Hormone Replacement Therapy

What is menopause?

Absence of uterine bleeding for a year, especially when accompanied by typical symptoms is a clinical definition of menopause.
The average age in the US is around 51-52.

What are the symptoms of menopause?

The absence of estrogen in the body affects women differently. Some women have no symptoms. Most women have one or more of several symptoms:

  • Hot flushes
  • Night sweats
  • Vaginal dryness
  • Mood swings
  • Depression
  • Decreased libido
  • Skin dryness
  • Arthritis-like symptoms
  • Mental dysfunction

Why use HRT?
A woman with no or minimal menopausal symptoms usually does not seek HRT.

Studies have shown that estrogen replacement can reduce or eliminate moderate to severe menopausal symptoms, leading to improved quality of life(QOL).

Hot flashes and night sweats lead to sleep deprivation which can affect mood, mental function and other QOL. Some women do not experience hot flashes or night sweats but report sleep and/or mental QOL is vastly better on HRT.

All the symptoms described above are relieved by HRT in most women.

What does HRT mean anyway?
Modern medical science led to production of estrogen for human consumption and had an enormous impact on QOL for many women.

 Progesterone, testosterone and other minor metabolites of these hormones are also available now.

HRT can mean single or multiple hormones being replaced to relieve menopausal symptoms. HRT can be given orally, transdermally or by subcutaneous implant. These can be commercial FDA approved prescriptions or compounded formulas.

FDA approved HRT means a pharmaceutical company has gone through a rigorous process of proving safety and effectiveness. They are available by prescription and are covered to some extent by insurance.

Compounded preparations are not overseen by the FDA and cannot make claims of proven safety and effectiveness. However, scientific knowledge about how these hormones work is known and should not deter a woman from seeking compounded products when the benefit outweighs the risk. This is a decision made between doctor and patient.

What is bio-identical HRT?
Bio-identical HRT is a “buzz” phrase. You want to feel better. Bio-HRT sounds cool. Is it worth the cost?

In general Bio-HRT refers to transdermally absorbed hormones. A woman needs to know about the science of HRT to make an informed decision. FDA approved products have the most accurate data.

Estrogens available for E-HRT are E1(estrone), E2(estradiol) and E3(estriol). E2 is the most potent, and used in FDA approved transdermal HRT. Addition of E1 and E3 has sub-accurate data to support any benefit.

Testosterone science reports modest improvement of libido in postmenopausal women. T-HRT with E-HRT may also help libido in women without ovaries. Considerable sexual dysfunction is relationship related.

Progesterone HRT is necessary if a woman has her uterus. It is not considered necessary after hysterectomy. How to give P-HRT should be individualized.
What should I know about oral HRT?
Generic oral E-HRT can cost as little as $5 per month. The risk compared to transdermal HRT is relatively minimal. Oral progesterone-like meds are also inexpensive. Oral progesterone is available. Because of intestinal metabolism some women report drowsiness and better sleep when they take it in the evening.

What are the Risks?

Uterine cancer
E-HRT in combination with P-HRT reduces the risk of uterine cancer. E-HRT only is ok after hysterectomy.

Breast Cancer
E-HRT alone may not increase the risk of breast cancer. For women who take P&E-HRT there is a reasonable estimate of a 1% increased risk of a breast cancer after five years.

Blood Clots
HRT increases risk. Oral appears slightly riskier. Smoking, obesity and other medical conditions also affect risk. If the risk of a clot was 1 in 1,000, is 2 in 1,000 okay risk to feel normal again?

P&E-HRT may be a problem for women with endometriosis. E-HRT alone is usually not a problem.

HRT has minimal risk for women with high blood pressure.

Weight gain
Weight gain due to HRT is minimal to none in large controlled trails.

This is a nuisance for some women on HRT. Ultrasound is usually the first step. Biopsy is not always necessary.

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