Hormone Replacement Therapy


Questions are always asked about hormone replacement therapy ( HRT), or really it’s just hormone therapy ( HT ), so I thought it best to cover it briefly.

Now is the time to point out I am not a doctor or medical professional of any modality. So all I can give is my personal opinion and my experience as a woman. I will also state right here, I do not take any kind of hormone therapy myself. I have done some research and a small amount of study on the endocrine system ( hormone system of the body ) and what I discovered is the whole system is so finely tuned that I would not attempt to control it artificially with either manufactured hormones or bio-identical hormones. I find the risk of adverse effects is not worth the possible upside. That is my choice. I use Chinese herbs, acupuncture, homeopathy and quality supplements – no side effects. However, I do not live in your body, so if you wish to take hormone therapy that is your choice and your decision. Please just research it first, so you know what you are getting into, both good and bad. Know what side effects you could experience. How much relief you can expect. How long it will take to get relief. Ask women who are taking it already to see how they find it.

What is it?

Picture of the ovaries, fallopian tubes and uterus

Time for a quick biology lesson – the hormones that drive the female monthly cycle are estrogen and progesterone, produced by the ovaries. Progesterone and estrogen are necessary to prepare the uterus for menstruation, and their release is triggered by the hypothalamus.

Once you reach puberty, the ovaries release a single egg each month (the ovaries typically alternate releasing an egg)—this is called ovulation. The hypothalamus sends a signal to the pituitary gland to release gonadotrophic substances (follicle stimulating hormone and luteinizing hormone). These hormones are essential to normal reproductive function—including regulation of the menstrual cycle.
As the egg migrates down the fallopian tube, progesterone is released. It is secreted by a temporary gland formed within the ovary after ovulation called the corpus luteum. Progesterone prepares the body for pregnancy by causing the uterine lining to thicken. If a woman is not pregnant, the corpus luteum disappears.

Menopause is a normal part of aging. It refers to the time when ovarian reproductive function ends—when a woman’s ovaries stop producing eggs and making the hormones estrogen and progesterone. Menopause is retrospectively diagnosed 1 year after your last period.

Menopause tends to occur in a woman’s late 40s to early 50s, but varies by country, with an average age of 51 years in the United States. Occasionally, women may have premature ovarian failure or early menopause. In addition, menopause may occur abruptly in a woman who has her ovaries removed or who undergoes chemotherapy or radiation.

What is Perimenopause?
Perimenopause refers to the time period leading up to menopause (premenopause) and the time following it (postmenopause). During the years preceding menopause, hormone levels fluctuate and average estrogen levels may even be higher. After menopause, hormone levels gradually decline.

You can still become pregnant during premenopause, even with erratic periods, making contraception important for women who don’t wish to become pregnant.

What are the Symptoms of  Perimenopause?
Hot flush with fanDuring the years leading up to menopause, periods are often irregular, and vasomotor symptoms such as hot flashes and night sweats often occur. Vasomotor symptoms refer to a difficulty regulating body temperature. These vasomotor symptoms may persist for years but do usually dissipate over time.

During the postmenopausal period, estrogen levels gradually decline, which may cause symptoms of vaginal dryness and increase the risk of cardiovascular and bone problems (discussed below). Sleep disturbances also are common throughout the entire perimenopausal period.

A host of other symptoms have been reported in association with perimenopause, but it is unclear whether they are directly related to menopause or are a result of aging. These other symptoms include fatigue, depression, irritability, anxiety, memory difficulties, weight gain, and urinary incontinence (trouble holding your bladder).

Signs and symptoms of perimenopause vary not only during a woman’s perimenopausal period, but also from person to person.

Health Changes with Menopause
The hormone changes that occur after menopause increase the risk for bone thinning (osteopenia and osteoporosis) and fracture, and heart disease. Thus, it is important to see your doctor during this time to monitor for these conditions and get treatment if necessary.

Management of Menopause Symptoms
Many women have difficulty with perimenopausal symptoms and may benefit from lifestyle changes and/or medications to manage symptoms and other health risks that occur with menopause. It is important to talk to your doctor about these issues.

Reference – this came direct from Endocrineweb

So hormone therapy is commonly prescribed for the hot flashes, night sweats and vaginal dryness of the peri-menopausal, menopausal and post- menopasal time of life. It is  considered, by many medical professionals, to be the most effective treatment.

Hormone therapy commonly refers to two different options:

–  combination estrogen plus progestin therapy (EPT), which is generally prescribed for women who still have a uterus ( womb).  The progestin is added to protect the uterus from cancer that can occur when estrogen is used alone                 – and one hormone, estrogen (ET) which is prescribed for women who have had their uterus removed.

There are many hormone therapy options available by prescription from your healthcare provider:

 a pill taken by mouth

 a patch, cream, gel, or spray that can be applied to your skin

 a cream, suppository, tablet, or ring that can be used within the vagina.

Many doses are available to meet your needs. Each of these options has different pros and cons that you can discuss with your healthcare provider.

In 2002, a large study called the Women’s Health Initiative (WHI) reported an increased risk of breast cancer, heart disease, stroke, and blood clots with the use of EPT. In the years since the reporting of those results, we have learned that the type of HT (ET versus EPT), how it is taken, and the timing of starting this treatment (early versus late after menopause) produce different benefits and side effects. The risk of side effects (such as heart attack, stroke, blood clot, or breast cancer) with HT in healthy women ages 50 to 59 is low. In contrast, using HT for a long time or starting HT when you are a number of years beyond menopause is associated with a higher risk of these side effects.Evaluating the benefits and risks of HT for you personally is an important discussion for you to have with your healthcare provider. Because you are unique, treatment options should be tailored to your needs and your concerns.

 If you have had blood clots, heart disease, stroke, or breast cancer, it may not be in your best interest to take HT. Be sure to discuss your health conditions with your healthcare provider. How long you should take HT is different for EPT and ET. For EPT, the time is limited by the increased risk of breast cancer that is seen with more than 3 to 5 years of use. For ET, no sign of an increased risk of breast cancer was seen during an average of 7 years of treatment, a finding that allows more choice in how long you choose to use ET.  Most healthy women below age 60 will have no increase in the risk of heart disease with the risks of stroke and blood clots in the lungs are increased but, in these younger age groups, the risks are less than 1 in every 1000 women per year taking HT.

 ET delivered through the skin (by patch, cream, gel, or spray) and low‐dose oral estrogen may have lower risks of blood clots and stroke than standard doses of oral estrogen, but all the evidence is not yet available. Research will continue to bring valuable information to help women with their decision about HT.

Reference –      NAMS website: www.menopause.org

NAMS is North America’s leading nonprofit organization dedicated to promoting the health and quality of life of all women during midlife and beyond through an understanding of menopause and healthy aging.

There are plenty of other websites with information also but bear in mind some of them will be promoting hormone therapy or supplements.