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Hormone replacement therapy is a treatment that includes female hormones. The drug is used to replace the estrogen that your body stops producing throughout menopause. Hormone therapy is commonly used to treat menopausal symptoms such as hot flashes and vaginal discomfort.
Hormone therapy has also been shown to improve bone loss and fracture risk in postmenopausal women.
However, there are certain hazards to adopting hormone therapy. These risks vary depending on the type of hormone therapy, the dose, the length of time the medication is taken, and your personal health risks. Hormone therapy should be adjusted to each individual and reevaluated on a regular basis to ensure that the benefits continue to outweigh the hazards.
WHAT ARE THE TYPES OF HORMONE THERAPY?
Hormone replacement therapy is largely concerned with replacing estrogen, which your body no longer produces after menopause. Estrogen therapy is classified into two types:
- Systemic hormone therapy: Systemic estrogen, which can be taken as a pill, skin patch, ring, gel, lotion, or spray, contains a larger amount of estrogen that is absorbed throughout the body. It can be used to treat any of the common menopausal symptoms.
- Low-dose vaginal products: Low-dose vaginal estrogen treatments, which come in cream, tablet, or ring form, reduce the amount of estrogen absorbed by the body. As a result, low-dose vaginal treatments are often solely used to treat menopausal vaginal and urinary symptoms.
If your uterus has not been removed, your doctor will usually prescribe estrogen in conjunction with progesterone or progestin (progesterone-like medication). This is due to the fact that estrogen, when not balanced by progesterone, can drive uterine lining growth, raising the risk of endometrial cancer. You may not need to take progestin if you have had your uterus removed (hysterectomy).
WHAT ARE THE RISKS OF HRT?
Hormone replacement therapy using an estrogen-progestin tablet (Prempro) increased the risk of certain serious conditions in the largest clinical trial to date, including:
- Heart disease
- Stroke
- Blood clots
- Cancer of the breast
Subsequent research has indicated that these hazards differ based on:
- Age: Women who begin hormone therapy at age 60 or later, or more than 10 years after menopause, are at a higher risk of the aforementioned illnesses. However, if hormone therapy is started before the age of 60 or within the first ten years of menopause, the advantages appear to exceed the dangers.
- The type of hormone therapy: The hazards of hormone therapy differ depending on whether estrogen is administered alone or in combination with progestin, as well as the dose and kind of estrogen used.
- Health history: Your family history, personal medical history, and risk of cancer, heart disease, stroke, blood clots, liver disease, and osteoporosis are all significant considerations when deciding whether hormone replacement therapy is right for you.
All of these concerns should be discussed with your doctor before choosing whether hormone therapy is right for you.
WHAT ARE THE BENEFITS OF HORMONE THERAPY?
If you're healthy and meet the following criteria, the benefits of hormone therapy may exceed the risks:
- You have hot flashes that range from mild to severe: Systemic estrogen therapy is still the most effective treatment for menopausal hot flashes and night sweats.
- You have other menopausal symptoms: Estrogen helps alleviate menopausal vaginal symptoms such as dryness, itching, burning, and pain during intercourse.
- You need to prevent bone loss or fractures: Systemic estrogen protects against osteoporosis, a bone-thinning condition. However, doctors typically prescribe bisphosphonates to treat osteoporosis. However, estrogen therapy may be beneficial if you are unable to tolerate or benefit from other treatments.
- You have early menopause or an estrogen deficiency: If you had your ovaries surgically removed before the age of 45, stopped having periods before the age of 45 (premature or early menopause), or lost normal ovarian function before the age of 40 (primary ovarian insufficiency), your body has been exposed to less estrogen than women who go through typical menopause. Estrogen therapy can help reduce your risk of developing certain health disorders such as osteoporosis, heart disease, stroke, dementia, and mood swings.
HOW CAN YOU LOWER YOUR RISK IF YOU USE HORMONE THERAPY?
Discuss the following strategies with your doctor:
- Choose the best product and method of delivery for you: You can take estrogen in the form of a tablet, patch, gel, vaginal cream, slow-releasing suppository, or vaginal ring. If you just have vaginal symptoms from menopause, estrogen in the form of a low-dose vaginal cream, tablet, or ring is usually a better option than an oral pill or a skin patch.
- Reduce the number of medications you take: Use the smallest effective dose for the shortest possible time to address your symptoms. If you are under the age of 45, you require adequate estrogen to protect you against the long-term health implications of estrogen insufficiency. If you have persistent menopausal symptoms that significantly impede your quality of life, your doctor may advise you to seek longer-term treatment.
- Seek routine follow-up care: Consult your doctor on a frequent basis to check that the benefits of hormone therapy exceed the risks, as well as for tests like as mammograms and pelvic exams.
- Choose a healthy way of life: Include physical activity and exercise in your daily routine, eat a nutritious diet, maintain a healthy weight, don't smoke, drink in moderation, manage stress, and manage chronic health concerns like high cholesterol or high blood pressure.
You'll need progestin if you haven't had a hysterectomy and are doing systemic estrogen therapy. Your doctor can assist you in determining the delivery method that provides the most benefits and convenience while posing the fewest dangers and costs.
WHAT ARE HORMONE THERAPY SIDE EFFECTS?
Hormone therapy, like practically all drugs, has side effects. The following are the most common side effects:
- Monthly bleeding (if you have a uterus and use cycled progestin [estrogen for 25 days of estrogen per month, progesterone for the last 10 to 14 days per month, and 3 to 6 days of no medication]).
- Irregular spotting.
- Tenderness in the breasts.
- Mood swings.
Hormone therapy's less common side effects include:
- Retention of fluid.
- Headaches (including migraine).
- Discoloration of the skin (brown or black spots).
- Breast density, which increases the difficulty of interpreting mammograms.
- Skin irritation caused by an estrogen patch.
How can I minimize the negative effects of hormone therapy (HT)?
In most situations, these adverse effects are minor and do not necessitate stopping your HT. If your symptoms are bothering you, talk to your doctor about modifying the dosage or the type of the HT to decrease the negative effects. Never change or discontinue your medicine without first visiting your provider.
WHAT CAN YOU DO IF YOU'RE UNABLE TO RECEIVE HORMONE THERAPY?
Menopausal hot flashes may be manageable by healthy lifestyle changes such as staying cold, reducing caffeinated beverages and alcohol, and practicing timed relaxed breathing or other relaxation techniques. There are also a number of nonhormone prescription drugs that may assist alleviate hot flashes.
A vaginal moisturizer or lubricant may provide relief for vaginal issues such as dryness or uncomfortable intercourse. You could also talk to your doctor about the prescription medicine ospemifene (Osphena), which may help with painful intercourse bouts.
HOW LONG SHOULD I CONTINUE TAKING HORMONE THERAPY?
In general, there is no time limit on the duration of hormone therapy. You should use the lowest effective dose of hormone therapy and continue routine monitoring with your healthcare professional to reevaluate your treatment plan once a year. If you develop a new medical condition while using HT, consult your provider to determine whether you should continue taking it.
CONCLUSION
The decision to use hormone therapy must be highly customized. Hormone therapy is not appropriate for everyone. Discuss the risks and advantages of hormone therapy with your healthcare physician during an office appointment dedicated to this topic. You'll need time to handle all of the concerns and answer all of the questions before making the best selection for you. Your age, family history, personal medical history, and the severity of your menopausal symptoms should all be taken into account.
Discuss the benefits and drawbacks of various types and forms of HT, as well as non-hormonal solutions such as dietary changes, exercise and weight control, meditation, and other options.