V. Very important things to know about Hormone Replacement Therapy (HRT)
i. What is HRT and is it right for everyone?
HRT is used to treat menopausal symptoms either because other methods were not sufficient or because that woman has chosen HRT and her doctor believes she is a good candidate for HRT. Consideration must include age, age of menopause, severity of menopausal symptoms, personal medical history and family medical history. This is to determine the risks and benefits to that individual. Once the decision is made to treat with HRT then the type, dose and route of administration should be determined. The typical rule of thumb is for a woman to go on the lowest dose for the shortest duration of time.
ii. What are the different hormones in HRT?
ESTROGEN
Estrogen plays an important role in reproduction for women during the fertile years. It is also influential in bone health, cardiovascular health and sexual function. Estrogen can only be taken alone (without the hormone progesterone) in a woman who no longer has her uterus (in other words she has had a hysterectomy). Estrogen taken alone, without progesterone, can increase that woman’s risk for developing a cancer of her uterine lining.
PROGESTERONE
Progesterone plays an important role in reproduction for women during her fertile years. It plays a role in cardiovascular health as well as sleep and emotional well-being. Combined HRT refers to estrogen and progesterone together and this is administered to women who have a uterus (has not had a hysterectomy) in order to protect the uterine lining from developing a abnormal cells or cancer.
TESTOSTERONE
When testosterone is added to HRT it is often because sexual desire has reduced to a point that it is causing distress, either personally or in her relationship, and this change cannot be attributed to other physical or emotional factors. Although the efficacy of testosterone for female sexual function remains controversial it is sometimes prescribed. The primary mode of administering testosterone is topical; patch, cream or gel, and not oral due to possible adverse effects on the liver.
BIO-IDENTICAL HORMONES
Bio-identical and natural hormones are not considered to be safer or better than what is used in traditional HRT. The term bio-identical means that the hormones administered have the same chemical make-up as the hormones your body produces and the term natural means that the chemical product was derived from either a plant or an animal and not created in a laboratory.
Iii. How are hormones administered?
There are a variety of ways to deliver hormones. Your personal provider can determine the best option for you including a PILL which can have estrogen, progesterone or estrogen and progesterone. The PATCH option has either estrogen or progesterone or both. SKIN CREAMS & SPRAYS have estrogen and should be used with a progesterone in a woman who retains her uterus. SUB-DERMAL PELLETS can be a combination of estrogen, progesterone and testosterone. And, VAGINAL CREAMS, RINGS & INSERTS have estrogen that has low absorption and usually does not require combination therapy, they are primarily used to help with vaginal dryness which can result in painful sex.
iv. What are the benefits of HRT?
HRT can alleviate many menopausal symptoms including hot flashes, night sweats, vaginal dryness as well as improve mood and emotions and reduce bone loss.
v. What are the risks and contraindications of HRT?
Like any medication, HRT is not without risks. The use of HRT may increase the risk of developing blood clots, breast cancer, stroke as well as increased gallbladder issues. Contraindications to taking HRT include a prior estrogen related cancer such as breast, uterine or ovarian cancer, abnormal vaginal bleeding that has not been assessed, a history of, or a risk factor for, developing a blood clot which includes increased risk for a stroke or heart attack and liver disease.
Specific questions about HRT can and should be provided by your personal care physician. Contact your provider for more information. Verbena does not provide medical advice, diagnosis, or treatment and is not a medical provider. If you think you may have a medical emergency, call your doctor or 911 immediately.