Hormone Replacement Therapy for Women
Age-related changes in the body are inevitable. Fatigue gradually accumulates, working capacity decreases, the body ceases to be flexible and obedient, wrinkles appear on the face. If aging causes serious discomfort, it is difficult to come to terms with it. This primarily relates to menopause in women.
What is hormone replacement therapy (HRT)?
According to statistics, menopause proceeds without complications only in 20-30% of women. The rest notice symptoms of menopausal syndrome of varying severity: hot flashes, increased sweating, sleep and memory disturbances, anxiety, tearfulness, and increased fatigue. Later, they may also experience burning sensation in the bladder, urinary incontinence, dry skin and brittle nails, obesity, osteoporosis, arthritis and even Alzheimer’s disease can occur. Hormone replacement therapy (HRT) was developed to combat these pathological conditions.
The principle of its action is based on the replenishment of hormones in the female body. During menopause, endocrine glands significantly reduce the independent production of estrogen and progesterone. Their deficiency also causes various symptoms of menopausal syndrome. With the introduction of hormonal drugs from the outside, the woman’s body continues to function in almost normal mode. Of course, one cannot turn back time and the climax will come anyway but a woman can avoid the majority of unpleasant sensations and consequences.
There are a lot of ridiculous myths about hormones. Many women think that they cause weight gain and sometimes even the growth of a woman’s mustache and beard, while everything happens quite the opposite. In fact, HRT is an almost indispensable tool for the prevention and treatment of the menopausal syndrome. Hormonal drugs can affect the immediate cause of menopause – a deficiency of sex hormones. All other methods, such as maintaining a healthy lifestyle, non-hormonal drug treatment of menopause symptoms, a special diet, will not eliminate the problem. Although it is worth noting that proper nutrition, exercise, refusal from bad habits can enhance the effect of HRT many times.
HRT for women: pros and cons
Hormone replacement therapy has both supporters and opponents. The pros and cons of HRT are regularly discussed by gynecologists, scientists and specialists involved in women’s health. Despite the popularization of a healthy lifestyle and a large number of different preventive programs, only HRT remains clinically proven medical method to combat the unpleasant manifestations of menopause.
- HRT has a protective effect on bone mineral density. In the absence of the necessary hormones due to leaching of calcium, the bones of women during menopause become fragile, osteoporosis can develop. HRT fights bone loss and reduces the incidence of fractures;
- HRT can reduce the risk of developing a cardiovascular disease that is the major cause of death among women during menopause. Hormone therapy has a positive effect on vascular function, blood pressure, cholesterol. According to studies, timely estrogen therapy has a cardioprotective effect, reduces the likelihood of developing diabetes and hypertensive crises;
- HRT prevents atrophic changes in the genitourinary tract caused by a lack of estrogen and fights against such an unpleasant symptom as dryness and itching in the vagina. It favorably affects the condition of the skin, hair, joints. Moreover, there is evidence that timely HRT can reduce the risk of Alzheimer’s disease;
- HRT significantly reduces the number and duration of hot flashes, successfully copes with neurosis and depression.
However, opponents of HRT put forward their arguments:
- The difficulty of developing the right treatment regimens.
- The inability to accurately dose hormones in accordance with the needs of a particular female body.
- The presence of side effects in the form of tumors, vascular thrombosis.
- The lack of reliable data on the effectiveness of HRT in the treatment of late complications of menopause.
- A large number of contraindications, such as diseases of the veins, liver, kidneys, smoking, history of cancer, etc.
Studies conducted in recent years have proved that theoretical risks in HRT can be minimized and the treatment benefits maximized. To do this, you need to choose the optimal treatment regimen and start it at the most appropriate time. Since the safety of hormone therapy in menopause is largely dependent on age, healthy women under 60 should not worry about the risks. According to the results of new studies and data from previous years, in most cases, the advantages of HRT significantly outweigh the disadvantages.
Indications for therapy
Specialists distinguish two groups of indications for HRT:
- Symptomatic indications that are aimed at treating the symptoms of menopausal syndrome: neurosis, sudden mood swings, stress, insomnia or drowsiness, etc .; genital atrophy; hot flashes, palpitations, hyperhidrosis, chills; disorders of the cardiovascular system – jumps in blood pressure, shortness of breath, heart pain, dizziness, headaches; painful uterine bleeding; pain in the limbs, lower back, in the lower abdomen; dry vagina, decreased libido; skin aging: loss of elasticity, dryness;
- Preventive indications aimed at preventing late complications, such as cardiovascular disease and osteoporosis in women at risk: with early menopause of any etiology; with a history of osteoporosis; with existing diseases of the cardiovascular system or with a hereditary predisposition to them.
In addition, HRT can also be indicated in the standard course of menopause at all its stages: in premenopause – to stabilize the cycle, in menopause – to reduce the onset of symptoms, in postmenopausal women to reduce the risk of tumors and improve the overall quality of life.
Nevertheless, there are a lot of contraindications for HRT, so a woman should undergo a full examination before starting treatment. You can not use hormone therapy (or should use it with caution) if you have any of the following diseases and pathologies:
- diseases of the mammary glands and uterus;
- impaired liver and kidney function;
- genital tumors (present of suspected);
- thromboembolism and thrombosis;
- endometriosis (ovaries);
- mastopathy epilepsy;
- bronchial asthma;
- vaginal and uterine bleeding of unknown origin, especially in the postmenopausal period.
A contraindication for HRT is also a hereditary predisposition for endometrium cancer, breast cancer and increased sensitivity to the components of the drug.
Side effects of HRT
Some women refuse to take hormonal drugs since they are afraid of side effects. However, studies show that there are not so many adverse reactions and most of them are not able to have any serious harmful effects on women’s health. So, what side effects can be caused by HRT?
- Soreness and engorgement of the mammary glands;
- Nausea, increased appetite, abdominal pain;
- Dryness of the vaginal mucosa or, conversely, an increase in the amount of cervical mucus;
- Irregular uterine bleeding;
- Fatigue, general weakness;
- Swelling of the extremities, weight gain;
- Cramping in the muscles of the legs;
- Acne and seborrhea;
You should remember that the risk of side effects of HRT is negligible. Otherwise, hormone replacement therapy would not be approved by the international medical community.
How long can a woman take HRT drugs?
When planning hormone therapy, a woman should understand that HRT is not short-term! Only when taken for a long period, hormonal drugs will help a woman cope with hormonal changes and to improve the quality of life. Of course, the effect on the early menopausal symptoms will be provided almost in the first week of taking hormonal drugs, but to consolidate the positive effect and treat the late symptoms, it should last a rather long time – from a year to several years.
Specialists developed two schemes for the implementation of HRT:
- Short-term, which helps get rid of hot flashes, psycho-emotional symptoms, and disturbances in the functioning of the urogenital system. The duration of taking the drugs in this case is 3 months to 6 months. If necessary, a woman repeats the course;
- Long-term, designed for 5-7 years or more. The purpose of this scheme is the prevention of late disorders, such as cardiovascular disease, osteoporosis, Alzheimer’s disease.
Today, there are virtually no restrictions on the duration of HRT. Of course, this applies only to those patients who are monitored by a gynecologist. The upper age limit of HRT is 65–70 years, provided that the therapy was started on time and not interrupted.
Hormone replacement drugs
There are several basic principles for taking hormone replacement therapy drugs developed by the International Menopause Society. Prescribing HRT should be part of a treatment strategy that also includes lifestyle recommendations: nutrition, physical activity, smoking cessation, and alcohol abuse. HRT should be prescribed strictly individually, taking into account the existing symptoms and the need for prevention. A doctor should also take into account the anamnesis of women, both her own and her family.
Women who have menopause at an early age, before 45 or even 40 years old, have an increased risk of osteoporosis, cardiovascular disease, dementia. In this case. The therapy should be continued until middle menopausal age is reached. HRT cannot be prescribed without objective indications for use. Women taking HRT drugs should visit a gynecologist at least once a year and undergo a full examination. The decision on the timing of HRT and its termination is made by the patient and her doctor, depending on the achievement of treatment goals. A woman should start the therapy with the lowest effective dose.
Today there are various release forms of HRT drugs:
- oral form (tablets, dragees, pills);
- transdermal form (subcutaneous injections and implants);
- local form (creams, candles, gels, plasters).
Pills are the most popular type of hormonal drugs since they are convenient to take. However, in the presence of diseases of the gastrointestinal tract or liver, tablets should be discarded in favor of local or transdermal drugs. They do not have a harmful effect on the digestive tract and do not interact with other drugs.
What to consider when buying a HRT drugs?
First of all, HRT must be prescribed by a doctor. Self-medication in this case is unacceptable. Only a specialist is able to determine which drug and in what doses can be taken to achieve maximum effect with minimal risks. But even the doctor does not always have the opportunity to prescribe HRT to the patient. This can be caused by the presence of contraindications, strong psychological and physiological reactions. Sometimes it is possible not to use HRT in menopausal syndrome of mild degree, as some alternatives have become known to medicine. Your doctor may also recommend taking phytoestrogens, for example, drugs based on genistein. They practically have no side effects and cope well effects of osteoporosis, hot flashes, and depression.
Category: Health and Wellness
Tags: hormonal disbalance, hormonal imbalance, hormone replacement therapy, hormones, women's health