What is Hormone Replacement Therapy?

Thursday 26 November 2020
Estrogen

Table of Contents


I. Overview

II. Types of Hormone Replacement Therapy

a. HRT Methods

b. HRT Routines

III. Benefits of Hormone Replacement Therapy

a. What are the Benefits?

b. Who can use HRT?

IV. Risks of Hormone Replacement Therapy

a. Breast Cancer

b. Other Forms of Cancer

c. Blood Clots and Stroke


Overview

Hormone replacement therapy (HRT) is a form of medication treatment that contains female hormones. Typically, HRT is used to treat the symptoms of menopause, such as hot flashes, sweating, and vaginal discomfort. For this reason, hormone replacement therapy may also be known as menopausal hormone therapy. However, HRT can also be prescribed for other reasons, including the prevention of bone loss during menopause.

Hormone replacement therapy can also be used to treat men. HRT may be prescribed to treat low blood testosterone levels, transitioning from the sex assigned at birth, or to treat prostate cancer. [1]

Menopause is a natural transition in a woman’s life and many women go through this time without requiring treatment. HRT is used to replace reduced hormone levels as you approach menopause, reducing menopausal symptoms.

Orange pills spilling out of a white bottle

Hormone replacement therapy usually involves estrogen or estrogen alongside progestin, which is similar to progesterone. Women that have not had a hysterectomy and have a uterus are normally prescribed estrogen and progestin. Women that have had a hysterectomy are more likely to be prescribed estrogen alone. This is because estrogen by itself can increase the risk of endometrial cancer. [2] Keep reading to learn about the main types of HRT and the benefits and risks of this treatment. 

Types of Hormone Replacement Therapy

There are several different forms of hormone replacement therapy. Your doctor will decide which form of HRT is best for you, depending on your age, symptoms, general health, and whether or not you have had a hysterectomy.

a. HRT Methods

Systemic Hormone Therapy: Systemic therapy comes in a variety of different forms, including pills, patches, gels, and creams. Systemic treatment involves the hormones being absorbed throughout the body and therefore, is usually given in a higher dosage. Systemic hormone therapy may be prescribed to treat any menopausal symptom. Common systemic medications can include Estraderm patches (estradiol), Climara Patches (estradiol), and Estrace (estradiol). [3]

Vaginal Hormone Therapy: Hormone therapy can also be localized to treat vaginal or urinary menopausal symptoms. Vaginal hormone therapy is typically given in a lower-dose. Common forms of this treatment can involve creams, vaginal pills, and vaginal rings. Common vaginal products include Vagifem (estradiol) and Premarin Cream (conjugated estrogens). [3]

b. HRT Routines

There are also different schedules that you must be aware of before starting hormone replacement therapy. Cyclical and continuous HRT are routines involving both estrogen and a form of progesterone such as Prometrium (progesterone).

Cyclical HRT: Cyclical (or sequential) HRT involves taking a form of estrogen every day and then taking a form of progesterone. For monthly HRT, a woman will take progesterone each day for the last 14 days of her menstrual cycle each month.  This form of cyclical HRT is typically used for women that are still having regular periods. For women that are having irregular periods, your doctor may suggest 3-monthly HRT. This still involves taking estrogen each day, but progesterone should only be taken for 14 days out of every three month period. [4]

Continuous Combined HRT: Continuous combined HRT is typically prescribed when a woman is postmenopausal. This form of hormone replacement therapy involves taking both estrogen and progesterone every day without a break. [4] 

A close-up of a calendar

Benefits of Hormone Replacement Therapy

There are many benefits to having hormone replacement therapy. Before any treatment, your doctor will weigh the benefits and risks to decide if HRT is right for you.

a. What are the Benefits?

The primary benefit of having hormone replacement therapy is the relief of menopausal symptoms. While many symptoms will pass naturally after a few years, they can be unpleasant and affect your quality of life while they are occurring. The main symptoms of menopause include:

  • Hot flashes (vasomotor symptoms)
  • Sweating, especially at night
  • Interrupted sleep
  • Fatigue
  • Vaginal dryness
  • A reduced sex drive
  • Mood swings [4] [5]

A woman fanning herself in her house

b. Who can use HRT?

Hormone replacement therapy is not suitable for everyone. It is most effective for women that have moderate to severe symptoms, especially hot flashes. HRT can also benefit women that are at risk of osteoporosis. Osteoporosis is often treated using another form of medication known as bisphosphonates. However, for women that cannot tolerate bisphosphonates, or if the medication is ineffective, then HRT can be beneficial in preventing bone loss.

Certain women may have reduced levels of estrogen before menopause. This occurs naturally or may be the result of ovary removal or primary ovarian insufficiency. HRT can help these women decrease their risk of other conditions, including heart disease, stroke, and dementia. [3] 

Risks of Hormone Replacement Therapy

Major organizations such as the North American Menopause Society (NAMS) and the American College of Obstetricians and Gynaecologists (ACOG) believe that the benefits of hormone replacement therapy outweigh the risks for many women. However, it is important to be aware of the risks of this treatment. [5]

It is believed that the risks involved with hormone replacement therapy depend on the woman’s age, general health, health history, and the type of hormone therapy that is being prescribed. [3]

a. Breast Cancer

Studies have shown that the risk of breast cancer increases when a combination of estrogen and progesterone is taken for longer than a year. The longer that the treatment lasts, the higher the risk of developing breast cancer.

After five years of hormone treatment, women in their 40s and 50s may experience one extra case of breast cancer:

  • Per 200 women taking estrogen-only HRT
  • Per 70 women taking cyclical HRT
  • Per 50 women taking continuous HRT

The rate of these cases is double for women that take HRT for over ten years. There is no increased risk of breast cancer for women that use estrogen-only vaginal hormone therapy. Research also shows that once you stop taking HRT, the risk of breast cancer decreases. [4]

A pink breast cancer ribbon

b. Other Forms of Cancer

Older research also links HRT to endometrial cancer and ovarian cancer. Estrogen-only therapy can increase the risk of endometrial (womb) cancer. For this reason, estrogen-only HRT is typically only prescribed for women that have had a hysterectomy, so they have no risk of developing this complication. [6]

It is believed that estrogen-only HRT and combined HRT can also increase the risk of ovarian cancer. However, it is thought that this risk is very small, and any risk will decrease once treatment has ended. [4]

c. Blood Clots and Stroke

The risk of blood clots depends on the form of HRT. Taking pills may increase your risk of blood clots, but this is not the case when patches or gels are used. While women that take HRT pills may have a risk of blood clots that is two or four times higher than other menopausal women, the risk is still very low.

Taking estrogen tablets can also slightly increase your risk of stroke. This risk is low for women under 60 years old. [4] It is important to speak to your doctor about all of the risks before beginning hormone treatment

The content in this article is intended for informational purposes only. This website does not provide medical advice. In all circumstances, you should always seek the advice of your physician and/or other qualified health professionals(s) for drug, medical condition, or treatment advice. The content provided on this website is not a substitute for professional medical advice, diagnosis, or treatment.