The female body produces various hormones at varying levels throughout her life. These hormones peak during her fertile years and decrease as she ages. The lack of sufficient hormones causes visible damage in the woman’s body. Hormone Replacement Therapy plays an effective role in such cases and helps restore the hormonal balance.
First, let’s understand what exactly Hormone Replacement Therapy is.
Also known as HRT, hormone replacement therapy is a treatment that aims to restore hormones the body is unable to produce. When certain hormone levels decrease, it causes an imbalance and leads to various complications and health issues. HRT aims to reduce such complications by providing the hormones in the required quantities to restore this delicate balance.
Are Hormone Therapy and Hormone Replacement Therapy the same? Many doctors may use the terms interchangeably, thus confusing.
Hormone Therapy is a broader term that can include hormone therapy for cancer or treatment for hormonal imbalances. Hormone Replacement Therapy, on the other hand, is more oriented to women going through menopause, where the body stops producing certain hormones, and the therapy aims to “replace” the natural hormones.
Hormone Replacement Therapy comes in two types –
In this treatment, you will be given only estrogen. The doctor will start you with a low dose of estrogen and increase the dosage as required. This treatment is usually recommended for women after a uterine removal. Long-term risks are lower in this form of HRT. Estrogen can be given in the following ways –
● Pills to swallow by mouth
● Patches to stick on the skin
● Gel to apply topically
● A ring to wear inside the vagina
● Cream to apply inside the vagina
● Tablets to place inside the vagina
● Spray for your arm
This treatment, as the name suggests, combines estrogen and progesterone. Progesterone, in its synthetic form, is known as a progestin. Women who still have a uterus will require progestin and, hence, this combination therapy.
Taking only estrogen increases the risk of uterine cancer when the uterus is not removed. To combat this risk, progestin is also given. When a woman reaches menopause, her uterus stops shedding the lining every month. The estrogen in the body can cause an overgrowth of cells, which can lead to uterine cancer. This combination therapy can help reduce that risk.
Combination therapy can be administered through pills that you can swallow or patches that you can stick on your skin. It also comes in the form of an IUD that needs to be inserted into the vagina by your health care provider.
Hormone replacement therapy is generally recommended for women of the following categories, where the therapy restores hormones the body is unable to produce as required -
● Menopause – During the months leading up to menopause, the ovaries shrink, and the production of estrogen and progesterone either reduces or stops. This causes hot flashes, night sweats, mood swings, or vaginal dryness.
● Early Menopause – Some women can experience menopause symptoms before they reach 40 years of age. When the hormone levels decrease at such an early age, it can lead to various health complications, including osteoporosis. HRT can help reduce such risks.
● Osteoporosis – Estrogen is essential for bone health. Women at risk of developing osteoporosis or weak bones can benefit from HRT. The therapy can prevent significant bone loss, especially when the woman reaches menopause.
Hormone Replacement Therapy typically replaces the body’s natural hormones with synthetic versions. The medications can be customised according to the woman’s needs. The frequency, dosage, and method of administering the hormones vary according to the woman’s needs.
For women with low estrogen and no uterus, giving just estrogen will suffice. For women who still have their uterus, progestin along with estrogen is necessary. Your healthcare provider can guide you better on your therapy based on the test results, your symptoms, and your requirements.
Hormone Replacement Therapy frequency depends on the symptoms and issues faced by the woman.
● For women who underwent a hysterectomy, estrogen is given daily.
● For women with an intact uterus, estrogen can be given daily, but progestin will be given only for about 10-14 days in a menstrual cycle. This helps the uterus shed its lining, causing menstrual bleeding.
● Postmenopausal women can be given a combination of estrogen and progestin every day.
● For localised symptoms like vagina dryness, vaginal estrogen in the form of a ring, cream, or tablet can be inserted.
Women undergoing Hormonal Replacement Therapy can benefit in the following ways –
● Bone Health – Estrogen is essential for maintaining bone health. A drop in this hormone increases the risk of weak bones and osteoporosis. G+HRT can mitigate this risk and keep the bones strong.
● Alleviate Menopause Symptoms – Women going through menopause can suffer from symptoms like hot flashes, dry vagina, night sweats, insomnia, mood swings, and weight gain. HRT can balance the hormones and make these symptoms less severe, if not disappear completely.
● Improve Libido – A fall in hormone levels will negatively impact a woman’s sex drive. With HRT, her libido can improve, and vaginal dryness can be reduced, thus making sex pleasurable again.
● Boost Mood – Fluctuations in hormones cause mood swings, and women can’t really control them, no matter how much meditation, art, or music they engage in. HRT helps restore the delicate balance and improve her mood. It can also reduce depression.
● Weight Management – One of the biggest impacts of menopause is weight gain and the inability to shed it despite all changes in diet and exercise. HRT helps replace these hormones, contributing to the weight gain, and makes it less difficult to lose weight. With HRT, proper diet, and exercise, women can manage their weight more effectively.
The risks associated with HRT can vary from woman to woman depending on the hormones she is taking, the dosage, frequency, and how her body is responding to the therapy. Some risks associated with HRT are –
● Blood Clots – Taking hormone tablets increases the risk of developing blood clots, which can lead to DVT or pulmonary embolism. The risk reduces once you stop taking the tablets.
● Heart Issues – Starting HRT 10 or more years after attaining menopause can significantly increase the risk of heart attack and stroke.
● Breast Cancer – Use of HRT for over 5 years can increase the risk of breast cancer. Stopping the therapy will reduce the risk.
● Endometrial Cancer – When women with a uterus take only estrogen and no progestin, it increases the risk of endometrial cancer. Taking progestin or removing the uterus will mitigate this risk.
● Gallbladder Disease – The increase in estrogen due to the therapy increases the risk of developing gallbladder stones by increasing the cholesterol in bile. The increase in progestin (especially oral forms) can impair gallbladder contractions. The risk decreases once you stop taking the hormones.
HRT is a highly customised therapy, and there is no one-size-fits-all treatment here. You can start and stop treatment, make adjustments to the dosage, frequency, and even the method of treatment, as and when necessary. Keeping track of the symptoms, impact of therapy, and noticing side effects early can help mitigate the risks associated with HRT.
Women going through menopause and struggling with symptoms like hot flashes, night sweats, insomnia, weight gain, mood swings, etc., can benefit from HRT. Women at risk of weak bones or osteoporosis can also consider HRT with proper guidance. Women who have undergone a hysterectomy to remove their uterus can opt for estrogen therapy under HRT.
Yes, there are two different types of HRT. One where only estrogen is given, and the other type involves a combination of estrogen with progestin. Estrogen therapy is recommended for women without a uterus, and combination therapy is recommended for those who still have their uterus. The HRT type and dosage of hormones will vary from woman to woman based on her symptoms and health condition.
There is no fixed duration for HRT. The length of your therapy and the dosage will vary according to your symptoms and their response to treatment. Discuss with your doctor to decide on how long you should continue the therapy and if you can reduce the dosage over time.
Changes to the diet, exercise routines, and some herbal supplements can help improve the hormonal imbalances instead of opting for HRT. However, these do not have enough supporting evidence. It is best recommended to have a detailed discussion with your healthcare professional and follow their advice.
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