Hormones & Cycles

Hormone replacement therapy (HRT)

Hormone replacement therapy (HRT) is a procedure used to relieve the symptoms of menopause. Menopause is defined as the point in time 12 months after a woman's last period (1). At this moment, the levels of estrogen fall, causing symptoms such as hot flashes and vaginal dryness and increasing the risk of osteoporosis (2). HRT is a medication that contains the female hormone estrogen together or not with progestins (the synthetic form of progesterone). The medication is taken to replace the estrogen that your body stops making during menopause and relief the common menopausal symptoms (2,3). HRT is also used in other contexts like after a hysterectomy, a surgery where the uterus is removed (2). The estrogen can come in the form of pills, patches, vaginal rings, gel, or spray, which is considered a systemic hormone therapy. These approaches usually contain higher doses of estrogen, which is absorbed throughout the body. There are also low-dose vaginal products, used mainly to treat the vaginal and urinary symptoms of menopause.
There’s also an estrogen/progesterone/progestin hormone therapy or combination therapy. This type of approach is directed to women who still have their uterus and is associated with lowering the risk of endometrial cancer. Progestins can be taken as pills or intrauterine progestin. Which therapy to use would depend on each case. A medical doctor should take into consideration your health history, this means you and your family history of cancer, heart disease, stroke, blood clots, liver disease, and osteoporosis. For each woman, the benefits of going through an HRT should outweigh the risks.
HRT may relieve hot flashes and night sweats, increase sleep quality, ease vaginal dryness and itching, make sex less painful, and prevent osteoporosis. In some women, it can also decrease the risk of heart disease, and lower the chance of dementia. Nevertheless, like any other medication, the HRT has some associated risks like endometrial cancer if estrogen is taken without progestin, blood clots, stroke, and breast cancer. Other side effects may be bloating, breast swelling, headaches, mood changes, nausea, vaginal bleeding. To prevent some of these side effects, it is recommended to use the lowest effective dose and for the shortest period, as well as get regular mammograms and pelvic exams. It has been established that if hormone therapy is started before the age of 60 or within 10 years of menopause, the benefits appear to outweigh the risks.

Some women prefer to manage the menopausal symptoms naturally with healthy-lifestyle approaches. For example for hot flashes you can try to keep yourself cool, limiting caffeinated beverages and alcohol, and practicing paced relaxed breathing or other relaxation techniques. Also, for vaginal issues like dryness or painful intercourse, a vaginal moisturizer or lubricant may provide relief (3).

References:

  1. National Institute of aging. What is menopause. https://www.nia.nih.gov/health/what-menopause#:~:text=Menopause%20is%20a%20point%20in,between%20ages%2045%20and%2055.
  2. Johnson, T. 2021. Hormone Replacement Therapy for Menopause https://www.webmd.com/menopause/guide/menopause-hormone-therapy
  3. Hormone therapy: is it right for you? https://www.mayoclinic.org/diseases-conditions/menopause/in-depth/hormone-therapy/art-20046372
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