Hormone replacement therapy (HRT) is a type of treatment that restores low hormone levels. It is often recommended for women and men with hormonal imbalances, especially those brought on by ageing. While there are many benefits of this treatment, there are some risks, like increased chances of developing heart disease or breast cancer in some people, due to which caution is required while prescribing it. Therefore, it becomes essential to understand the benefits and risks of HRT in order to make informed decisions.
In this article, we'll take a quick look at all the relevant aspects of hormone replacement therapy.
HRT replaces hormones that the body no longer naturally produces on its own. Typically, it involves replacing estrogen and progesterone (or related hormones) in women, whereas in men it involves replacing testosterone. While menopause and a decline in testosterone due to natural ageing are common causes, they are not the only reasons. Surgical removal of a woman’s ovaries, cancer treatment, pituitary gland disorders, or the use of opioids or other medications can cause low hormone levels and require treatment.
● Estrogen-only therapy: It is for women who have undergone a hysterectomy (uterus removal). It is prescribed in the form of gels, tablets, patches, vaginal rings, creams, or sprays.
● Combined estrogen-progesterone therapy: It is intended for women who still have a uterus and need help controlling abnormal menstrual bleeding. Estrogen stimulates the endometrium, but this stimulation increases the risk of endometrial cancer. Adding progesterone helps reduce the risk. It is available as both patches and tablets.
● Testosterone therapy: It is recommended for men diagnosed with a medical condition called hypogonadism (diminished sex hormone secretions). This can be in the form of patches, gels, skin creams, or injections.
Your doctor would prescribe the best type of HRT and dosage based on your gender, age, symptoms, medical history and preferences.
Women are prescribed HRT when they experience uncomfortable menopausal symptoms like:
● Night sweats
● Hot flashes
● Vaginal dryness
● Mood swings
● Leaking pee
● Insomnia
● Mood swings, irritability or depression
● Help with bone loss due to osteopenia or osteoporosis
● Hormonal disorders
Men diagnosed with low testosterone are prescribed HRT when they experience symptoms like:
● Erectile dysfunction
● Low libido
● Fatigue
● Muscle loss
● Depression
● Testicular removal
● Pituitary gland disorders
● Ageing
Hormone replacement therapy can also be part of the treatment plan for individuals opting for sex change procedures.
Hormone replacement therapy offers numerous benefits for both genders. Let’s examine these in detail:
One of the main benefits of HRT is that it relieves perimenopause and menopause symptoms. According to studies, undergoing menopause treatment with HRT reduces hot flashes, one of the most uncomfortable symptoms, by 80%. Other symptoms that you get relief from are:
● Insomnia
● Low mood
● Anxiety
● Night sweats
● Vaginal dryness
Osteoporosis is a condition characterised by bone thinning, which increases the risk of fractures. It is a common condition after menopause due to low estrogen levels. Studies show that HRT reduces this risk by 30 to 50% by increasing estrogen in the body, which is essential for bone strength.
Loss of muscle mass is common as you age and reach menopause. HRT can help improve and strengthen the muscles.
As you reach menopause, your libido decreases due to issues like vaginal dryness, thereby making intercourse uncomfortable and less desirable. HRT restores reproductive hormones, reduces vaginal dryness and boosts your sexual health, thus increasing your libido.
Hormones are essential for your mood, and as you age, progesterone and estrogen decline, leading to mood swings and depression. HRT helps in balancing these hormones, boosts concentration, improves mood, and reduces depression symptoms.
Testosterone replacement therapy improves energy levels, improves muscle strength, increases sex drive, boosts metabolism, reduces abdominal fat and improves focus and concentration.
Serious side effects of HRT are low and depend on the type of HRT administered, the duration of treatment, age and medical history. Given below are some potential HRT risks and side effects:
HRT is safe for most people, but it is not advised for those with a past cancer history. Estrogen-only HRT is safer for women who have a hysterectomy. For women who still have a uterus, estrogen-only or combined HRT may slightly raise the risk of some ovarian cancers. Long-term use of combined HRT can also raise breast cancer risk by a small amount.
Hormone replacement therapy could raise the risk of blood clots, but the risk is very low. The likelihood of pulmonary embolism or deep vein thrombosis is 1 out of 1000 women. For women taking HRT tablets, the risk doubles to 2 in 1000. Other forms of HRT, such as gels, sprays and patches, have a lower risk as they are absorbed through the skin.
HRT could cause a few other side effects in women, such as:
● Headaches
● Bloating
● Nausea
● Emotional or behavioural changes
● Fluid retention
Men undergoing HRT treatments may experience mild cases of acne or other skin issues.
Gynecomastia, or breast enlargement, may occur. The change in hormone levels may stimulate the growth of tissue in either one or both breasts.
Extra fluid in the body (edema) may cause slight swelling in the hands, feet or ankles.
Some men may notice changes in urination or an increase in prostate size after or while undergoing HRT.
A few studies have shown that HRT could potentially increase the risk of cardiovascular issues. Hence, some men may experience heart problems and diabetes after undergoing HRT.
Mood swings, depression, anxiety, lapses in memory, etc., could be possible side effects of HRT. Therefore, constant monitoring and evaluations are necessary to resolve any negative effects from HRT.
● Women under 60 and within 10 years of menopause who have moderate to severe menopausal symptoms
● Those at risk of osteoporosis
● Women with premature menopause <less than 40 years)
● Men with hypogonadism and symptoms of low testosterone
● People with a history of cancers (breast, ovarian or prostate)
● People with a history of blood clots, heart issues, stroke, high blood pressure or liver disease
● Pregnant women
There is no single best HRT plan that works for all. It must be personalised based on individual circumstances.
There are many non-hormonal therapies and alternatives to manage age-related hormone imbalances. It includes:
● Exercise regularly. Consider yoga or meditation, both of which are low-impact.
● Eat a balanced diet, rich in Vitamin D (ex., fortified foods, salmon, tuna) and calcium.
● Manage stress
● Control your weight
● Limit alcohol and caffeine
● Non-hormonal medications for mood instability or hot flashes.
● For night sweats, prescription medications are also available.
● Acupuncture
● Vitamin or herbal supplementation, such as evening primrose oil and/or black cohosh, may also be helpful.
The best strategy to deal with menopause is the solution that works for you. Start by discussing your symptoms with your doctor, who will assess your symptoms, provide an assessment of whether HRT is for you, and discuss the risks and benefits based on your medical history. Your doctor will also want to see you regularly for follow-ups and dosage adjustments to ensure you get HRT benefits and that any risk is outweighed.
HRT can be a great option to manage the symptoms of hormone imbalances when used appropriately. However, HRT recommendations should always be based on medical evaluation and all the risks and benefits examined. The best approach to making informed choices is to have an in-depth conversation with your doctor. If you feel like your symptoms are too much, make an appointment to discuss them today!
HRT can be taken for 2 to 5 years, and in some cases, it could be taken for a longer period of time. The best form of HRT patches, gels or sprays.
Yes. It protects the heart if started early after menopause.
HRT prevents bone loss and osteoporosis by increasing estrogen levels.
Many people worry that HRT always causes cancer, heart issues or weight gain. In reality, these risks are often smaller than they think and depend largely on age, health and the type of HRT treatment used.
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