When Are People Prescribed Hormone Replacement Therapy
Hormone replacement therapy may be recommended for people with menopause to help with treatment of difficult menopausal symptoms. But that doesnt mean you need hormone therapy when you reach that time in your life.
When should you consider hormone therapy? That depends. “If hot flashes are your primary concern, estrogen in pill or patch form will be very effective in reducing the frequency and severity,” explains OB-GYN and Modern Fertility medical advisor Dr. Eva Luo, MD, MBA. “But if vaginal dryness is your primary concern, then estrogen in vaginal cream, ring or tablet form may be most effective in providing a localized dose of estrogen to the affected area.”
For those who don’t want to take HRT, the American College of Obstetricians and Gynecologists also recommends a few alternatives:
- Over-the-counter vaginal moisturizers and lubricants for vaginal dryness
- Antidepressants for hot flashes
- Selective estrogen modulators , which block the effects of estrogen on certain tissues, for hot flashes or pain during sex
- Dehydroepiandrosterone , a daily vaginal insert, for pain during sex
- Gabapentin for hot flashes or sleep problems
- Clonidine for hot flashes and sleep problems
- Plant and herbal supplements
Why Is This Medication Prescribed
Combinations of estrogen and progestin are used to treat certain symptoms of menopause. Estrogen and progestin are two female sex hormones. Hormone replacement therapy works by replacing estrogen hormone that is no longer being made by the body. Estrogen reduces feelings of warmth in the upper body and periods of sweating and heat , vaginal symptoms and difficulty with urination, but it does not relieve other symptoms of menopause such as nervousness or depression. Estrogen also prevents thinning of the bones in menopausal women. Progestin is added to estrogen in hormone replacement therapy to reduce the risk of uterine cancer in women who still have their uterus.
Estrogen Therapy And Cancer Risk
In women who still have a uterus, using systemic ET has been shown to increase the risk of endometrial cancer . The risk remains higher than average even after ET is no longer used. Although most studies that showed an increased risk were of women taking estrogen as a pill, women using a patch or high-dose vaginal ring can also expect to have an increased risk of endometrial cancer.
Because of this increased cancer risk, women who have gone through menopause and who still have a uterus are given a progestin along with estrogen. Studies have shown that EPT does not increase the risk for endometrial cancer.
Long-term use of vaginal creams, rings, or tablets containing topical estrogen doses may also increase the levels of estrogen in the body. Its not clear if this leads to health risks, but the amounts of hormone are much smaller than systemic therapies.
ET is not linked to a higher risk of breast cancer. In fact, certain groups of women taking ET, such as women who had no family history of breast cancer and those who had no history of benign breast disease, had a slightly lower risk of breast cancer.
The WHI study of ET did not report any results about ovarian cancer.
To put the risk into numbers, if 1,000 women who were 50 years old took estrogen for menopause for 5 years, one extra ovarian cancer would be expected to develop.
ET does not seem to have any effect on the risk of lung cancer.
Oestrogen Formulations And Modes Of Delivery
Oestrogens are available as tablets, skin patches and gels. These products contain different kinds of oestrogen which are all effective in treating menopausal symptoms. There is no clear consensus about which delivery method is best overall, although there are some circumstances where transdermal therapy is preferred.
Patches or gels are better for those who have high triglyceride concentrations, those with hypertension, those who may not absorb tablets adequately and those at increased risk of venous thromboembolic disease . This includes those women who are overweight or smokers . Patch therapy may be better tolerated by women with migraine .
Vaginal oestrogen in creams, pessaries or tablets is available for women with symptomatic vaginal dryness and can be used either alone or in combination with systemic therapy .
Risks Of Hormone Replacement Therapy
HRT has been connected to an increased risk for certain types of cancers, especially breast cancer. The studies that discovered a link between HRT and breast cancer refer to people being treated with EPT, but not estrogen alone.
But there are no studies that show that bioidentical HRT is any safer than synthetic HRT. The risk of breast cancer increases the longer someone engages in EPT, and the risk decreases once EPT is stopped.
On the other hand, a higher risk for uterine cancer also exists when menopausal people with a uterus use estrogen only.
Other risks for people undergoing HRT include stroke.
What Questions Remain In This Area Of Research
The WHI trials were landmark studies that have transformed our understanding of the health effects of MHT. Its important to note that women who were enrolled in the WHI trials were, on average, 63 years old, although about 5,000 of them were under age 60, so the results of the study may also apply to younger women. In addition, the WHI trials tested single-dose strengths of one estrogen-only medication and one estrogen-plus-progestin medication .
Follow-up studies have expanded and refined the original findings of these two trials. But many questions remain to be answered:
- Are different forms of hormones, lower doses, different hormones, or different methods of administration safer or more effective than those tested in the WHI trials?
- Are the risks and benefits of MHT different for younger women than for those studied in the WHI trials?
- Is there an optimal age at which to initiate MHT or an optimal duration of therapy that maximizes benefits and minimizes risks?
Why Do Some Women Need Hormone Replacement Therapy During Menopause
For some women, these symptoms go on for years or decades after they’ve stopped their periods — into the time called postmenopause.
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Q: Is There A Need To Talk To My Healthcare Provider About This
A: Only seek the help of your healthcare provider if you have been experiencing prolonged bad side effects after your bio-identical hormone replacement therapy. Suppose these side effects are no longer manageable or do not disappear in the shortest of time. In that case, it might be because you have a very high hormone level. Best go to your doctor for immediate and permanent solutions for these side effects.
Before undergoing BHRT, the best thing to do is consult your doctor first so that all the necessary information is discussed and explained to you before your treatment. Bio-identical hormone replacement therapy is proven safe and can only be effective if the right type and dose are given to each patient. So take time to research this first to produce the best results for your body and reduce the risks of side effects in the long run. Bio-identical hormone replacement therapy or BHRT is one of the innovations that can become the future and may change the medical field eventually.This article is already jam-packed with information necessary for you to make that decision in undergoing BHRT. If you still have questions, best consult and talk to our friends from Forma Medical Aesthetics and have your answers addressed today!
Who Can Use It
You can begin hormone replacement therapy as soon as you start experiencing menopausal symptoms.
The average age for women to experience the menopause in the UK is 51. However, some women have the menopause when they are in their 30s, 40s or 60s. There is no way of predicting exactly when the menopause will happen.
Some women have menopausal symptoms, such as hot flushes and vaginal dryness, in the 3 to 4 years before the menopause. This is known as the peri-menopause.
The peri-menopause occurs because levels of the female sex hormones, oestrogen and progesterone, fall when the number of remaining eggs drops below a certain level. This means you may experience menopausal symptoms even when you are still having periods.
In most cases, HRT can be used without taking a test to confirm you are starting the menopause. A test for the menopause is usually only necessary if you are under 40 years old or have unusual bleeding patterns during your period.
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Estrogen Gel Cream Or Spray
These are estrogen-only products that are rubbed or sprayed onto the skin. They are usually applied once a day. Brand names include:
These medications release estrogen directly into the vagina. The estrogen does not circulate through your body as widely as with other types of HRT. These medications are mainly helpful for vaginal and urinary symptoms, and do not help as well with other body-wide menopause symptoms .
These medications may have a lower risk for complications than body-wide HRT. In some cases, they can be used without taking progesterone even if you still have a uterus. They can also be added to other types of HRT if you are having ongoing vaginal symptoms.
What Is Known About Hormone Therapy And The Risk Of Heart Disease
Scientists continue to learn about the effects of HT on the heart and blood vessels. Many large clinical trials have attempted to answer questions about HT and heart disease. Some have shown positive effects in women who started HT within 10 years of menopause some have shown negative effects when started greater than 10 years of menopause. Some studies have raised more questions about the potential benefits of HT.
Based on the data, the American Heart Association issued a statement for use of HT. They say:
- Hormone therapy for the sole purpose of preventing heart disease is not recommended.
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To Cope With Vaginal Dryness Use Vaginal Lubricants And Moisturizers
If your vagina or vulva is getting dry and irritated, stop using soap to clean there clean water works just as well. If sexual penetration is painful because of dryness, try an over-the-counter lubricant or moisturizer. Use lubricants right before sexual activity avoid oil-based ones, which can cause irritation and cause condom failure. Apply moisturizers as a regular healthcare regimen.
What Is Hormone Replacement Therapy
The term “hormone replacement therapy” or HRT, refers to the hormones estrogen and/or progesterone that are taken regularly to stabilize and increase a menopausal woman’s hormone levels. It’s good to know all the options that are available, from pills to patches, creams, and vaginal rings. Your doctor can explain them.
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What Hormones Are Used To Treat The Symptoms Of Menopause
The hormones most commonly used to treat symptoms of menopause are estrogen and progesterone. . Often, these 2 hormones are used together, but some women are given estrogen alone. Its important to know which hormones you are talking about when looking at the risks.
Common estrogen preparations used to treat menopausal symptoms include conjugated equine estrogens and estradiol, but several forms or types of estrogen are available.
There are also many progestins available, but medroxyprogesterone acetate , is often used with an estrogen to treat menopausal symptoms. Some preparations contain both an estrogen and a progestin.
Androgens are also sometimes used to treat menopausal symptoms. This is not common, though, and because only a few studies have looked at this practice, it isnt clear how safe it is in the long run.
Tibolone is a synthetic hormone drug that can act like estrogen, progesterone, and testosterone in different tissues of the body. Because this drug isnt available in the US, its not discussed here.
Does Hrt Cause Cancer
The American Cancer Society point out that the risk may depend on the type of treatment and the type of cancer.
They report that while one type of HRT may increase the risk of breast cancer slightly, another type may reduce the risk.
Anyone who is thinking of using HRT should talk to their doctor about the specific risks and benefits.
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Who Can Take Hrt
Most women can have HRT if they’re having symptoms associated with the menopause.
But HRT may not be suitable if you:
- are pregnant it’s still possible to get pregnant while taking HRT, so you should use contraception until 2 years after your last period if you’re under 50, or for 1 year after the age of 50
In these circumstances, alternatives to HRT may be recommended instead.
Information On Estrogen Hormone Therapy
Overview of Feminizing Hormone TherapyUCSF Transgender CareUniversity of California – San FranciscoJuly, 2020
Hi, I’m Dr. Maddie Deutsch, Associate Professor of Clinical Family & Community Medicine at the University of California San Francisco , and Medical Director for UCSF Transgender Care. In this document I will review various aspects of feminizing hormone theray, including, choices, risks, and unknowns associated with feminizing hormone therapy.
As you prepare to begin treatment, now is a great time to think through what your goals are. Do you want to get started right away on a path to the maximum degree of medically appropriate feminizing effects? Or, do you want to begin at a lower dose and allow things to progress more slowly? Perhaps you are seeking less-than-maximal effects and would like to remain on a low dose for the long term. Thinking about your goals will help you communicate more effectively with your medical provider as you work together to map out your care plan.
Many people are eager for hormonal changes to take place rapidly which is totally understandable. It is important to remember that the extent of, and rate at which your changes take place, depend on many factors. These factors primarily include your genetics and the age at which you start taking hormones.
There are four areas where you can expect changes to occur as your hormone therapy progresses. Physical, emotional, sexual, and reproductive.
The first is physical.
Hormone Replacement Therapy For Menopausal Symptoms
Chelsea K. Sanchez, PharmD, BCPSInternal Medicine/Antimicrobial Stewardship
San Antonio, Texas
US Pharm. 2018 43:21-26.
ABSTRACT: Hormone replacement therapy is the most effective treatment for the vasomotor and genitourinary symptoms associated with menopause. Adverse effects associated with HRT are dependent on various factors, including dosage, route, duration of use, timing of initiation, and choice of agent. The decision to start HRT should include a risk assessment, and HRT should be individualized to the patient. The many existing HRT options come in a wide array of dosages and dosage forms. Pharmacists should be able to counsel patients about HRT and its side effects.
The average woman will live one-third of her life in or past menopause.1 Treatment of menopausal symptoms has gained increasing importance owing to the morbidities associated with aging in women.2Hormone replacement therapy , a term used to describe estrogen therapy, estrogen-progesterone combination therapy, or estrogen receptor agonist or antagonist therapy, continues to play a major role in the mitigation of perimenopausal and postmenopausal symptoms.3 Although each womans experience is different, vasomotor symptoms and vulvovaginal symptoms are two of the most common complaints associated with the hormonal changes involved in menopause.4
Choosing The Best Type Of Estrogen Therapy
When deciding what type of estrogen therapy to get, work closely with your doctor. While oral estrogen has been around for a long time and is well studied, some modes of taking hormone therapy are not. They may have lower risks or different risks that we don’t know about yet. Your doctor should be up to date on the latest research.
Right now, the full risks of hormone therapy are unclear. So if you do decide to get ERT, experts generally recommend that you get it at the lowest dose for the shortest time possible. Talk to your doctor about how long you should expect to take ERT and how you can limit your risks.
ACP Medicine web site: “Menopause.”
Canonico M et al, Circulation, Feb. 20, 2007 vol 115: pp 840-845.
MedicineNet web site: “Hormone Creams: Safe and Effective?”
National Cancer Institute web site: “How to Deal with Surgical Menopause.”
National Institutes of Health web site: “Facts About Menopausal Hormone Therapy.”
National Institutes of Health Medline Plus web site: “Estrogen,” “Estrogen Vaginal,” “Estradiol Topical,” “Estradiol Transdermal.”
National Women’s Health information Center: “Menopause and Menopause Treatments.” WebMD Medical Reference: “Estrogen Replacement Therapy,” “Low Dose Estrogen for Dryness and Atrophy.”
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What Else Can I Do To Ease Menopause Symptoms
There are many things you can do to curb hot flashes, night sweats, insomnia, vaginal dryness, and lost libido. Lifestyle changes — such as regular exercise, a healthy diet, relaxation techniques, and keeping a regular sleep schedule — can help. If you smoke, quit . Avoid caffeine and alcohol. Lubricants can greatly ease vaginal dryness and heighten sexual sensation.Stay active to avoid depression and seek social support from woemn like you
Your doctor can give you more information about these techniques and other treatment options. The use of selective serotonin reuptake inhibitors has become more common in women who are not good candidates for hormone therapy or prefer not to use hormones. Paroxetine is the only non hormonal therapy specifically approved by the FDA for hot flahes, but some relief has been found with gabapentin .