Contraception Pregnancy And Hrt
Oestrogen used in HRT is different from oestrogen used in the contraceptive pill, and is not as powerful.
This means it’s possible to become pregnant if you are taking HRT to control menopausal symptoms. In some cases, a woman can be fertile for up to 2 years after her last period if she is under 50, or for a year if she is over 50.
If you don’t want to get pregnant, you can use a non-hormonal method of contraception, such as a condom or diaphragm.
An alternative is the IUS , which is also licensed for heavy periods and as the progestogen part of HRT. You will need to add oestrogen as either a tablet, gel or patch.
How Long Can I Have Bioidentical Hormone Replacement Therapy
Dr. Christy recommends that women in menopause only take HRT when their symptoms are hard to deal with, usually only up to five years. For some patients, yes, symptoms may return, but you can try other hormonal replacement therapies, including topical creams. If youre having hormone therapy through pellets, they last about four months at a time. Our staff can determine the proper frequency of your therapy sessions.
How To Deal With Stubborn Rebound Symptoms
After making exciting progress in the first few weeks of weaning off HRT, women may plateau and find themselves with stubborn symptoms that wont go away. They may jump to the conclusion that the lack of hormones and estrogen replacement is to blame and say, This isnt working. But in fact, the natural alternative to HRT is working its gradually healing the issues that created the conditions in the first place. And if you can find relief from common rebound symptoms, youll be able to complete the process of tapering down with targeted support.
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Diagnosis & Tests For Hormone Replacement Therapy
If you are age 45 and above, your doctor may not test you for signs and symptoms of menopause. Once symptoms occur, your doctor may examine you, take a personal and medical history, and work out lifestyle factors that improve your symptoms.
If you are under age 45, your doctor may perform blood tests to determine your hormone levels. They may also perform ultrasounds and physical exams to find the cause of your hormone deficiency.
What Are The Steps Before I Can Be Prescribed Hormones To Transition To My Affirmed Gender
It usually takes two separate visits to the UI LGBTQ Clinic before you will be prescribed hormones.
During the first appointment, you will meet with one of the doctors and she will review your personal and family health history and perform an exam. You will also meet with the pharmacist who will review the medications commonly used. She will review the risks of the medications and common side effects as well as a timeline of expected changes. You will have baseline blood work done during this visit. If you recently had blood work done, please bring these results with you for the doctor to review.
We generally require people to have at least one evaluation from a mental health professional such as a therapist, counselor, or psychiatrist. The evaluation should focus on your gender history and ability to understand the risks and benefits of treatment used to transition to another gender. After the evaluation, the mental health professional will provide you with the necessary letter that you will share with the doctor. If you need help finding a therapist who has experience working with transgender and gender non-conforming people, we can help identify a mental health provider for you. While it is not required that you have ongoing appointments with the therapist, the doctor or therapist may recommend this.
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How To Get Started On Hrt
Speak to a GP if you’re interested in starting HRT.
You can usually begin HRT as soon as you start experiencing menopausal symptoms and will not usually need to have any tests first.
A GP can explain the different types of HRT available and help you choose one that’s suitable for you.
You’ll usually start with a low dose, which may be increased at a later stage. It may take a few weeks to feel the effects of treatment and there may be some side effects at first.
A GP will usually recommend trying treatment for 3 months to see if it helps. If it does not, they may suggest changing your dose, or changing the type of HRT you’re taking.
Healthier Teeth And Gums
Recent studies have shown that HRT can help you get healthier teeth and gums. The loss of bone density that comes with aging can cause teeth to become loose, and as we age, our teeth also become more susceptible to disease. However, when women take hormone replacement drugs, theyre much less likely to experience periodontitis, which is the underlying cause of bone and tooth loss. The improvement in oral health is likely due to the prevention of osteoporosis through HRT.
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Choosing The Right Hrt For You
Finding the right type of HRT can be tricky.
A low dose of HRT hormones is usually recommended to begin with. It is best to start with the lowest effective dose, to minimise side effects. If necessary, you can increase your dose at a later stage.
Persevere with HRT and wait a few months to see if it works well for you. If not, you can try a different type or increase the dose. Talk to your GP about any problems you have with HRT.
While there are more than 50 different preparations of HRT, the three main types are discussed below.
Hrt Vs Birth Control Pills: The Ultimate Guide
Birth control pills or HRT?Whats the Difference? Why are they prescribed? And which one is right for me? This helpsheet provides the best in-depth comparison of birth control pills and hormone replacement therapy , answering these questions and more.
Some of us going through early menopause or premature ovarian failure are put on birth control pills others on hormone replacement therapy.
Both act as hormone replacement in other words, in both cases, youre taking them to replace the hormones your body used to make. But there are significant differences between the two.
So, inevitably, questions come up: What are the differences? Is one better than the other? Why am I on one and not the other? As youd expect, there are really no simple answers!
That said, though, weve set about explaining this issue, the pros and cons of each and the reasons your doctor may have prescribed one or the other of these for you.
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When Is The Best Time To Stop Taking Hrt
Theres no set time for when a woman should come off HRT it all depends on individual factors based on the various pros and cons. As a rule of thumb, for healthy women that is, those who do not have a weakened immune system or any underlying health issues HRT is safe to use in small doses for short-term relief of menopausal symptoms. However, because the accompanying risks appear to increase with age and the duration you take HRT, women aged 59 or above who have taken the treatment for 5 or more years should think about stopping.
In females whose menopause is induced by a hysterectomy , who are prescribed estrogen-only treatment after surgery, their likelihood of developing any type of cancer is not increased, so they may decide to stay on the treatment for a longer period.
If youre feeling confused, apprehensive, or unsure about the best time to quit HRT, a conversation with your doctor will help to demystify the topic and make it less of a daunting prospect.
How Is Hormone Therapy Used To Treat Hormone
Hormone therapy may be used in several ways to treat hormone-sensitive prostate cancer, including:
Early-stage prostate cancer with an intermediate or high risk of recurrence. Men with early-stage prostate cancer that has an intermediate or high risk of recurrence often receive hormone therapy before, during, and/or after radiation therapy, or after prostatectomy . Factors that are used to determine the risk of prostate cancer recurrence include the grade of the tumor , the extent to which the tumor has spread into surrounding tissue, and whether tumor cells are found in nearby lymph nodes during surgery.
The use of hormone therapy before prostatectomy has not been shown to be of benefit and is not a standard treatment. More intensive androgen blockade prior to prostatectomy is being studied in clinical trials.
Relapsed/recurrent prostate cancer. Hormone therapy used alone is the standard treatment for men who have a prostate cancer recurrence as documented by CT, MRI, or bone scan after treatment with radiation therapy or prostatectomy.
Hormone therapy is sometimes recommended for men who have a “biochemical” recurrencea rise in prostate-specific antigen level following primary local treatment with surgery or radiationespecially if the PSA level doubles in fewer than 3 months.
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What Are The Side Effects Of Hormone Therapy For Prostate Cancer
Because androgens affect many other organs besides the prostate, ADT can have a wide range of side effects , including:
- loss of interest in sex
Studer UE, Whelan P, Albrecht W, et al. Immediate or deferred androgen deprivation for patients with prostate cancer not suitable for local treatment with curative intent: European Organisation for Research and Treatment of Cancer Trial 30891. Journal of Clinical Oncology 2006 24:18681876.
Zelefsky MJ, Eastham JA, Sartor AO. Castration-Resistant Prostate Cancer. In: Vincent T. DeVita J, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles & Practice of Oncology, 9e. Philadelphia, PA: Lippincott Williams & Wilkins 2011.
Smith MR, Saad F, Chowdhury S, et al. Apalutamide and overall survival in prostate cancer. European Urology 2021 79:150158.
Hormone Therapy For Adults
The aim of hormone therapy is to make you more comfortable with yourself, both in terms of physical appearance and how you feel. The hormones usually need to be taken for the rest of your life, even if you have gender surgery.
Its important to remember that hormone therapy is only one of the treatments for gender dysphoria. Others include voice therapy and psychological support. The decision to have hormone therapy will be taken after a discussion between you and your clinic team.
In general, people wanting masculinisation usually take testosterone and people after feminisation usually take oestrogen.
Both usually have the additional effect of suppressing the release of unwanted hormones from the testes or ovaries.
Whatever hormone therapy is used, it can take several months for hormone therapy to be effective, which can be frustrating.
Its also important to remember what it cannot change, such as your height or how wide or narrow your shoulders are.
The effectiveness of hormone therapy is also limited by factors unique to the individual that cannot be overcome simply by adjusting the dose.
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Evidence Of Risks And Benefits
Many women reconsidered taking HRT due to recent studies on the long-term use of HRT. The Heart and Estrogen-Progestin Replacement Study found in the first year of HRT there was a 50% increase in heart attack and stroke. But, after two years of HRT, they had a decrease in these diseases.
The Womens Health Initiative performed a larger study. Its the largest study that examined the effects and risks of HRT in menopausal women.
In 2002, the WHI stopped giving women both estrogen and progestin therapy. Data from this group found an increased risk of heart disease, breast cancer, stroke and blood clots in the lungs and legs.
In 2004, they ended the group taking only estrogen because results indicated an increased risk of blood clots, stroke, and heart attack.
Due to these studies, they created new guidelines for prescribing HRT. These include:
- Stopping the use of HRT as a prevention of heart attack or stroke.
- Weigh the pros and cons of using HRT for prevention of osteoporosis
- Women with pre-existing heart disease should think about other options.
- Use in only the short-term for menopausal symptoms.
- Discourage long-term use
Transgender Hormone Therapy Is Safe When Monitored For Certain Risks
One of the most often cited reasons by medical providers for hesitation in providing hormone therapy to transgender individuals is the fear of harm. The review demonstrates that hormone therapy is relatively safe, at least as far as the modest literature out there can determine. Providers should be reassured that the harms that do exist are relatively rare and can often be avoided with conventional monitoring.
The take-home points from the review are:
1. The current literature suggests that transgender hormone therapy is safe for most situations and reasonable to monitor.
2. The current literature is quite thin, with a need for large, more carefully done studies to address concerns regarding more subtle harms.
The findings align with the hormone approach found in both the World Professional Association for Transgender Health Standards of Care and The Endocrine Society Guidelines. The primary difference between this review and the two guidelines is the failure to detect increased cancer risk despite the concerns raised in the guidelines.
Use of hormone therapy in trans* adults is considered safe when carefully monitored for certain risks, such as venous thromboembolism in trans women women with use of estrogen therapy, according to a literature review published in the February 24 issue of the Journal of Clinical and Translational Endocrinology. The findings may help reduce the barriers for transgender individuals to receive medical care.
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When To See A Doctor For Hormone Replacement Therapy
Menopause is a normal part of aging and most symptoms will pass on their own. Some people find them mildly uncomfortable and others find they interfere with normal living. When you begin to experience menopausal symptoms or find them unbearable, you can see a doctor to discuss how to proceed.
If you have symptoms related to other conditions, like early menopause before age 45, or chronic period problems, abnormal periods or bleeding, or infertility, you should see your doctor to determine the cause.
Examples Of Menopause Hormonal Therapy
Menopause hormonal therapy is available as oestrogen alone or as oestrogen with progestogen. It is also available in different formulations such as creams, pessaries, tablets and skin patches. Some of these are used every day, while others may be used only for a few days or once or twice a week. The following are examples of menopause hormonal therapy products available in New Zealand. The choice of product depends on your individual circumstances and preferences. When using MRT, use the lowest dose that eases your symptoms for the shortest time and get your treatment reviewed at least once every year to assess whether to continue it or not.
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Is Measuring Hormone Levels Required For Treatment
Yes. This is the only way to know for sure if you have a hormone imbalance. At our office, we will administer a blood, saliva, and/or urine test to detect the levels of hormones in your body. Additionally, this test will identify the hormones you need to supplement, since this is not the same for everyone. This will allow us to create a customized treatment plan that is targeted to your specific needs.
What Are The Benefits Of Mrt
Without treatment, menopausal symptoms such as hot flushes, night sweats, sleep problems and headaches may last for a few years. Most women manage their menopause symptoms themselves, but some may need help from their doctor. MRT has been found to:
- reduce the number and severity of hot flashes and night sweats
- improve symptoms of vaginal dryness and soreness
- help to reduce recurrent urine infections
- lower the risk of osteoporosis, because oestrogen slows bone thinning and helps increase bone thickness
- slightly reduce the risk of diabetes.
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Why Aren’t Compounded Bioidentical Hormones Fda Approved
The FDA doesn’t approve any compounded products, for any condition, because those products aren’t standardized.
That doesn’t mean that compounding is bad. Compounding can be useful for patients who are allergic to an additive in an FDA-approved product, says Kathleen Uhl, MD, the FDA’s assistant commissioner for women’s health.
But “the purpose of compounding is to do it on a patient-by-patient basis, so there’s nothing that’s submitted to FDA to evaluate, so they’re not FDA approved,” Uhl explains.
And because compounded products don’t go through the FDA approval process, they don’t bear the same warnings as other hormone therapy.
A woman who gets a prescription for an FDA-approved hormone therapy for menopausal symptoms is “going to get a lot of warning information,” but if she gets a compounded product instead, “you don’t get any of those warnings,” Uhl says. “There’s no requirement for them to provide that because those products are not FDA approved.”
L.D. King, executive director of the International Academy of Compounding Pharmacists, suggests that patients look for accredited compounding pharmacies listed on the web site of the Pharmaceutical Compounding Accreditation Board .
Manson points out that with FDA-approved “bioidentical” drugs available, “most women interested in bioidentical formulations do not need to take custom-compounded products .”
Stroke And Heart Attacks
The latest analysis from Women’s Health Concern regarding the risk of heart disease and stroke for women taking HRT states that:
- the risk of stroke is increased in women who smoke and are overweight
- women starting HRT and aged below 60 are not at an increased risk of stroke
- HRT is not recommended for women with a history of stroke or deep vein thrombosis
Speak to your GP if you are taking HRT and are worried about the risk of stroke or heart disease.
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