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Home > Woman Corner > Drugs / Classess of Drugs > Hormone Replacement Therapy HRT

Written By: Abier Hamami. RPH. CPHQ

Abstract: Hormone Replacement Therapy (HRT) is commonly used to help control the symptoms of menopause for some women. There are many things to learn about HRT before you make the choice that is right for you.

What Is Hormone Replacement Therapy?
What Is HRT Used For?
How Is HRT Taken?
Are Their Specific Tests Needed Before HRT Is Prescribed?
What Are The Side Effects Of HRT?

What Are The Benefits And Risks Of HRT?
Based On This Information Should Women Take HRT?
What Are Natural Hormones?

What Is Hormone Replacement Therapy?
Hormone Replacement Therapy (HRT) or what is also known as Menopausal Hormones, is a treatment with prescription hormonal medications to restore a woman's declining hormone levels. HRT usually involves treatment with either estrogen alone or estrogen in combination with progesterone or progestin, a synthetic hormone with effects similar to those of progesterone.

What Is HRT Used For?
HRT is usually prescribed by physicians to counter some of the problems often associated with the onset of menopause as hot flashes, night sweats, sleeplessness, and vaginal dryness, or to prevent some long-term conditions that are more common in postmenopausal women, such as osteoporosis. Also among women who are prescribed these hormones, women who have undergone a surgery to remove the uterus or the ovaries even at a younger age to counteract the effect of what is called induced menopause.

How Is HRT Taken?
There are many different ways to take HRT and many different combinations and dosages, all of which means that there are more options for women.

Estrogen comes in many forms and dosages. You could use a skin patch or vaginal tablet or cream, take a pill, or get an implant, shot, or vaginal ring insert. Progesterone or progestin is often taken as a pill, sometimes in the same pill as the estrogen. It also comes as a patch, shot, IUD (intrauterine device), vaginal gel, or pessary.

The form your doctor suggests may depend on your symptoms. For example, patches or pills can relieve hot flashes, night sweats, and vaginal dryness. Other formsvaginal creams, tablets, or ringsare used for vaginal dryness. The vaginal ring insert might also help some urinary tract symptoms. But, the dose found in these other forms is probably too low to relieve hot flashes.

Are Their Specific Tests Needed Before HRT Is Prescribed?
HRT is not appropriate for all women. Therefore, the doctor should have a number of initial tests before he decides to prescribe it. These tests may include:

  • Breast examination
  • Internal pelvic examination
  • Blood pressure
  • Thyroid function
  • Measurement of weight and height in order to determine body mass index (BMI)

While you are taking HRT your blood pressure should be checked every six months and you should continue having regular cervical smears and breast screening.

What Are The Side Effects Of HRT?
Common side effects include breast tenderness, nausea, headaches, leg cramps, irregular bleeding, weight gain and bloating. Less common side effects are reduced sex drive, depression, vaginal bleeding, and pains in the chest, groin and legs. Inflammation and itching has sometimes been reported with skin patches.

Progestogens may cause various symptoms including swollen feet and ankles, premenstrual tension, weight gain, breakthrough bleeding (that is when bleeding occurs at times other than the expected monthly bleed) depression and jaundice.

Adverse effects should always be reported to your doctor and those in the less common group are of more concern.

What Are The Benefits And Risks Of HRT?
Much of the HRT benefits and risks determined are based on the Womens Health Initiative (WHI), an important clinical trial funded by the US National Institutes of Health. This study looked at estrogen (conjugated equine estrogens) used alone or with a particular progestin (medroxyprogesterone acetate) for postmenopausal women. Both the WHI estrogen-plus-progestin trial and estrogen-alone trial were halted early because the health risks of the hormones studied exceeded benefits.

HRT has the following benefits;

Relieves hot flashes, night sweats, and vaginal dryness

Reduces risk of bone fractures

Improves cholesterol levels

Reduces risk of colon cancer ( not certain for estrogen when used alone)

And it increases the risks of :

Stroke

Serious blood clots

Heart attack ( not with estrogen if used alone)

Breast cancer (not with estrogen if used alone)

Increases risk of dementia, when begun by women age 65 and older

As the series of WHI results became available, the FDA encouraged manufacturers to update their labels for estrogen- and progestin-containing drug products for postmenopausal women to include the information of these results.


For more information on updated labels for HRT products visit this link:

Based On This Information Should Women Take HRT?
Whether to take HRT or other alternatives appropriate for menopausal symptoms is a mutual decision between women and their doctors. Only a physician can help you weigh the potential risks of therapy against the potential benefits to make an informed decision.

The U.S. Food and Drug Administration (FDA) currently advises women to use HRT for the shortest time and at the lowest dose possible to control menopausal symptoms.

There are still a lot of unresolved questions that researchers should find answers to. These questions include whether different forms of the hormones, lower doses, different hormones, or different methods of administration are safer or more effective; whether risks and/or benefits persist after women stop taking hormones; whether women might be able to take hormones safely for a short period of time; and whether certain subgroups of women, including women with a history of cancer, might be at higher or lower risk than the general population.

What Are Natural Hormones?
The natural hormones are estrogen and progesterone made from plants such as soy or yams. The compounded natural hormones are not regulated and approved by the U.S. Food and Drug Administration (FDA). So, we dont know much about how safe or effective they are or how the quality varies from batch to batch.

References:

http://www.nlm.nih.gov/medlineplus/hormonereplacementtherapy.html

http://www.niapublications.org/tipsheets/hormones.asp

http://www.fda.gov/cder/drug/infopage/estrogens_progestins/default.htm

http://www.cancer.gov/cancertopics/factsheet/Risk/menopausal-hormones

http://pillslib.com/women-health

http://www.medem.com/medlb/article_detaillb_for_printer.cfm?article_ID=ZZZACTPUCKC&sub_cat=0

http://www.fda.gov/womens/menopause/mht-FS.html

http://www.thirdage.com/healthgate/files/19829.html

http://www.womenshealthlondon.org.uk/leaflets/hrt/hrt.html

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