What Is The Best Type Of Hormone Replacement Therapy
While andropause is generally not treated as a definite phenomenon in mens lifecycles, menopause is identified by doctors as a definitive change in womens physiology that is characterized by a reduction in the secretion of particular hormones. Women are likely to begin experiencing menopause, post the age of fifty. Some women experience pre-menopause as early as in their late 30s.
For men, the main hormone in question is testosterone. Hormone replacement therapy typically involves a combination of testosterone and other hormones. However, in some cases, HRT for men is conducted with a few hormones like DHEA, HGH, thyroid hormones, progesterone and melatonin along with testosterone.
These hormones are not only essential, in the act of reproduction, but are extremely vital in the maintenance of bone density, muscle mass, keeping fatty tissue in balance, improving immunity and countering other conditions like erectile dysfunction.
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Hrt Today Key Points
The balance of benefit to harm always needs to be assessed but appears to have shifted favourably for HRT. Users can be reassured provided:
- HRT is taken for the correct reasons, i.e. to alleviate the symptoms of the menopause. It has a role in the prevention of osteoporosis but long term use is often required
- The dose and duration of HRT use should be made on an individual basis after discussing the risks and benefits. No arbitrary limit should be set on duration of use
- HRT users are assessed by their GP at least once a year.
If women start HRT around the time of menopause the risk is very small and there appear to be cardiovascular and bone protective benefits. It is not usually appropriate for women over 60 to be starting HRT but as the WHI study shows, women initiating it over 60 years do not seem to be at increased risk of cardiovascular events or mortality.
Many women seek advice on the effects of HRT on sexual activity and desire. Whilst there is no definitive answer, case studies indicate that the estrogen in HRT can help maintain or return sex drive. It will also help other menopausal symptoms such as vaginal dryness and pain with intercourse. If vaginal symptoms are the only problem, then the use of local vaginal estrogen or dehydroepiandrostenedione may be preferable. Separate factsheets on Sexual Health are available for download from the Womens Health Concern website.
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What Should I Know About Storage And Disposal Of This Medication
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from heat and moisture .
Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website for more information if you do not have access to a take-back program.
It is important to keep all medication out of sight and reach of children as many containers are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location â one that is up and away and out of their sight and reach.
Who Needs Hormone Replacement Patch
Hormone replacement therapy and bioidentical hormone replacement therapy patches let representatives of both genders ease their menopause symptoms thanks to a properly selected medication that involves regular consultations, tests, monitoring, and systematic intake of hormones in the form of oral drugs, implants, and HRT patches.
Female bodies enter the transition period after forty-five and can experience its negative effect for more than seven and even fourteen years without hormone patches. To the negative consequences of hormonal imbalance without timely application of HRT patches belong:
- severe headaches
- overall fatigue and body pain
- pain in the vagina during the sex act
- lack of calcium
HRT patches reviews state that females can suffer from above-enlisted symptoms without HRT patches or pills earlier as a result of surgery and cancer. Anomalous menopause occurs in women whose uterus and ovaries were extracted and in those whose body is exhausted by chemo- and/ or radiation therapy.
Speaking about males, menopause is also resulted by the aging process and the analogical to the womens surgery when the reproductive organs are removed. The reaction of the body resembles the one a female body and includes:
- energetic crisis
- overall muscle weakness
- low muscle mass
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What Are The Types Of Hormone Therapy
There are two main types of hormone therapy :
- Estrogen Therapy: Estrogen is taken alone. Doctors most often prescribe a low dose of estrogen to be taken as a pill or patch every day. Estrogen may also be prescribed as a cream, vaginal ring, gel or spray. You should take the lowest dose of estrogen needed to relieve menopause symptoms and/or to prevent osteoporosis.
- Estrogen Progesterone/Progestin Hormone Therapy : Also called combination therapy, this form of HT combines doses of estrogen and progesterone .
The Benefits Of Oestrogen
- Oestrogen reduces the severity and frequency of hot flushes by around 85%.
- Oestrogen improves vaginal dryness.
- Oestrogen reduces the risk of post-menopausal bone fracture, including hip fracture .
- Oestrogen use is not associated with weight gain .
- Women who go through menopause before 45 years are advised to take oestrogen until the age of average menopause at 50 years. The decision to continue oestrogen beyond 50 should be reviewed annually by the woman in consultation with her doctor .
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The Risks Of Oestrogen
Oral oestrogen increases the risk of blood clots . The risk increases with age and other risk factors such as obesity, previous thromboembolism, smoking and immobility. In women less than 60 years, the risk with oral oestrogen alone is 3 per 10,000 per year which is not significantly different from placebo.
- Oral oestrogen increases the risk of stroke and the risk increases with age. Stroke risk is not significantly increased in women younger than 60 years with normal blood pressure. The risk may be lower with lower doses and the use of transdermal oestrogen .
- Oral oestrogen is associated with an increased risk of gallbladder inflammation . There are no data regarding gel or skin patches.
- Oestrogen alone does not appear to increase the risk of breast cancer. The risk of breast cancer is primarily associated with combined oestrogen/progestogen therapy and related to the duration of use. Oestrogen alone has not been shown
to increase breast cancer risk in high quality randomized controlled trials . In a large observational study there was no significant increase in breast cancer with oestrogen only therapy for 20 years .
- Oestrogen alone commenced at the time of menopause does not increase the risk of coronary heart disease and may decrease the risk .
- For a fuller discussion of risk and benefit see the AMS Information Sheet Risks and Benefits of Menopausal Hormone Therapy.
Bioidentical Hormone Replacement Therapy
Bioidentical hormone therapy or bioidentical HRT can treat hormonal imbalances and depletion with a synthetic hormone that originated from plant estrogen. With that, you can say that bioidentical hormones are like hormones that have the same molecular structure as the ones that the human body can produce naturally. Moreover, the majority of BHRTs have plant hormones that mimic estriol, progesterone, dehydroepiandrosterone , and melatonin.
The two types of BHRT are United States Food and Drug Administration -approved BHRT, which are quite similar in terms of safety as the standard HRT medications, and custom-compounded BHRT medications, wherein a pharmacist would mix according to what the doctor prescribed.
The benefits of bioidentical HRT include the following:
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If Bioidentical Hormones Are The Next Step
We want you to know that if you and your healthcare provider determine you need hormone replacement therapy, there is a bioidentical option that will work well for you. It may take a few tries, but you are worth the effort. Understanding some basics will help you know what to ask for.
If youre looking for bioidentical hormone replacement therapy but dont want or cannot access compounded bioidentical hormones, there are some simple ways to cue your practitioner toward alternative forms of hormonal support rather than synthetics. Explain that:
- you dont want to take estrogen in conventional pill or capsule form.
- you dont want Premarin or Prempro conjugated equine estrogens or synthetic progesterone/progestin products in any form.
- youd prefer to stick with estradiol, a natural human estrogen, and Prometrium, which is bioidentical progesterone, at least to start with. . You may also want to ask your healthcare practitioner about Bi-Est in particular, which is a combination of estriol and estradiol . This combination may be safer than estradiol alone, and can be combined with bioidentical progesterone as well.
Often it is usually best to schedule a special appointment for discussing hormone therapy with your practitioner, so they allot enough time to answer all your questions rather than try to squeeze the topic in during a physical.
What If Hrt Isnt Right For Me Are There Other Options
Though HRT is the best overall treatment for many people, menopause symptoms can sometimes be managed with lifestyle changes and home remedies. Non-prescription herbs, supplements, and mindbody treatments may also be worth considering. About 50% of people will use some sort of natural treatment during menopause, and 60% find these treatments at least somewhat helpful. There are also several types of non-hormonal prescription medications that can help.
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Relief From Menopause Symptoms
HRT is the most effective treatment for menopause symptoms. Body-wide HRT can help with many symptoms, including:
Vaginal estrogen is especially good at helping with vaginal dryness and pain during sex. Vaginal estrogen may also help with urinary tract symptoms, like an overactive bladder and recurrent UTIs.
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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Protection For Your Bones And Colon
After menopause, many people experience bone loss. This can lead to osteoporosis, a condition where your bones become weak and brittle. People with osteoporosis are more likely to have bone fractures, which can lead to other problems.
Body-wide estrogen can help protect you against osteoporosis. Though there are other types of medications that can also help to protect your bones, HRT can be a good option if your osteoporosis medication isnt working or if theres a reason that you cant take this type of medication. Its also a great choice for bone protection if you have other symptoms of menopause, like hot flashes, night sweats, or mood changes.
Theres also some evidence that combination HRT may reduce your risk for colon cancer.
Cardiovascular Disease And Hrt
Women over 60 have a small increased risk of developing heart disease or stroke on combined oral HRT. Although the increase in risk is small, it needs to be considered when starting HRT, as the risk occurs early in treatment and persists with time.
Oestrogen used on its own increases the risk of stroke further if taken in tablet form, but not if using a skin patch. Similarly, tibolone increases the risk of stroke in women from their mid-60s.
Women who commence HRT around the typical time of menopause have lower risks of cardiovascular disease than women aged 60 or more.
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How To Use Premarin
Read the Patient Information Leaflet if available from your pharmacist before you start using this medication and each time you get a refill. If you have any questions, ask your doctor or pharmacist.
Take this medication by mouth with or without food as directed by your doctor. You may take it with food or right after a meal to prevent stomach upset.
If you are taking the extended-release tablets, do not crush, chew, or dissolve them. Doing so can release all of the drug at once, increasing the risk of side effects. Also, do not split extended-release tablets unless they have a score line and your doctor or pharmacist tells you to do so. Swallow the whole or split tablet without crushing or chewing.
The dosage is based on your medical condition and response to treatment.
Take this medication regularly to get the most benefit from it. To help you remember, take it at the same time each day as directed. Follow your dosing schedule carefully. Do not increase your dose or take this medication more often or for a longer time than directed.
Tell your doctor if your condition does not improve or if it worsens.
Frequently Asked Questions Expand All
When progestin is added, it can come in different forms, including pills you take by mouth, or tablets and gels you place in the vagina. The intrauterine device , which releases progestin, also may be an option. Progestin also can be combined with estrogen in the same pill or patch.
You and your obstetriciangynecologist can talk about what form may work best for you. You can decide based on your symptoms, medical history, and lifestyle.
Estrogen-only therapy is taken daily. There are two ways to combine estrogen and progestin for women who still have a uterus:
Continuous-combined therapy: Both estrogen and progestin are taken every day.
Cyclic therapy: Estrogen is taken daily. Progestin is added for 10 to 14 days each month . Another name for this is sequential hormone replacement therapy.
You and your ob-gyn can discuss the approach that works best for you.
Talk with your ob-gyn about what may work best for you based on your symptoms and your personal and family medical history. If you decide to take hormone therapy, you and your ob-gyn should talk every year about whether to continue hormone therapy. Each year, this decision will depend on your symptoms, risks, and benefits. Some women may need longer therapy if their symptoms go on for a long time.
Both systemic and local estrogen therapy relieve vaginal dryness.
Breast or endometrial cancer
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Do I Need A Prescription For Hormone Replacement Therapy
Yes. In the U.S., HRT is not available without a prescription. Because of the potential risks involved, you should talk with a healthcare provider before starting HRT.
Though its possible to get HRT over the internet or through the mail, you should be wary of any online pharmacies willing to sell hormones without a prescription. If you do get your medications online, make sure you use only a provider verified by the National Association of Boards of Pharmacy, like GoodRx.
If you are interested in getting a prescription for HRT, you can talk to your healthcare provider about options. Some people may prefer to work with an OB-GYN or menopause specialist.
You can also consider a telehealth consultation like GoodRx Care an especially convenient option during COVID-19. There are even menopause-specific telehealth options for managing all of your care from home. If finances are a challenge, many free clinics and Planned Parenthood are offering virtual options during COVID-19.