When women enter menopause in their 50s, for some it could be as early as their 30s and 40s, the levels of two important hormones, namely estrogen and progesterone, drop below what is considered normal. Estrogen and progesterone these two hormones play a very important role in a woman’s body and how it functions.
Estrogen is responsible for the release of an egg through ovulation every month. It also helps in maintaining bone density, maintaining the temperature of the skin and the moistness of the vagina. While progesterone is responsible for the thickening of the uterine lining to prepare for pregnancy. With the fall in the level of these hormones, especially estrogen, a woman’s body goes through some drastic physical and emotional changes, namely:
- hot flashes and night sweats
- vaginal dryness
- loss of libido (sex drive)
- sleep problems
Hormonal Replacement Therapy
Hormonal Replacement Therapy or HRT is a treatment that is used to help relieve these symptoms of menopause. It helps in the restoration of the levels of these hormones and thus helps in relieving the symptoms of menopause to a great extent.
However, it is not advisable to take hormonal replacement therapy as a long term option as long term use can cause various side effects and can raise the risk of developing breast cancer, uterine cancer, blood clots, and cardiovascular diseases. When used as a short term treatment option, the benefits of it generally outweigh the risks.
Estrogen Replacement Therapy
Estrogen replacement therapy or ERT is a type of hormonal replacement therapy where estrogen is used to help raise the amount of the dropped levels of estrogen in the body to a normal level. It helps in relieving the symptoms associated with menopause like hot flashes, vaginal dryness, sleep disturbances. As a result, if the lowered levels of estrogen in the body due to menopause a woman’s body is also susceptible to developing osteoporosis or thinning of bone density.
Estrogen replacement therapy also helps in preventing osteoporosis. There are some risks involved with the use of hormonal replacement therapy, especially in women who are 60 and above. The risks of hormonal replacement therapy include:
- heart disease
- blood clots
- breast cancer
Types of Estrogen Replacement Therapy & Their Pros & Cons
Before starting on estrogen replacement therapy, it is important to consider a few things as to what type of it to opt for. There are many types of estrogen replacement therapy as well as forms in which they come, namely, pills, suppositories, patches and such.
It is also important to consult a doctor to make an assessment based on the patient’s health condition, the symptoms exhibited, and personal preferences. If a patient has not had a hysterectomy or surgical removal of the uterus and the ovaries, in that case, progestin is prescribed along with the estrogen to reduce the risk of developing endometrial cancer. Types of estrogen replacement therapy are:
The most common form in which estrogen replacement therapy is taken is in the pill form. Most of these pills are taken once a day with food, while some have complicated schedules. Some examples of estrogen replacement therapy are conjugated Estrogens (Premarin), estradiol (Estrace), and Estratab.
These pills help in resolving or reducing some bothersome symptoms associated with menopause. They can help in relieving the symptoms of menopause and also lower the risk of developing osteoporosis.
Estrogen replacement therapy pills cause some side effects like headache, vaginal discharge, tender and swollen breasts, nausea. Taking estrogen, only HRT also raises the risk of developing blood clots, heart diseases, breast cancer, stroke, and other complications. Patients that have liver issues are advised against taking estrogen pills. These pills also tend to not fully absorb in the body when taken with certain medications or taken by patients that have stomach issues. Since these pills are metabolized in the liver, it also increases the level of cholesterol in the body.
Another form of estrogen replacement therapy are the patches. These patches are worn on the lower part of the stomach below the waistline. The hormones in the patch are absorbed through the skin by blood vessels and then delivered throughout the body. These patches need to be changed once or twice a week according to instructions provided.
Some types of patches are Alora, Climara, Estraderm, and Vivelle-Dot. Combination estrogen and progestin patches — like Climara Pro and Combipatch — are also available. Menostar one such type that is used to reduce the risk of osteoporosis, it has a lower dose of estrogen than other patches.
Estrogen replacement therapy in patch form delivers the same benefits as the pill. Still, it has some additional benefits; for example, the pill form of estrogen replacement therapy is dangerous for patients with liver problems. The patch does not pose any problems as estrogen is absorbed directly into the bloodstream without passing from the liver as it is the case with the pill. Another added benefit is that it is very convenient as compared to the pill; you have to stick it on and forget about going through the hassle of taking a pill every day.
It is no doubt that the patch form of estrogen replacement therapy is much more convenient as compared to the pill, but somehow it still carries the same risks that are involved with the pill type of estrogen replacement therapy. It does raise a small risk of developing cancer and stroke. Its side effects include tender swollen breasts, vaginal discharge, headache, and nausea. Apart from that, it is not advisable to expose to patch to high temperatures as it causes the release of estrogen too quickly than intended. Therefore it is not advisable to use tanning beds and saunas while the patch is on. The patch also might irritate the skin where it is applied.
Topical Creams, Gels, and Sprays
Estrogen replacement therapy can also be taken in the form of topical creams like Estrasorb, gels like Estrogen and Divigell and sprays like Evamist). Just like the patches, they are absorbed through the skin directly into the bloodstream and so it does not pose any risks to patients with liver and cholesterol problems. These creams, gels, and sprays have certain specifications as to how they are to applied and how many times, usually they are applied once a day. Gels like Estrogel is applied on one arm, from the wrist to the shoulder. Creams, like Estrasorb, is applied to the legs. Evamist is applied to the arm.
These are applied directly to the skin and are absorbed directly into the bloodstream. As a result, they are safer for people with liver and cholesterol problems as compared to the pill form of estrogen therapy.
Estrogen creams, sprays, and gels are safer than the pill form of estrogen, but there isn’t enough study to back up the claims. They also carry the same risk of cancer and stroke. Along with that gels, creams and sprays can be rubbed and washed off easily before it has had enough time to get absorbed. So it is advised to let them dry completely before putting on clothes. As the estrogen in these are absorbed through the skin, it is advisable not to let other people get in contact with these as this might lead to them absorbing the estrogen too.
Vaginal Suppositories, Rings, and Creams
Vaginal Suppositories, Rings, and Creams are another form of estrogen replacement therapy, and these can be directly applied to the vaginal area. These come in tablet forms like Imvexxy, Vagifem, creams like Estrace or Estradiol, and insertable rings like Estring or Femring. These are generally opted for by women that are troubled with vaginal dryness, painful sex, itchiness.
These Vaginal tablets are used daily for a couple of weeks; after that, they can be used twice a week. Creams can be used daily, several times a week. Vaginal rings need to be changed every three weeks.
Just like the patches, some of these treatments are more convenient than taking a pill every day. Some vaginal rings and suppositories have low doses of estrogen. As a result, it affects just the particular area where it is applied. Hence they don’t expose the whole body to estrogen unnecessarily. These treatments are more effective in treating vaginal dryness in a better way than other forms of estrogen replacement therapy.
Since vaginal suppositories and rings have low doses of estrogen, they do not treat other symptoms of menopause like hot flashes other than vaginal dryness. There are some higher dosed ones available, but then again they raise the risk of cancer and stroke. Women that still have their uterus intact or in other words haven’t had hysterectomy long term use of vaginal estrogen therapy is not advised as it can cause endometrial cancer.
Selecting the Right Estrogen Replacement Therapy
Menopause is that time in a woman’s life when the ovaries stop releasing eggs. It is due to the reduced levels of the hormones estrogen and progesterone, which brings with it some unwanted symptoms. The symptoms include hot flashes, night sweats characterized by intense sweating, the sudden feeling of warmth over the face, neck and the chest, vaginal dryness which leads to painful sex. To help menopausal women get some relief from these symptoms, Hormonal Replacement Therapy is recommended. Through this treatment, the hormones estrogen and a synthetic version of progesterone called progestogen is used to replace and replenish the lowered levels of these hormones in the body.
Estrogen replacement therapy is one such way of administering this treatment, and here only the hormone estrogen is used in the form of pills, vaginal suppositories, rings, gels, creams, and sprays.
When it comes to choosing the right estrogen replacement therapy a lot of things need to be considered carefully. A patient with a family history of problems related to blood clots, liver disease, the stroke should be very careful in choosing an option that is right for them. For someone that has not had their uterus and ovaries removed surgically (hysterectomy) taking estrogen-only hormonal replacement therapy can lead to the risk of developing endometrial cancer.
In such cases, a progestogen is also prescribed along with the estrogen. The doctor also needs to be well informed if the patient is planning on getting pregnant because getting pregnant while taking hormone replacement therapy can be fatal to the fetus. Additionally smoking while taking this medication can increase the risk of blood clots, and stroke, it can also reduce the effectiveness of the medication.
Oral estrogen and its effects have been backed by various studies. However, some modes of taking hormonal therapy are still questionable. When starting with estrogen replacement therapy, it is advised to start with the lowest dose and for the shortest amount of time possible.