Hormone replacement therapy or HRT for short is the use of female hormones (estrogen and progesterone) alone or in combination in women during or after menopause. The available hormone replacement therapy formulations include :
- oral pills/tablets
- vaginal creams, rings, gels
- skin creams, gels, patches
Menopause is a normal stage in a woman’s life commencing around 45 to 55 years. It is characterized by a change in the hormone levels when the monthly menstrual cycles end (secondary amenorrhea). In menopause, a women does not have periods (no periods) for one year or more without being pregnant, severely ill, on certain drugs or breastfeeding. Some consider the phase of irregular periods, before the complete cessation to be menopause whereas medically it is called the perimenopausal phase (perimenopause).
At menopause the levels of female hormones fall below normal. These hormones are not only essential for reproduction, but also for normal physiological functions of the body. The decrease in the levels of these hormones leads to some characteristic signs and symptoms which vary in severity. The immediate symptoms can be hot flashes/flushes (face, neck and chest ), vaginal dryness, night sweats and sleep disturbances. Hormone replacement therapy, using estrogen or progesterone alone or in combination, can stabilize the hormone levels in the body and relieve most of the symptoms.
There are some long term effects of the hormonal change seen in menopause which is not related to the female reproductive organs. The two more common and often serious effects is :
- Osteoporosis where there is accelerated bone loss with thinning and weakening of bones. It can lead to a loss of height and increased risk of bone fractures
- Hyperlipidemia is the change in the levels of lipids in the blood and increases risk of heart disease.
Hormone replacement therapy may slow the onset and progression of these conditions or possibly prevent it altogether.
Benefits of Hormone Replacement Therapy
A combination of estrogen and progesterone in optimal doses and for optimal duration may provide both symptomatic relief, thereby improving the quality of life, and delay or prevent associated conditions.
- Relieves the night sweats, vaginal dryness and hot flashes.
- Decreases the bone thinning and thus prevents the occurrence of fractures.
- Improves the lipid profile. A debate about the benefit of HRT in preventing cardiovascular disease is ongoing. The benefits versus exacerbating heart disease depends upon the status of the heart at the time of menopause.
- HRT may decrease the incidence of colon cancer.
Ideally hormone replacement therapy should be taken in the first few years of menopause. There is evidence to suggest that starting HRT after 60 years of age may be associated with the risk of developing certain complications. However this is often weighed against the potential benefits on an individual basis.