Let’s explore Hormone Replacement Therapy for women

October 15, 2024

Discussion of HRT for women written by Kenneth Power, MD

Hormone Replacement Therapy, or HRT, is a treatment that helps ease the symptoms caused by decreasing hormone levels during perimenopause and menopause. Many women experience uncomfortable symptoms such as hot flashes, night sweats, mood changes, and vaginal dryness. HRT works by supplementing the body with hormones like estrogen and progesterone, which helps alleviate these symptoms and improve overall quality of life.

Perimenopause is the period leading up to menopause, during which the body’s levels of estrogen and progesterone start to decline rapidly. It can last several years sometimes. Menopause itself is defined by the absence of menstruation for 12 consecutive months.

The loss of these hormones during perimenopause and menopause can lead to various other symptoms, including sleep disturbances, weight gain, loss of sex drive, and brain fog. HRT provides supplemental estrogen, progesterone, or both to relieve these symptoms and support a better sense of well-being.

Hormone Therapy vs. Hormone Replacement Therapy

Hormone Therapy (HT) is a broad term that includes different types of treatments for hormonal imbalances, such as those caused by cancer or other medical conditions. Hormone Replacement Therapy (HRT) specifically refers to the use of hormones to manage symptoms related to menopause, providing relief by replacing the hormones that the body no longer produces in sufficient amounts.

Systemic Hormone Therapy vs. Local Hormone Therapy

Hormone therapy can be thought of as systemic or local. Systemic hormone therapy is absorbed throughout the body and is used to address symptoms like hot flashes and night sweats. It can be taken in forms such as pills, patches, or even implantable pellets!

Local hormone therapy, on the other hand, is targeted to specific areas of the body, such as vaginal, and is used to treat localized symptoms like dryness, irritation, or pain/discomfort. Local therapy is administered via creams or suppositories.

Traditional vs. Bioidentical Hormone Replacement Therapy

Traditional hormone replacement typically uses synthetic hormones or hormones derived from animal sources (Premarin). These hormones are effective but differ slightly from those naturally produced by the body.

Bioidentical Hormone Replacement Therapy (BHRT) uses hormones that are chemically identical to those produced by the human body. BHRT is often marketed as a more natural alternative, and many women report positive outcomes.

However, there is no concrete evidence that BHRT is more effective than traditional HRT, so the choice between BHRT and traditional HRT should be made in consultation with your healthcare provider.

Is Bioidentical Hormone Replacement Therapy (BHRT) safer?

The answer is a solid “maybe”. There is an ongoing debate about whether BHRT is safer than traditional HRT. While it may make sense intuitively, it turns out to be quite difficult to study and prove scientifically. So, while BHRT does use hormones that are chemically identical to the body’s own, there is still no strong evidence to prove that it is significantly safer than traditional HRT.

Both forms of therapy carry potential risks, including an increased risk of blood clots, certain cancers, and other side effects. It is essential to discuss all available options with your healthcare provider to determine which approach you want to pursue.

The cost difference between HRT options

The cost of HRT can vary depending on whether you choose traditional HRT or BHRT. Traditional HRT is always covered by insurance and is, therefore, more affordable. BHRT, which is typically custom-compounded, is usually more expensive since it is rarely covered by insurance. If trying both, most women ultimately make the decision if the extra cost is worth it based on how they feel after a few weeks, especially if the regimen is different (for example, adding testosterone into BHRT for libido and metabolism).

Signs you might need Hormone Replacement Therapy

HRT might be beneficial if you are experiencing:

  • Hot flashes or night sweats
  • Vaginal dryness or discomfort
  • Difficulty sleeping
  • Mood swings or irritability
  • Trouble losing weight or gaining weight


HRT duration recommendations

The recommended duration of HRT depends on individual needs and the severity of symptoms. Most healthcare providers recommend using the lowest effective dose for the shortest time necessary to manage symptoms. Many women use HRT for a few years to get through the worst of their menopausal symptoms. Prolonged use could increase certain health risks, so regular follow-ups with your healthcare provider are essential to determine whether continued treatment is appropriate.

Monitoring requirements for HRT

Regular monitoring is a key component of safe HRT use. Women on HRT should have periodic check-ins with their healthcare provider, which may include:

  • Routine physical exam to evaluate overall health
  • Breast exams and mammograms, as HRT may slightly increase the lifetime risk of breast cancer
  • Blood pressure monitoring, as HRT could elevate blood pressure
  • Blood tests to check hormone levels and liver function
  • Ongoing assessment of symptoms to determine whether HRT should be adjusted or discontinued


Who should not use Hormone Replacement Therapy?

HRT is not suitable for everyone. Women in the following categories are generally advised to avoid HRT:

  • History of breast cancer, uterine cancer, or other hormone-sensitive cancers
  • History of blood clots, such as deep vein thrombosis (DVT) or pulmonary embolism
  • Untreated high blood pressure
  • Active liver disease
  • History of heart disease or stroke


Alternatives to Hormone Replacement Therapy

If HRT is not suitable or you prefer not to take hormones, several alternatives can help manage menopausal symptoms:

  • Lifestyle changes: Regular exercise, a healthy diet, and avoiding triggers like alcohol and caffeine reduce hot flashes and improve well-being.
  • Non-hormonal medications: Antidepressants (SSRIs or SNRIs), blood pressure medications (such as clonidine), and medications for nerve pain (such as gabapentin) can help alleviate symptoms for many.
  • Herbal supplements: Black cohosh, red clover, and soy isoflavones are popular herbal remedies.
  • Cognitive Behavioral Therapy (CBT): CBT might help with managing mood changes, anxiety, or sleep disturbances.
  • Vaginal moisturizers and lubricants: These can help relieve vaginal dryness and improve comfort.

These alternatives may not provide the same level of relief as HRT for all women, but they can be valuable options for those looking to avoid hormone therapy.

For more information, start your research at the National Center for Biotechnology Information, The North American Menopause Society, and WebMD.

If you are a WeCare tlc patient, contact your health center for more information. Remember, the health center is at no cost to you and your family!*

Source:
National Center for Biotechnology Information (NCBI) – Bioidentical Hormones: An Evidence-based Review

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