Key Points: Venous Thromboembolism
- 1. MHT increases the risk of venous thromboembolism. Particularly, the risk of VTE increases with age and increases in women initiating hormone therapy more than 10 years from menopausal onset.
- 2. The risk of venous thromboembolism increases in the first 1 to 2 years of MHT and decreases afterwards.
- 3. Estrogen therapy has a lower risk of venous thromboembolism than EPT, and if used in the early postmenopausal period, the risk of venous thromboembolism does not increase.
- 4. Oral estrogen therapy is banned for patients with anamnesis of venous thromboembolism, and they must use transdermal estrogen.
- 5. The occurrence of venous thromboembolism in Asian women is very low, and there has been no report of factor V Leiden mutation in South Korea.
Hrt For Breast Cancer Survivors
It is advisable for women with a history of breast cancer to avoid HRT unless other treatments are ineffective, and their quality of life is made intolerable by menopausal symptoms. In these circumstances, HRT should only be prescribed in consultation with the womans breast surgeon or oncologist.
Evidence has not conclusively shown that HRT will increase the risk of breast cancer recurring in a woman with a history of the disease. However, oestrogen and progestogens may stimulate some types of cells in the breast and some types of HRT use have been associated with an increase in the risk of breast cancer in women without a history of breast cancer.
What Is Natural Estrogen Replacement
Natural estrogen replacement hormones are an alternative hormone replacement therapy for women going through menopause. During menopause, the body produces a much lower amount of estrogen and progesterone, and the woman no longer has a menstrual cycle because her ovaries have ceased releasing eggs on a monthly basis. Natural estrogen replacement therapy consists of consuming products and foods which stimulate or have a high level of phytoestrogen. Chemical estrogen replacement therapy is available, but there have been studies that have shown that these chemicals greatly increase the womans chance of developing breast cancer, so many women look for natural alternatives to chemical hormone replacement therapy.
Soy bean products are extremely rich in isoflavones, a group of foods that contain phytoestrogen. Tofu, edamame, soy milk, and supplements are the most popular food sources containing high amounts of soy beans. Soy bean consumption by menopausal women has been the subject of many studies, and it has been found to reduce the side effects of menopause while increasing the womans bone mineral density.
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Selective Estrogen Receptor Modulators
The clinically oldest selective estrogen receptor modulator , tamoxifen, acts in breast tissue as an estrogen antagonist and therefore it is used in treatment and chemoprevention of breast carcinoma while its agonistic effect causes endometrial hyperplasia.39
Bazedoxifene is a new SERM that verifiably reduces bone mass loss in postmenopausal women and reduces the risk of vertebral and nonvertebral fractures without stimulating breast tissue or endometrium.40
It can be used for treatment or prevention of osteoporosis in postmenopausal women. It does not stimulate the mammary gland or the endometrium. When used at a dose of 20 or 40 mg per day, it protects the endometrium during systematic estrogen treatment .41
What Is Thyroid Hormone Replacement Therapy
Thyroid hormone therapy is the use of manmade thyroid hormones to raise abnormally low levels of natural thyroid hormones in the body. Thyroid hormone is usually given in pill form and is often used to treat an underactive thyroid that is secreting little or no thyroid hormones. The most commonly prescribed thyroid hormone replacement is pure synthetic thyroxine .
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Estrogen Therapy After Oophorectomy: Age Matters
JoAnn E. Manson, MD, DrPH
This transcript has been edited for clarity.
Hello. This is Dr JoAnn Manson, professor of medicine at Harvard Medical School and Brigham and Womens Hospital in Boston, Massachusetts. Id like to talk with you about our study with the Womens Health Initiative on estrogen-alone therapy and health outcomes among women with and without bilateral oophorectomy. The study was recently published Annals of Internal Medicine and included 10,000 women with prior hysterectomy who were aged 50-79 at the time of randomization.
In all of the reports from the WHI hormone therapy trial, there has never been a previous study where the estrogen results differed between women who had their ovaries surgically removed versus the women with conserved ovaries. When we looked at the overall cohort across all age groups, we found minimal differences between the women with oophorectomy and those with conserved ovaries. The findings tended to be neutral, null, with no significant increases or decreases in major health outcomes.
However, when we looked at the results stratified by age, there were major differences across age groups among the women with bilateral oophorectomy and minimal differences among the women with conserved ovaries. During the intervention phase of 7 years, there was a generally adverse global index effect of estrogen therapy among women aged 70 and older, a neutral effect among women in their 60s, and a favorable effect among women in their 50s.
Is It Ever Too Late To Start Hormone Replacement Therapy
HRT should ideally be used in people younger than 60, or who are within 10 years of menopause. For people in these categories, the benefits clearly outweigh the risks. But what if you are outside this window of opportunity? Is it reasonable to still consider using HRT?
The short answer: It depends. In certain cases, the risks of HRT might outweigh the benefits. In people who are further out from menopause like 10 to 20 years, or more HRT is associated with a higher risk of:
Still, there are times when HRT makes sense for older people. About 20% of people have hot flashes into their 60s and 70s others have osteoporosis that doesnt respond well to medications. These are examples where HRT could be a reasonable choice. There are also other options, like antidepressants, estrogen patches, or creams, that can help.
If it has been a while since you went through menopause or youre older than 60 talk to your healthcare provider about what options are right for you. Remember: Hormone treatment isnt one size fits all. The risks and benefits of HRT are different for different people.
And finally, its never too late to use vaginal estrogen. Vaginal estrogen creams, tablets, and rings can help with dryness, pain during sex, and UTI prevention. They also do not increase the risk for cancer, heart disease, or hip fracture even when used later in life.
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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.
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 , orpostmenopausal 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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What Are The Risks Of Hrt
Depending on your personal history and hormone use, HRT may increase your risk for:
Stroke: Estrogen-only HRT and combined HRT can both increase your risk of having a stroke. But if you start HRT early, this risk is very low in fact, in some cases, HRT may even have a protective effect. In a large study, there was no increased risk for stroke in people who started HRT within 5 years of starting menopause. The risk also goes away once you stop taking hormones.
Blood clots: In a large study, oral HRT increased the risk of serious blood clots by 43%. However, blood clots do not seem to be a risk if you use an estrogen injection, or an estrogen that is absorbed through your skin .
Uterine cancer: Estrogen can encourage the lining of your uterine to grow, increasing your risk for uterine cancer. Taking progestin at the same time may lower this risk. Low-dose vaginal estrogen may also have a lower risk for uterine cancer than body-wide HRT.
Breast cancer: HRT can increase your risk for breast cancer, but only if you take it for a long time. Breast cancer risk only increases after 7 years on estrogen-only HRT, and after 3 to 5 years on combined HRT. This risk may be even lower with some types of progesterone.
In addition, you are also more likely to have complications from HRT if you:
What Is Menopause Hormonal Therapy
During menopause, the amount of oestrogen produced by a womans body drops and this can cause symptoms associated with menopause such as hot flushes, night sweats, sleep problems, muscle and joint pains, mood changes, vaginal dryness and discomfort with sex. Read more about menopause.Menopause hormonal therapy is the use of hormone therapy to replace the oestrogen that your ovaries no longer make during and after menopause. It can help relieve some of the symptoms of menopause. Hormone therapy may have either oestrogen alone or oestrogen plus progestogen, depending on what is best for you. Menopause hormonal therapy is not recommended in certain situations, such as for women who have a history of breast cancer, are at risk of heart disease, or have had a blood clot or are high risk of having a blood clot. Ask your doctor whether menopause hormonal therapy is right for you there are also other non-hormone options that can help with menopausal symptoms.
- For women who still have their uterus, MRT will have both oestrogen and progestogen. This is because oestrogen alone can overstimulate the cells lining your uterus, causing an increased risk of endometrial cancer . To counter this risk, women who have a uterus are advised to take progestogen together with oestrogen.
- In women who have had their uterus removed surgically , MRT will have oestrogen alone.
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Offers Protection Against Cardiovascular Disease
Numerous studies have confirmed that when HRT is started early, within 10 years of menopause, it can help protect your heart and vascular system from disease.
Before starting HRT, its important to undergo a physical exam to be sure you dont already have signs of cardiovascular disease. Your doctor will likely want you to have a check-up every year while youre on HRT to be sure youre maintaining good heart health.
Am I A Candidate For Hrt
The best candidates for hormone replacement therapy are men and women struggling with the symptoms associated with hormone deficiencies. These symptoms can negatively impact everyday life and prevent you from enjoying your favorite activities. The following are some of the most common symptoms of hormone imbalance:
- Chronic fatigue
- Poor quality skin and nails
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Hormone Replacement For Men
Standard hormone replacement for men often involves one specific hormone: testosterone. While commonly associated with virility and aggression, testosterone serves many purposes that play critical roles in male health including:
- Production of Red Blood Cells
- Sperm Production
Failing to properly manage testosterone levels can result in physical, emotional, and sexual health challenges for men. Hormone replacement treatments can reduce mens risk of heart disease, diabetes, and death.
Men may elect to use testosterone injections , patches or gels . It is best to choose one that works best with your lifestyle.
What Happens During Pellet Therapy Treatment
To begin treatment, we will clean your treatment site, which is most commonly an area on the hip with fatty tissue. Then we will numb the area to ensure that you stay comfortable during the process. A nearly invisible incision will be made in your skin, and the tiny pellet will be inserted just below the skins surface. Then, we will use a tiny, dissolvable suture to close the incision.
The entire process will take 30 minutes or less. Once your treatment is over, we will provide you with a complete list of instructions on caring for your insertion site during the next five to seven days.
Experts Answer: Is Hormone Replacement Therapy Safe
30 May 2013
Each week, MyHealthNewsDaily asks the experts to answer questions about your health.
This week, we asked gynecologists, endocrinologists and oncologists: Is hormone replacement therapy safe? Hereâs what they said.
Dr. K. Flood-Shaffer, associate professor in the department of obstetrics and gynecology at the University of Cincinnati in Ohio:
âUnfortunately, there is no simple yes or no answer to that question. But the good news is that there is definitely a place a safe place for hormones. The Womenâs Health Initiative Study , which began to provide good data in 2004, was the first study to slow the unfettered use of hormones in the United States. The data is still being gathered and that is why there is so much confusion on the matter.
âThat being said, hormones are also NOT a âforeverâ medication. Women who have a clear cut indication for hormones and no contraindications , the careful, judicious and temporary use of hormones is considered safe. Women must see their gynecologist, family physician or internist to discuss their own personal situation and risk factors and have a very individualized plan devised for them under close supervision with their physician.â
Dr. Joseph Ragaz, medical oncologist and clinical professor of medicine in the School of Population & Public Health at the University of British Columbia in Canada:
Price Of Consultation With Hormone Specialist
Consultation: $70 US
Therapy: $700 US
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How Does Hormone Replacement Therapy Work
Your period is controlled by reproductive hormones made by your ovaries. As your ovaries age, they slowly stop making hormones. This causes your periods to slow down and eventually stop.
HRT replaces two of the key hormones made by your ovaries: estrogen and progesterone. In your body, these replacement hormones work just like the estrogen and progesterone that your ovaries make. Increasing your hormone levels can help reduce menopause symptoms and can have other health benefits as well.
HRT can be dosed in different ways. Dosing may depend on whether you are still having a regular period. Two common approaches are:
Cyclical dosing: This is for people who have menopausal symptoms but still have a period. Different doses of hormones may be used during certain weeks of your menstrual cycle.
Continuous dosing: This is usually for people who have completed menopause . In continuous dosing, you take the same dose of hormones every day without a break.