Disadvantages Of Hormone Therapy
The risk of various medical problems already increased after one year, and then continued to increase after that. The following disadvantages were found in women who had treatment with estrogen and progestin:
Table: Frequency of thromboembolism, stroke and breast cancer with and without estrogen and progestin treatment.
|33 out of 1,000 women||26 out of 1,000 women||7 out of 1,000 women|
The risk of heart attacks might increase a little too. If women take a combination of estrogen and progestin for longer than five years, their risk of breast cancer will probably stay higher even after they stop hormone therapy. Also, one analysis showed that women who have long-term hormone therapy are more likely to develop dementia.
Women who only took estrogen didn’t have a higher risk of breast cancer and heart attacks. They had a similar risk of stroke and thromboembolism as women who took a combination of estrogen and progestin did:
Table: Frequency of stroke and thromboembolism with and without estrogen therapy
|21 out of 1,000 women||16 out of 1,000 women||5 out of 1,000 women|
Individual Benefits And Risks
In Hormone Replacement Therapy : Benefits and Risks the NHS elaborate on:
Many studies on HRT published over the past 15 years highlight the potential risks. As a result, some women and doctors have been reluctant to use HRT.
But recent evidence says that the risks of HRT are small and are usually outweighed by the benefits.5
What is HRT?
HRT can be an abbreviation for Hormone Replacement Therapy.
Menopausal Hormone Therapy And Cancer Risk
For decades, women have used hormone therapy to ease symptoms of menopause, such as hot flashes and sweating. This is called menopausal hormone therapy, and you may see it abbreviated as HT or MHT. You may also hear it described as hormone replacement therapy , postmenopausal hormone therapy , or postmenopausal hormones .
In the past, many doctors and their patients believed that MHT didnt just help with hot flashes and other symptoms it had important health benefits. But well-conducted studies have led many doctors to conclude that the risks of MHT often outweigh the benefits.
This information covers only how MHT can affect a womans risk of getting certain cancers. It does not cover other possible risks of MHT such as heart disease or stroke.
You can use this information when you talk to your doctor about whether MHT is right for you.
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Principles Of Prescribing Hormone Replacement Therapy
HRT is contraindicated in women with unexplained vaginal bleeding, estrogen-sensitive breast and endometrial cancers, a history of blood clots, coronary artery disease, and elevated triglyceride levels, or chronic liver disease. HRT should be an individual decision that each woman makes with help from her clinician based on her quality of life and attitude toward menopause, time since menopause and menopausal symptoms, medical history, and risk factors.
Use the lowest effective dose of HRT to treat symptoms and minimize risks.
Initiate HRT early and treat for the shortest duration of time, regularly evaluating for ongoing need and effectiveness.
According to the Global Consensus Statement on Menopausal Hormone Therapy, Benefits are more likely to outweigh risks for symptomatic women before the age of 60 years or within 10 years after menopause. For combined estrogen and progesterone therapy, re-evaluate continued use at 3-5 years due to small increased risk of breast cancer. For estrogen-only therapy, duration of use can be longer.
Use the safest preparation of hormones that is associated with the lowest risks.
Consider vaginal administration of HRT if symptoms are limited to vaginal dryness. Consider transdermal or topical estrogen, which bypasses the first-pass liver effect resulting in a lower risk of venous thromboembolism compared to oral preparations.. Consider oral micronized progesterone rather than synthetic progestins to minimize breast cancer risk. .
Symptoms Or Chronic Conditions
What can it also be important to be clear about with HT benefits and risks information?
It can also be important to be clear about whether HT benefits and risks information is about the use of HT for the management of menopausal symptoms such as hot flushes, night sweats and vaginal dryness or for the prevention of chronic conditions such as cardiovascular disease, cancer and osteoporosis.
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Transdermal And Topical Estrogens
Transdermal and topical estrogens bypass first pass metabolism so can be dosed lower than oral estrogen. Because of the avoidance of the first pass metabolism, they have less impact on triglycerides, coagulation factors and gallbladder disease . Absorption varies based on how the patches and gels are applied. Transdermal therapy may not significantly increase VTE risk, in contrast to oral therapy, as seen in the Estrogen and Thromboembolism risk trial . A single nested case-control study showed stroke risk was not increased with transdermal HT, while it was with oral HT. KEEPS, the only randomized control trial comparing oral and transdermal estrogen, was too small to allow a comparative analysis of risks of stroke, VTE, or other clinical events .
Transdermal estrogen patches have a higher likelihood of causing skin irritation compared to other topical or oral formulations. Topical formulations including gels, sprays and emulsions may lead to a small amount of estradiol transferred if skin-to-skin contact is made within two hours of administration .
Memory Loss And Dementia
More than half of the observational studies suggest that women who take estrogen preserve or improve cognitive function better than women who do not. These results have not been confirmed by the only two published large randomized clinical trials, one a prevention trial in cognitively intact women and one a treatment trial in women with early Alzheimer’s disease In HERS, approximately 1000 cognitively intact women with heart disease completed six cognitive function tests before and 4 years after randomization to HRT or placebo women assigned to HRT did not perform better on any test than women assigned to placebo. In the Alzheimer’s treatment trial, 120 women were randomly assigned to placebo, or unopposed CEE in the standard or high dose women did not differ by treatment on global assessment of change, the primary outcome, but scores on the clinical dementia rating scale were worse in women assigned to estrogen. Thus, at present, there is no evidence that estrogen taken for at least one year prevents memory loss or slows the progression of dementia.
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What Is Menopausal Hormone Therapy
Menopausal hormone therapy also called postmenopausal hormone therapy and hormone replacement therapyis a treatment that doctors may recommend to relieve common symptoms of menopause and to address long-term biological changes, such as bone loss, that result from declining levels of the natural hormonesestrogen and progesterone in a womans body during and after menopause.
MHT usually involves treatment with estrogen alone or estrogen plus progestin, a synthetic hormone whose effects are similar to those of progesterone.
Women who have a uterusthat is, who have not had a hysterectomyare generally prescribed estrogen plus progestin for MHT. This is because estrogen alone is associated with an increased risk of endometrial cancer, but estrogen plus progestin is not. Estrogen is used alone only in women who have had a hysterectomy.
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Hormone Pellet Therapy Is A Long
Bioidenticalhormone pellet therapy serves as a true long-term solution. After treatment is established, insertion of pellets by trocar two or three times a year provides reliable estrogen replacement.
There aretestosterone pellets for women and men.
Trocar Supplies specializes indisposable medical tray kits and trocar wrap kits for insertion of extended-release bioidentical hormone pellets. Trocar Supplies trocar kits are engineered for minimal risk of herniation and infection and minimal discomfort from the insertion procedure.
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Hrt And Cancer There Is Strong Evidence That Using Hrt Raises A Womans Risk Of Breast Ovarian And Uterine Cancers At The Same Time It May Lower The Risk Of Colorectal Cancer
Combined HRT for menopause is a known cause of breast cancer, mainly in women who recently used or are still using the therapy. There is also some evidence suggesting that estrogen-only HRT may also increase the risk of breast cancer.
Studies suggest that both combined and estrogen-only HRT increase a womans risk of ovarian cancer but the risk is low.
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Does Hormone Replacement Therapy Make You Gain Weight
Typically, hormones are thought to the be main drivers of weight gain, which can understandably breed concern when it comes to HRT. However, hormones themselves do not cause weight gain, rather, hormone depletion or imbalances are often a key driver of weight loss resistance or gradual weight gain. For instance, in women, both high levels and low levels of estrogen can lead to weight gain. In men, often a drop of testosterone levels can result in loss of muscle mass and fat loss resistance. Following a BHRT protocol designed specifically based on your hormone levels, and adopting healthy lifestyle habits, can help balance hormones for optimal body composition over time.
Who Benefits From Bioidentical Hormone Replacement Therapy
Wondering if this approach to managing symptoms associated with aging really works and if its necessary or even safe?
Hormone production increases during puberty and reaches a peak in healthy adults during their 20s and early 30s. Whether we like it or not, hormone levels then start to decline beginning around our mid-30s to early 40s and continue to remain at lower levels for the remainder of our lives. This drop in hormones is natural and unavoidable in many ways, but we can still help control how rapidly or smoothly this change happens and how we adapt to its effects.
BHRT might help some adults transition through these changes more easily, but this doesnt mean that hormone treatments are always necessary or the best and only solution. Before we go further into the pros and cons of BHRT, lets discuss who uses these treatments most often. What are some signs that your hormones are shifting and, therefore, that you might be a candidate for BHRT? These include:
Part of the problem is that symptoms that are often attributed to aging or menopause, such as weight gain and fatigue, can actually begin in women before menopause takes place because theyre caused by other lifestyle factors. For example, its not common for women even in their 20s or mid-30s to already report having trouble sleeping, digestive issues or a lack of energy.
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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 .
Managing Hormone Replacement Therapy
Principally natural estrogens are used in HRT rather than the more potent synthetics used in oral contraceptives. In addition to oral estrogens, transdermal patches and vaginal creams are widely available. Oral estrogens are the least expensive, offer the most flexibility in regulating dosage, and have the greatest immediate beneficial effect on lipids. Both oral and transdermal estrogens have been found to prevent bone loss in the spine and hip .
With transdermal administration, the
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Prescribing Hormone Replacement Therapy
It is important that an individualised approach is undertaken at all stages of diagnosis, investigation and management of menopause.
The dose, regimen and duration of HRT need to be individualised. There is no maximum duration of time for women to take HRT. Discussion with women who continue to have symptoms generally show their benefits from HRT usually outweigh any risks. Systemic HRT should not be arbitrarily stopped at age 65 years instead treatment duration should be individualised based on patients’ risk profiles and personal preference.
Micronised progesterone is a natural, ‘body-identical’ progestogen, devoid of any androgenic as well as glucocorticoid activities but being slightly hypotensive due to anti-mineralocorticoid activity. It may be the optimal progestogen in terms of cardiovascular effects, blood pressure, VTE, probably stroke and even breast cancer but this evidence is only from observational studies. There is only one currently available to prescribe in the UK.
As transdermal oestrogen is associated with fewer risks than oral HRT, a transdermal route may be preferable for many women. This route is also advantageous for women with diabetes, history of VTE and also those with thyroid disorders. In addition, transdermal HRT is preferable to those women with a history of migraine or gallbladder problems.
Some Women Benefit From Hormone Replacement Therapy But There May Be Added Risks Of Taking It Find Out Whether Or Not Menopausal Hormone Replacement Therapy Is Right For You
Menopause is a normal part of aging that describes the changes women go through before and after menstrual cycles. This ultimately marks the end of the reproductive period, in which the ability to have children is over.
The ceasing of menstruation is caused by the natural decline in women reproductive hormones. As women approach their late 30s, the ovaries start making less estrogen and progesterone. These female-dominant sex hormones regulate menstruation and ovulation.
Lower levels of these hormones lead to common symptoms of menopause, including mood swings, vaginal dryness, hot flashes, and night sweats. Menopause also increases the risk of heart disease and bone loss.
Menopause can likewise be the result of medical conditions and treatments. For instance, a hysterectomy is the removal of a female’s uterus, which ends menstrual cycles. Radiation, chemotherapy, and certain medications can also induce menopause. A rarer condition, known as primary ovarian insufficiency, disrupts normal periods in women aged 40 or younger.
But because menopause is mostly considered a normal part of aging, there is no cure. Instead, a number of treatment options exist to lower negative side effects and enhance the quality of life.
Some women may use hormone replacement therapy , or simply known as hormone therapy . While some women benefit from HRT, there are added risks of taking it. Find out whether or not menopausal hormone replacement therapy is right for you.
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What Should Women Do If They Have Menopausal Symptoms But Are Concerned About Taking Mht
Women who are seeking relief from hot flashes and vaginal dryness should talk with their health care provider about whether to take MHT, the possible risks of using MHT, and what alternatives may be appropriate for them. FDA currently advises women to use MHT for the shortest time and at the lowest dose possible to control menopausal symptoms. The FDA provides additional information about the risks and benefits of MHT use for menopausal symptoms on its Menopause & Hormones: Common Questions fact sheet.
Do Local Formulations Of Menopausal Hormone Therapy Have Different Risks
Both systemic and local treatment options for MHT are available in the United States. Which option a woman receives depends on the menopausal symptoms the treatment is meant to address. Systemic MHT is usually prescribed to treat hot flashes and to prevent osteoporosis. Systemic MHT with combined estrogen plus progestin or with estrogen alone can be given as oral medications as transdermal patches, gels, or sprays and as implants.
Local MHT is prescribed to treat genitourinary symptoms such as vaginal dryness. Local MHT contains low-dose estrogen only and is prescribed to women regardless of their hysterectomy status. Local MHT with low-dose estrogen alone includes creams, tablets , and rings.
Findings from the Womens Health Initiative Observational Study showed that, among women with an intact uterus, those who used vaginal estrogen and those who didnt had similar risks of stroke, invasive breast cancer, colorectal cancer, endometrial cancer, and pulmonaryembolism/deep vein thrombosis .
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