The Truths and Myths About Hormone Replacement Therapy

Beginning the Discussion

Hormonal replacement therapy in women generally aims to supplement any deficiencies in estrogen and progesterone due to congenital anomalies like hypogonadism, premature ovarian failure, menopause or surgical removal of ovaries. Estrogen is essential for the healthy reproductive development and secondary sexual characteristics that arise later.







Contextual Background

There are some things we just don’t get anymore… Premenopausal women unable to produce enough female sexual hormones may benefit from estrogen therapy combined with progestin (synthetic derivatives of progesterone) to mimic the natural cycle and promote secondary sexual development; this therapy must continue throughout life. Hormonal replacement therapy for postmenopausal women has recently come under scrutiny due to new revelations regarding its potential adverse side effects. At first, hormonal replacement therapy for postmenopausal women was initiated as an attempt to alleviate some of the distressing and unwanted features experienced after cessation of menstruation/ovulation cycles and subsequent decrease in estrogen levels in their bodies. These features include vasomotor symptoms such as hot flushes and atrophy of vagina, vulva, urethra and trigone of bladder; decreased bone remodeling leading to osteoporosis and an increase in myocardial infraction risk – it was thought that exogenous estrogen might help alleviate some of these features.

Later research indicated that some of the expected benefits of hormone replacement therapy weren’t actually present and may expose women to more risks than benefits. Due to these findings, there was a marked reduction from 16 million women prescribed hormone therapy in 2001 to just 6 million in 2006 in the USA. Studies have also demonstrated that the therapeutic effects and risks associated with hormone replacement therapy depend upon factors like type of estrogen/progesterone used, age of start up of therapy, health status of patient as well as duration. HRT may increase the risk of breast cancer, particularly lobular carcinoma and ductal lobular cancer after its use for at least eight to ten years, as well as increase venous thromboembolism, deep vein thrombosis and stroke risk. Women undergoing chemotherapy treatments during their initial two years and those predisposed to hypercoagulable states due to hereditary diseases that result in mutation of V Lieden factor or other clotting factors are at greater risk than other groups. Studies have demonstrated that estrogen alone increases endometrial cancer risks 3-6 fold after 5 years and over 10 fold after 10 years of therapy. Therefore, when providing hormone replacement therapy today, progestin must always be combined with estrogen in order to lower the risks of endometrial carcinoma in women who have not undergone hysterectomy. Conversely, for those who have already had their uterus removed unopposed estrogen therapy should be used due to possible unwanted side-effects from adding progestin that might change lipid profiles unfavorably and limit estrogen’s beneficial effects on lipid parameters.

Benefits of Hormone Replacement Therapy

Hormone Replacement Therapy has shown to halt atherosclerosis progression and lead to lower rates of coronary heart disease; however, its effect is only visible among women under 60 who began HRT early. Younger women may experience this effect due to estrogen receptors helping maintain homeostasis of calcium ions in blood vessels. Studies conducted since menopause have demonstrated little or no beneficial effect of estrogen on decreasing myocardial infarction risk; thus, its role in managing cardiovascular diseases among postmenopausal women remains debatable. Estrogen can reduce bone resorption and help decrease fracture risk, helping women prevent future breaks. So far, calcium supplements have proven effective for both treating and preventing osteoporosis; however, due to recently identified adverse side effects and new guidelines regarding other therapies like alendronate-based drugs for treating osteoporosis should be given preference as initial therapies for treatment of this disease. Diet and exercise that increase calcium consumption may help delay or stop osteoporosis without resorting to hormone replacement therapy (HRT). According to the America Menopause Society’s guidelines, HRT should be administered with minimal dose and duration in order to treat postmenopausal symptoms such as hot flushes and vaginal atrophy as well as mitigate its well-known risks factors.

Common Questions About Hormone Replacement Therapy

1. What are the symptoms and signs that indicate someone needs HRT or hormone replacement therapy (HRT)?

As hormone levels decline, symptoms such as mood changes, hot flashes, fatigue, sleep issues and vaginal dryness become evident. HRT provides an additional boost to balance out body’s natural hormone levels to alleviate symptoms by augmenting natural levels with synthetic hormones to rebalance them and alleviate them. HRT may include female hormones like estrogen plus progesterone therapy or estrogen alone as the solution.

2. What are my options for the safest HRT treatment?

Estrogen-only treatments have proven highly protective for breast cancer. Women under 60 can safely take these pills, helping reduce heart attack risk as well as blood clot or stroke risks.

3. What are the potential adverse reactions of Hormone Replacement Therapy (HRT)?

HRT may cause side effects including headache, bloating, breast tenderness or swelling, mood changes, nausea and vaginal bleeding.

4. Which doctor provides hormone replacement therapy?

Spartan Medical Associates’ endocrinologists specialize in diagnosing and treating various internal medical conditions, such as diabetes or hormonal disruptions or changes.

5. How long should an individual remain on hormone replacement therapy (HRT)?

HRT should last between one and five years, depending on individual patient circumstances. Women who underwent uterine resection or removal can take estrogen supplementation alone as treatment.

6. At what age is hormone replacement therapy appropriate?

Hormone replacement therapy typically begins for adolescents around 16 years of age and should ideally begin prior to developing secondary sexual characteristics. HRT is not commonly practiced among children.

7. Does HRT help people appear younger?

HRT supplements the natural hormone levels found within your body, helping maintain younger-looking, smoother and more beautiful skin. Puberty determines much of a person’s facial features; as we age our estrogen levels naturally decline causing facial structure changes that must be made up later in life through increasing estrogen. As such, taking HRT can improve facial skin appearance in later life.


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