Is Hormone Replacement Therapy Right For You?

Is Hormone Replacement Therapy Right For You?

Hormone replacement therapy, also known as hormone therapy, is a treatment which can be started in menopausal or peri-menopausal women to replace the lower levels of hormone in their bodies, when they are approaching menopause. During menopause, estrogen levels fall and some women suffer from symptoms such as hot flushes, vaginal dryness, and mood changes. So, to meet the requirements of estrogen deficiency in the body, hormone replacement therapy (HRT) is given or recommended to a patient.

Benefits Of HRT

The main benefits of HRT is that it can provide relief from almost all symptoms of menopause such as:

  • Hot flushes
  • Vaginal dryness
  • Mood swings
  • Decreased libido

Though these symptoms also disappear after a while, but for some women, these signs can be so severe and discomforting, that they need to start hormone therapy to get some relief from the symptoms.

Opting For Hormone Therapy

Hormone therapy can be helpful for those who have the following conditions:

  • Suffering from extreme symptoms
  • Osteoporosis or bone loss
  • Cannot tolerate other medications
  • Menopause before the age of 40

Types Of HRT

Estrogen Therapy
This can be prescribed in various forms, depending on the symptoms shown by the patients. Estrogen pills are the most common form of HRT. Low dose conjugated estrogen is given, if not contraindicated. In the absence of the uterus, estrogen therapy is given and if the uterus is present then combined estrogen and progesterone therapy is prescribed. Estrogen patches are also available, in which the drug is absorbed through the skin. Some patches should be replaced on a daily basis, while some can even work for around a week. Topical estrogen can also be used and these are available in gel, cream and spray form. Vaginal estrogen is available in the form of pessaries, creams, and vaginal rings. This is more suitable for women suffering from vaginal dryness and local symptoms and also in cases where systemic estrogen is contraindicated

Combination Therapy (Estrogen/ Progesterone/Estrogen And Progesterone Therapy)
The combination therapy is more suitable for women with a uterus, to avoid unopposed estrogen action on the endometrium which can cause endometrial hyperplasia. Taken in pill form, it includes medroxyprogesterone acetate or synthetic progestins such as norethisterone. Natural progesterones are also prescribed and these have minimal side effects.

Contraindications For HRT

  • History Of stroke, hypertention
  • History of clots or tendency to form clots or a bleeding disorder
  • Heart or liver disease
  • Stroke
  • Cancer history or family history of cancer (ovarian, breast or uterine cancer)
  • If pregnant

Side Effects Of HRT

  • Bloating
  • Nausea
  • Headache
  • Vaginal bleeding (rare cases)
  • Breast tenderness
  • Indigestion

Hormone Replacement Therapy (HRT) is given or recommended to a patient to meet the requirements of estrogen deficiency in the body

When To stop HRT

There is no set time limit as to how long HRT can be taken, but your doctor would suggest the stipulated time period
Usually, women stop HRT once their symptoms are relieved
Stopping HRT gradually is always better than to stop abruptly, as rebound symptoms occur if stopped suddenly
You may have to start HRT again, if symptoms reappear after stopping HRT

Alternatives Of HRT

  • Lifestyle measures – regular exercise, meditation and healthy diet help to reduce the severity of the symptoms. Also, cutting down on alcohol, spicy food, caffeine intake and stopping smoking helps too
  • Reduce stress and practice yoga
  • Use of vaginal lubricants for dryness
  • Wear loose clothes and keep yourself cool at night to avoid hot flushes
  • Tibolone is an alternative, where oral estrogens are contraindicated and the effects are similar to estrogen containing HRT
  • Clonidine can be used for night sweats and hot flushes, but the effects are short-term
  • Antidepressants can also help but sometimes they cause dizziness and agitation
  • Natural hormones or bioidentical hormones are some plant products which mimic natural hormone actions. These are considered a safer and natural alternative to synthetic hormones
  • Complimentary therapies and many herbal remedies are sold for menopausal symptoms such as ginseng, St John’s Wort, Black cohosh, etc. Though there is no scientific evidence with regard to their clear-cut benefits in menopausal symptoms, but it has been seen in observational studies that they help alleviate menopausal symptoms.

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