During menopause the body stops producing the same levels of hormones that it has throughout the reproductive years. This hormonal decrease can result in unpleasant side effects such as hot flashes, vaginal dryness, and night sweats. Hormone Replacement Therapy (HRT) treats these symptoms with medication that replace the hormones, typically estrogen and progesterone/progestin, that are no longer being produced naturally in the body throughout menopause. HRT is also often used an effective prevention against osteoporosis (bone thinning).
A Brief History of HRT
The Food and Drug Administration approved the use of Hormone Replacement Therapy for treatment of menopausal symptoms in the 1940s and for decades afterward HRT was broadly prescribed to women to mitigate the side effects of menopause. It was also thought that HRT possessed additional health benefits such as reducing the risks of heart disease and dementia.
Unfortunately, clinical trials later showed that that while HRT decreased menopause symptoms it also presented other significant health risks, particularly when given to older women. Hormone Replacement Therapy is therefore no longer prescribed as broadly to menopausal women, and it is not recommended for long term use or as a general preventative against disease. However, HRT still has many beneficial properties and some women should consider it if their menopausal symptoms are particularly severe or they have a certain medical conditions.
Categories of HRT
There are two main types of Hormone Replacement Therapy: systemic hormone therapy and low-dose vaginal preparations.
Systemic hormone therapy comes in the form of a pill, gel, spray, or skin patch and has proven to be an effective treatment for most of the side effects associated with menopause, including hot flashes and night sweats.
Low-dose vaginal preparations of estrogen come in the form of creams, vaginal rings, or suppositories and they help specifically with vagnial symptoms including dryness, burning, itching, intercourse discomfort, and some urinary tract issues. Unlike systemic hormone therapy, low-dose vaginal products have the benefit of not being absorbed by the body, however, they do not treat hot flashes or night sweats and this method offers no protection against osteoporosis.
Bioidentical Hormone Replacement Therapy (BHRT)
Bioidentical hormones are medical hormones that are chemically identical to the hormones produced in an individual person. They are usually synthesized from saliva samples. However, the hormone composition found in an individual's saliva is not necessarily the same level found in the blood and may not reflect the appropriate levels to treat menopausal symptoms. Furthermore, while some women may find relief from their menopausal symptoms from BHRT, the risks are the same as they are for conventional HRT.
Benefits of Hormone Replacement Therapy
Hormone Replacement Therapy is an effective solution for women suffering extreme symptoms of menopause, or for women experiencing premature menopause (menopause before the age of 40) due to a medical condition. Systemic hormone therapy is also a useful treatment for women dealing with osteoporosis, particularly if they are not able to take other medications for bone loss or previous treatments have not worked.
HRT Safety Concerns
HRT has many benefits but it also comes with risks. Systemic hormone therapy in particular is not recommended for long-term use for most women and studies show that HRT can increase the risk of stroke, blood clots, heart disease, weight gain, and certain breast cancers.
The risks of HRT depends upon the type of therapy prescribed and the length of time it is given. Low-dose vaginal products are not as effective in treating all symptoms of menopause, but since the hormones are not absorbed by the body, this method does not pose as many health risks other therapies. Furthermore, some clinical trials show evidence that estrogen only therapies (Premarin) may not increase the risk of heart disease.
Health risks posed by medical intervention are always concerning and should be taken seriously, but in some cases the benefits outweigh the potential risks. For women coping with premature menopause, or women who have had a hysterectomy (removal of the uterus) and/or oophorectomy (removal of the ovaries), HRT can help prevent bone thinning, depression, and coronary heart disease.
Best Candidates for HRT
The decision to pursue Hormone Replacement Therapy should be taken on a case-by-case basis. A woman’s current symptoms, age, and medical and family history should be factored into determining whether HRT is the right course of action and, if so, which kind of treatment will pose the greatest benefit with the least amount of risk.
Women who are interested in Hormone Replacement Therapy should consult her gynecologist and carefully consider which option would best fit her needs. HRT may not be the routinely prescribed cure-all generations past thought it was, but it can still offer health benefits and relief for women struggling with menopause or related health issues.