Hormone replacement therapy is the term used to describe the administration of hormones in postmenopausal women. It is an attempt to alleviate the symptoms that often occur as a result of hormone deficiency. When HRT was first introduced on the market, there was great optimism that it would have anti-aging benefits but this was quickly dispelled when many of the negative effects came to light. Traditionally HRT meant a combination of estrogen and progestin but in some instances might include testosterone.
Most HRT preparations contain a daily dose of estrogen and either a 14-day dose of progestin or a daily dose of progestin. The primary purpose of the progestin is to prevent endometrial hyperplasia and subsequent endometrial cancer. HRT dosage was initially designed to simulate the normal menstrual cycle. The use of a daily low dose progestin along with estrogen was found to have a number of advantages; thus the advent of the two most popular administration schedules.
After many decades of research and experience using various formulations of HRT, we have learned a lot. Currently HRT is recommended for the relief of moderate-severe vasomotor symptoms due to menopause. Estrogen is considered to be the “gold standard” for the relief of hot flashes and night sweats. Internal estrogen is the first choice in the treatment of urogenital atrophy. Previously, HRT was thought to provide some benefits in the prevention of certain chronic diseases such as heart disease and osteoporosis. Even though there are select benefits, HRT is no longer recommended for the prevention of chronic diseases. When prescribed, it should be used for the shortest interval possible, no more than 2-3 years.
As with all therapies, there are some down sides. HRT is not the miracle youth pill it was initially touted to be. Estrogen alone, given to women who still have their uterus can lead to endometrial cancer. There is now a proven association between HRT and the development of breast cancer. HRT increases the chance of venous thromboembolism, pulmonary emboli and stroke. In older, postmenopausal women the risk of coronary heart disease is also increased. Finally, oral HRT can have an adverse effect on the circulating lipid levels, which in turn increases the risk of cardiovascular disease.
Even though HRT is not the wonder drug it was initially promoted as, it has still provided tremendous benefits for many generations of women. Menopausal symptoms can have a significant impact on the quality of life, including the family and friends of those affected. It is the duty of the healthcare provider to take a thorough history, perform a complete physical examination and give in depth counseling before prescribing HRT. Women who have a history of breast cancer, stroke, coronary heart disease, thromboembolic event, and active liver disease should not use HRT. It is important to understand your risks and the potential benefits before starting any medications, including HRT.
I hope this article has provided you with information that will help you make wise choices, so you may:
Live healthy, live well and live long!