-only HT
Biliary pathology: Use of estrogen only or combined estrogen/progestogen HT
How Long Should I Take Hormone Therapy
In general, there is no time limit to how long you can take hormone therapy. You should take the lowest dose of hormone therapy that works for you, and continue routine monitoring with your healthcare provider to reevaluate your treatment plan each year. If you develop a new medical condition while taking HT, see your provider to discuss if its still safe to continue taking HT.
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Does It Cause Weight Gain
Some people worry that hormone treatment might lead to weight gain, but there is no evidence to support this.
Eating a healthful diet and getting plenty of exercise can help manage the weight gain that commonly affects both females and males in midlife.
provide different combinations and amounts of hormones.Common types include:
Estrogen-only HRT: A doctor may recommend this if a person has had their uterus and ovaries removed, in which case progesterone is not necessary.
Cyclical, or sequential, HRT: This may be a good option if symptoms occur before menopause the dosage can align with the menstrual cycle.
Continuous HRT: After menopause, a doctor may prescribe a continuous combination of estrogen and progesterone.
Local estrogen: Vaginal tablets, creams, or rings can help with urogenital symptoms, including vaginal dryness and irritation.
The doctor will prescribe the lowest possible dosage that addresses the persons symptoms, and arriving at this dosage may take some trial and error.
Ways of delivering HRT include:
When a person no longer needs the treatment, the doctor will describe how to stop it gradually.
Various lifestyle adjustments can help manage the symptoms of menopause.
Also, it is a good idea to ask the doctor about nonhormonal treatment options.
The Food and Drug Administration do not recommend or regulate herbal treatments. A person cannot be sure what a product contains or whether it is safe or effective to use.
Breast Cancer And Hrt
Women over 50 years of age who use combined oestrogen and progestogen replacement for less than five years have little or no increased risk of breast cancer. Women who use combined HRT for more than five years have a slightly increased risk. Women on oestrogen alone have no increased risk up to 15 years of usage.
There is no evidence to suggest that a woman with a family history of breast cancer will have an added increased risk of developing breast cancer if she uses HRT. The risk with combined oestrogen and progestogen is greater than with oestrogen alone, or with newer HRT agents such as tibolone , and may also depend on the type of progestogen used. Studies suggest that medroxyprogesterone acetate and norethisterone have higher risks than dydrogesterone and progesterone.
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Why Your Healthcare Provider Might Not Prescribe Bioidentical Hormones
Again, remember most healthcare providers are prescribing bioidentical hormones as most synthetic hormone replacement options manufactured by drug companies are bioidentical.
Many healthcare providers will not give you a prescription for compounded hormone replacement. The biggest concern for clinicians is the lack of evidence to support the use of compounded hormone replacement. And this goes against their principle of practicing evidence-based medicine.
But, some clinicians will prescribe compounded hormone replacement. But it is important that you understand that there is no evidence to say that it is better or safer than the hormone replacement made by drug companies.
Are There Alternatives For Women Who Choose Not To Take Menopausal Hormone Therapy
Women who are concerned about the changes that occur naturally with the decline in hormone production that occurs during menopause can make changes in their lifestyle and diet to reduce the risk of certain health effects. For example, eating foods that are rich in calcium and vitamin D or taking dietary supplements containing these nutrients may help to prevent osteoporosis. FDA-approved drugs such as alendronate , raloxifene , and risedronate have been shown in randomized trials to prevent bone loss.
Medications approved by the FDA for treating depression and seizures may help to relieve menopausal symptoms such as hot flashes . Drugs that have been shown in randomized clinical trials to be effective in treating hot flashes include venlafaxine , desvenlafaxine , paroxetine , fluoxetine , citalopram , gabapentin , and pregabalin.
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Is Hormone Replacement Therapy The Right Treatment For You
HRT, or hormone replacement therapy, is a type of treatment where female hormones are used to help the body maintain a healthy level of estrogen because it stops producing this hormone on its own.
HRT is usually used to help women fight symptoms of menopause, which include, amongst others, hot flashes and vaginal issues. Also, HRT helps with the reduction of bone fractures and bone loss.
Although hormone therapy for women has been proven to be a good solution for issues with reproductive health, many pieces of research have proven that there are different risks associated with using HRT.
If you are looking for hormone replacement therapy for menopause, be aware that your chosen doctor must elaborate more on the potential risks of this type of treatment. The expert team at My OBGYN Specialists is responsible and experienced enough to advise and guide all the patients about the potential risks of hormone therapy for women.
Taking Estrogen With A Progestin Vs Estrogen Alone
Treating menopausal symptoms with estrogen and progestin together is known as estrogen-progestin therapy or combined hormone therapy. Although estrogen alone improves the symptoms of menopause, it increases the risk of cancer of the uterus . Adding a progestin to the estrogen lowers the risk of endometrial cancer back to normal. Because of this, EPT is given to women who still have a uterus . EPT can be given 2 ways:
- Continuous EPT means the same dose of estrogen and progestin is taken each day. Women often prefer continuous EPT because it rarely leads to menstrual-like bleeding.
- Sequential EPT means different amounts of each hormone are taken on specific days. There are different ways to do this. For example, estrogen can be taken by itself for 14 days, then estrogen plus progestin for 11 days, then neither hormone for 3 to 5 days. Other schedules involve taking progestin only every few months. This lowers the amount of progestin that you are exposed to. Monthly regimens are also thought to result in hormone levels that are more like the natural menstrual cycle. Cyclical EPT can produce bleeding like a menstrual period, but it can occur less often than monthly.
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Hormone Therapy And Cardiovascular Disease
The incidence of cardiac disease is heightened in postmenopausal women. This finding has been linked to a causative pathogenic role of ovarian hormone deficiency.
When the concept of HT was initially introduced, it was believed that replacing ovarian hormones would reduce the observed increase in the risk of cardiovascular disease. However, this expected result has not been unequivocally demonstrated in various trials over the years.
The WHI study revealed an increased annual risk of heart attacks of 7 per 10,000 women who took combined therapy as opposed to women who took estrogen alone, in whom no significant difference was noted. Subsequent re-analysis showed similar results for breast cancer, demonstrating no increased risk in the fifth decade, though the risk rose with advancing age.
Two important clinical trials have been conducted to examine the relationship between cardiac disease and HT: the Postmenopausal Estrogen/Progestogen Interventions Trial and the Heart and Estrogen-Progestogen Replacement Study .
PEPI investigators looked at the effect of estrogen alone and combination therapies on bone mass and key risk factors for heart disease. They found generally positive results, including a reduction in low-density lipoprotein cholesterol and an increase in high-density lipoprotein cholesterol by both types of therapy.
Other Treatments For Menopausal Symptoms
Studies have shown that some prescription medications can reduce hot flushes and sweats. These treatments may be an option if HRT cannot be used for health or other reasons, and should be discussed with a doctor.
The herbal medicine, black cohosh, may take the edge off hot flushes and sweats, but there is no data to support long-term use. There is also a rare liver condition that may be associated with the use of black cohosh.
Other complementary and alternative medicines have not been shown to be effective for menopausal symptoms when compared with dummy or placebo treatment in research studies.
Commercially available vaginal moisturisers may reduce vaginal dryness if used regularly. Consult your doctor about what will work best for you.
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Herbs And Supplements During Menopause
Many over-the-counter natural products are promoted in stores and online as helpful with menopausal symptoms. These include vitamins and soy-based and herbal products . There are also endless arrays of special blends of herbs and vitamins that claim to reduce the discomforts of menopause.
These products are considered dietary supplements . They have not been evaluated by the Food and Drug Administration to be sure that they work or even that they are safe. Some supplements have been tested in small clinical trials, but often the studies only looked at taking the substance for a short time , so it isnt clear how safe it would be if taken for a long time. Another concern has been applying the results of a study of a particular version and dose of a supplement to others that werent tested.
Most of the plain herbs that are touted for menopausal symptoms carry a low risk of harm for most women, but some can interact with other drugs and/or cause unexpected problems. You should discuss herbs or supplements with your doctor before taking them.
Well-controlled scientific studies are needed to help find out if these products work and if they are any safer than the hormone therapy drugs now in use.
Transitioning From Contraception To Hormone Therapy
Transitioning from contraception to hormone therapy may be challenging because oral contraceptives have higher dosages than typical hormone therapy regimens. Also, measuring follicle-stimulating hormone levels after stopping oral contraceptives can be inaccurate during perimenopause.26 One small study found that a rise in follicle-stimulating hormone level without a change in estradiol levels two weeks after stopping oral contraceptives is evidence that it is safe to transition to hormone therapy.26 Others suggest discontinuation of contraception when women are in their mid-50s because spontaneous conception is rare at this age.27
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Can Increase The Risk Of Blood Clots
Studies have shown that HRT may raise your risk of blood clots and stroke. This risk may be highest for people over 60 or who started menopause over a decade ago. The longer you take HRT, the greater the increase in your risk.
Because of this risk, health experts recommend the lowest possible HRT dose for the shortest period of time for people over 60 or who are 10 years past the onset of menopause.
United States Preventive Services Task Force Recommendations
The United States Preventive Services Task Force found fair to good evidence that the combination of estrogen plus progestin has both benefits and harms. They suggested that benefits include increased bone mineral density and decreased risk of fracture and colorectal cancer . Harms include increased risk for breast cancer , venous thromboembolism , CAD , stroke (fair
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Hrt And Menopausal Symptoms
Among the most distressing consequences related to the onset of menopause are the vasomotor symptoms known as hot flashes, nocturnal sweats, and mood swings. Such symptoms are evidently related to estrogen deficiency and subside almost immediately after treatment initiation. Urogenital atrophy, vaginal dryness, and dyspareunia also respond to estrogen. It has been shown consistently that HRT improves the sense of well-being in women with symptoms of estrogen deficiency . The physiologic
The Importance Of Bio
Both Dr. Guglin and Dr. Cabeca stress that HRT should be done with bio-identical hormones, which means processed hormones that are made specifically to mimic the hormones the body makes. These hormones are made from plant-based materials, like tapioca and sweet potatoes, explains Dr. Guglin.
To ensure youre getting a bio-identical hormone, he recommends looking at the chemical names of the actual human-based hormones. For instance, the branded hormone named Premarin is a conjugated equine estrogen that is made from the urine of pregnant mares, says Dr. Guglin. It is a cluster of hormones, none of which are bio-identical estradiol, which is the human estrogen that is typically replaced in bio-identical hormone replacement therapy.
If youre thinking of trying HRT, its important that you speak with your provider about the type of hormone treatment you may be getting, urges Dr. Dorr. Unfortunately, some providers may only know or offer one therapy, and thats what their patients get, he says.
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Brief History Of Hormone Therapy
Estrogen has been used to treat symptoms of menopause since the 1950s and 1960s. By 1975, estrogen had become one of the most commonly prescribed drugs in the United States.
In the mid-1970s, studies demonstrated that postmenopausal women who used estrogen therapy alone had a significantly increased risk of endometrial cancer. Researchers found that adding progestogen to estrogen provided protection against uterine cancer. As a result, progestogen was added to HT regimens prescribed for women with an intact uterus.
Over the years, HT became a popular treatment, as it was recommended not only for treating menopausal symptoms but also for providing long-term protection against osteoporosis and related fractures, heart disease, and even Alzheimer disease. However, in 2002, the Women’s Health Initiative , a large-scale study conducted by the National Institutes of Health , was stopped early because evidence linked HT to a slightly increased risk of stroke, heart disease, and breast cancer. As a result of this study, many women turned to nonUS Food and Drug Administration approved compounded bioidentical HT , or natural HT, as a perceived safer alternative. However, no clear evidence suggests that custom CBHT formulas are safer or more effective than FDA-approved HT products. Physicians may wish to use custom formulas for those patients who cannot tolerate standard HT.
Hrt: Benefits And Risks
Although there have been concerns raised about HRT and the potential risks to various aspects of womens health, more recently published findings show that although not entirely risk free, it remains the most effective solution for the relief of menopausal symptoms and is also effective for the prevention of osteoporosis. It may in certain age groups provide protection against heart disease.
This leaflet sets out the known facts about HRT. It summarises the results of studies regarding its safety and addresses the controversy that still surrounds it, together with current thinking about its suitability. It is written specifically for women wishing to know about HRT. Our medical advisory panel strongly recommends that you should discuss with your doctor both the benefits and the risks of HRT on an individual basis. The types of HRT available are listed below.
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What Is Known About Hormone Therapy And The Risk Of Breast Cancer
Taking combined hormone therapy can increase your risk of developing breast cancer. Here are some important findings:
- Taking combination hormone therapy showed a rare increase of absolute risk of less than one additional case of breast cancer per 1000 person years of use.
- There was a nonsignificant reduction in breast cancer seen in women with hysterectomies on estrogen only therapy.
- If youve been diagnosed with breast cancer you should not take systemic hormone therapy.
Podcast Biggest Hormone Replacement Therapy Safety Myths With Dr Shawn Tassone
Biggest Hormones Replacement Therapy Safety Myths with Dr. Shawn Tassone
Between the latest online fads and the crazy media headlines, its easier than ever to get confused about your health. If you want to make better decisions about your health today so you can feel better and live longer, youve come to the right place.
Its no secret that many women suffer extensively from the symptoms of perimenopause and menopause. This major life change is the cause of sleep disturbances, changes in cognitive function, weight changes, hot flashes, night sweats, migraines, and more. Hormone replacement therapy has proven to be an effective and welcome relief from such symptoms, but is it safe? Does it cause breast cancer? Are there other health benefits or dangers associated with HRT that you need to know about? Weve seen an increase in data on this topic over the last few years, as well as a shift in perspectives that may surprise you.
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