Hormonal Replacement Therapy or HRT is a treatment that is used to help relieve the symptoms of menopause. When a woman enters menopause that is at around the age of 50; however, some women go through menopause as early as their 30s and 40s the levels of hormones, namely Estrogen and progesterone drop dramatically. Estrogen and progesterone these two hormones play a vital role in a woman’s body.
Estrogen is responsible for the release of an egg through the process of ovulation every four weeks, maintaining bone density, the temperature of the skin and moistness of the vagina. Progesterone is responsible for the thickening of the uterine lining to prepare for pregnancy. With the fall in the levels of these hormones, especially Estrogen, a woman’s body goes through scores of physical and emotional changes like:
- bone thinning, or osteoporosis
- vaginal dryness
- hot flashes and night sweats
- mood swings
- sleep problems
- concentration and memory difficulties
- loss of libido (sex drive)
Most of the symptoms mentioned above pass in 2-3 years; however, vaginal dryness gets worse. It is through Hormone replacement therapy. These symptoms can be alleviated. Hormone replacement therapy helps in replacing the levels of these hormones.
Benefits of Hormonal Replacement Therapy
During menopause, usually around the age of 50 the levels of the two most important hormones namely Estrogen and progesterone fall the body which causes various physical and emotional distress including hot flashes, vaginal dryness, mood swings, bone thinning or osteoporosis etc.
Hormonal replacement therapy helps in restoring the levels of those hormones and thus helps in relieving the symptoms of menopause to a great extent. Although it is not advisable to take hormonal replacement therapy as a long term option as long term use can cause various side effects and risks of developing breast cancer, uterine cancer, blood clots and cardiovascular diseases. However, when used as a short term treatment, the benefits outweigh the risks.
Some of the benefits of taking Hormonal replacement therapy are seen in relieving the symptoms of menopause like:
- hot flashes
- night sweats
- mood swings
- vaginal dryness
- reduced sex drive
Some added benefits of hormonal replacement therapy are:
- Diabetes – reduction in the risk of developing diabetes when taken by menopausal women
- Osteoporosis – with menopause comes osteoporosis or bone density loss, hormonal replacement therapy can greatly help in slowing down the bone loss and preventing the risk of fractures which is helpful especially in premenopausal women below 60 years of age.
- Colon Cancer – when used at the time of menopause hormonal replacement therapy can reduce the risk of developing colon cancer.
- Cardiovascular diseases – Hormonal replacement therapy also helps in reducing the risk of developing cardiovascular diseases.
Types of Hormonal Replacement Therapy
Hormonal therapy hormones help in replacing the levels of hormones in a woman’s body which is lowered during menopause. These two hormones that are used in this treatment are:
- Estrogen – this is taken from either plants or the urine of pregnant horses
- Progesterone – a synthetic form of progesterone known as progesterone is used since it is easier for the body to absorb
Women can either take the Estrogen only hormone replacement therapy or a combination of Estrogen and progesterone. However, taking Estrogen, only HRT raises the risk of developing endometrial cancer. Taking it along with progesterone helps in minimizing this risk. The main types of Hormonal replacement therapy are;
- Estrogen only HRT – It is recommended for those women that have had a hysterectomy or the removal of the uterus and ovaries. There is no need to take the progesterone as there is no risk of endometrial cancer involved. Learn more about types of estrogen replacement therapy in our blog Which Estrogen Therapy is Right For You?
- Cyclical or sequential HRT – This is recommended for those women that still have their periods but are experiencing menopausal symptoms.
Types of cyclical hormonal replacement therapy:
- Monthly HRT – where Estrogen is taken every day, and progesterone is taken at the end of the menstrual cycle for 12-14 days. This type of therapy is recommended for women that have a regular menstrual cycle.
- 3 – monthly HRT – where Estrogen is taken every day, and progesterone is taken for 12-14 days every 13 weeks. This type of therapy is recommended for women that have an irregular menstrual cycle.
- Continuous HRT – This type of therapy is taken by postmenopausal women. Here a combination of Estrogen and progesterone is taken every day without a break.
- Long cycle HRT – In this patient experiences withdrawal bleeding every three months instead of every month. This is generally recommended for women that experience side effects when they take progesterone. Its safety has not to be proven.
- Local Estrogen – Under local Estrogen comes vaginal tablets, creams and rings. It can help with vaginal dryness and irritation.
Risks Related To Hormonal Replacement Therapy
When women near the age of 50 their bodies go through various physical and psychological changes brought on by the onset of menopause or a period when the ovaries no longer produce and egg every four weeks and the levels of the hormone estrogen drop below the normal levels. The drop in Estrogen causes the following changes in the body:
- vaginal dryness
- hair thinning
- loss of libido or sex drive
- hot flashes or night sweats
- accumulation of fat around the abdomen
- osteoporosis or loss of bone density making them more prone to fractures
Hormonal replacement therapy or HRT is a treatment that uses the two hormones Estrogen and a synthetic version of progesterone known as progesterone to replace the low levels of hormones in the body thereby keeping in check the various symptoms of menopause.
Its main benefit is that it helps in slowing down the pace at which a woman loses bone density due to menopause. Apart from that, it also helps in reducing the risk of developing colon cancer, diabetes, and cardiovascular diseases. Though the benefits of hormonal replacement therapy outweigh its risks, yet its risks cannot be ruled out and need to be considered before opting for an HRT.
a) Breast cancer and HRT
According to the Cancer Research UK, women taking HRT have a higher risk of developing breast cancer. This risk is more when taking the combination HRT as compared to an estrogen-only HR. The longer women take HRT, the higher is the risk of developing breast cancer. However, when a woman stops taking HRT within five years of it, the risk of developing breast cancer drops to normal. Types of HRT like medroxyprogesterone acetate and norethisterone have higher risks than dydrogesterone and progesterone.
b) Cardiovascular disease and HRT
When taking the combined form of hormonal replacement therapy women over 60 have a small risk of developing cardiovascular diseases and stroke. If taken in pill form rather than a patch estrogen only HRT can increase the risk of stroke further. Women that take HRT at the onset of menopause are at a lower risk of developing cardiovascular diseases compared to women at 60 and above
c) Venous thrombosis and HRT
These are blood clots that occur in a vein in the body, usually in the legs. It causes pain, swelling and tenderness in one of your legs (usually your calf or thigh). Hormonal replacement therapy in postmenopausal women usually under 50 and women aged 50-60 have a higher risk of developing venous thrombosis, this risk is highest at the immediate initiation of the hormonal replacement therapy which drops to the same low level as in non-HRT users when it is discontinued. The risk is seen when HRT is used in combination of Estrogen and progesterone usually in a pill form.
d) Endometrial cancer and HRT
In women that have had a hysterectomy or the surgical removal of the uterus and ovaries taking Estrogen, only HRT does not increase the risk of developing endometrial cancer. However, in women that have not had a hysterectomy using the Estrogen, only HRT greatly increases the risk of them developing endometrial cancer. This risk can be avoided if a combination of Estrogen and progesterone HRT is used.
e) Ovarian cancer and HRT
Taking HRT increases the risk of developing ovarian cancer slightly. However, the risk returns to normal after it is discontinued. HRT is linked to developing two types of tumours, namely- serous and endometrioid cancers.
f) Cholecystitis and HRT
Cholecystitis is the inflammation of the gall bladder, and it is often caused by stones that block the way leading from the gall bladder towards the small intestines. The Estrogen used in HRT is the main cause of Cholecystitis. This condition is benign in nature, and it can be treated through surgical removal of the gall bladder.
Frequently Asked Questions About HRT
Although there are various benefits of taking HRT from relieving menopausal symptoms to the prevention of serious illnesses like diabetes, stroke, colon cancer, there are certain risks involved. Hormonal replacement therapy should not be taken by women that have a history of:
- breast cancer, ovarian cancer or womb cancer
- blood clots or thrombosis
- untreated high blood pressure
- liver disease
- heart diseases
It should not be used by women that are pregnant or may become pregnant.
The use of hormonal replacement therapy has been linked to increases in the risk of developing endometrial, breast and ovarian cancer. According to two studies published by the Women’s Health Initiative (WHI) in the year 2002 and 2003. Another study published in The BMJ in the year 2012 came to a conclusion that “HRT may or may not increase the risk of breast cancer.” Instead, it was seen that hormonal replacement therapy might actually:
- improve muscle function
- reduce the risk of heart attacks and heart failure
- prevent skin ageing if used cautiously
Though there are risks as well as benefits involved, the benefits seem to outweigh the risks. It is highly advisable to consult a doctor before starting hormone replacement therapy, to be well versed with all the risks and benefits involved.
To summarize, it is apparent that the benefits of hormonal replacement therapy outweigh its risks. Hormonal replacement therapy helps women in relieving the symptoms of menopause, thereby improving their overall quality of life and general well being. It can stop the progression of osteoporosis or bone density loss which a major cause of concern in menopausal women. Not only does it help with osteoporosis, but it also helps in lowering the risk of developing diabetes, cardiovascular diseases, colon cancer.
Short term use of hormonal replacement therapy helps in relieving menopausal symptoms to a great extent. Some women also opt for long term use of hormonal replacement therapy for continued relief of the symptoms. Usually, women are started out on low doses which can be assessed depending on the duration of use and reasons for use.
Women undergoing hormonal replacement therapy need to follow up with their doctor at least once a year. It is highly important to consult a doctor before starting hormone replacement therapy to know about the pros and cons of i to conclude as to what type of hormonal replacement therapy is best suited for them. Many factors come into play here when it comes to choosing what type of hormonal replacement therapy to opt for like the age of the patient, risk factors, medical history and person liking.