All About Seniors Health

Advantages and Disadvantages of Hormone
    Replacement Therapy (HRT)
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What is HRT (hormone replacement therapy)?

Hormone replacement therapy (HRT) is a synthetic hormone treatment to reduce symptoms in women who have menopause.

HRT is used to help increase the amount of oestrogen especially, but also progesterone in the menopausal woman's body to decrease the symptom associated with menopause.

The hormones used in HRT are basically the same as the ones used in the contraceptive pill, but the only differences are with HRT, the oestrogen is either synthetic or comes from an animal source - from pigs' ovaries or from the urine of pregnant mares and the dosage of oestrogen is lower in HRT (while progesterone is the same) and the schedule of dosage is different.

 

Types of HRT

There are a number of different types of HRT therapy that are available for women:


The hormone replacement therapy medication can be taken a number of different way, with varying results:

Tablets

Most HRT is through the prescription of tablets and there are over 50 different combinations of oesterogen and progesterone available in tablet form.

Sometimes both oestrogen and progesterone are combined in one tablet and sometimes they are taken separately in one of the following ways:


There are a number of advantages and disadvantages to the tablet form of HRT:


Tibolone (Livial)

This is another form of HRT which consists of oestrogen, progesterone and androgen in one tablet, which is taken once a day. It is recommended for women whose menstrual cycle has stopped for one year, as it can cause some vaginal bleeding.

There are a number of advantages and disadvantages to taking Tibolone HRT:


Transdermal patches

Transdermal patches are small patches that stick onto the skin and which supply a regular, but small dose of oestrogen through the skin and into the blood stream. The patches are applied below the waist and need to be replaced every 3-4 days, on different parts of the lower body. In addition to this, progesterone still needs to be taken in tablet form from days 14-25. A combined oestrogen-progesterone patch is available which can be used by women who still have a uterus and needs to be replaced every 3-4 days, on different parts of the lower body.

Transdermal patches seem to be more effective at reducing severity and frequency of menopause symptoms such as: hot flushes, sweating and headaches.

There are a number of advantages and disadvantages to taking transdermal patches for HRT:


Hormone implants

Hormone implants are small pellets (around the size of a pip of an apple) that are inserted under the skin (in the layer of fat under the skin) through a medical procedure that is usually done by a gynaecologist in the surgery or in hospital under local anaesthetic. The skin needs to be cut a little to allow the implant to be inserted into the skin and afterwards, it is closed with a stitch or some plaster.

The oestrogen hormone inside the implant is released gradually and can last up to nine months. Women who still have a uterus are prescribed progesterone tablets in addition to the implant.

There are a number of advantages and disadvantages to taking hormone implant HRT:


Nasal sprays

Nasal spray as a form of HRT is quite new and involves spraying the oestrogen from a metred-dosage pump. The oestrogen is then absorbed through the lining of the nose and travels into the bloodstream and mimics naturally produced oestrogen by the body more closely than any of the other forms of HRT. Women who have had a hysterectomy still need to take progesterone tablets for at least 12 days of the cycle.

While women who have nasal problems may not be able to take this form of HRT, women who just have a cold should still be able to use this form (they just need to blow their nose prior to spraying into the nose and avoid blowing their nose for at least 15 minutes after taking a dose).

There are a number of advantages and disadvantages to taking nasal spray HRT:


Vaginal creams

Oestrogen in cream form can be inserted into the vagina from an applicator that already has the dosage. This is the way that HRT is used to treat the menopause symptom of vaginal dryness. Vaginal cream if often recommended for women who still experience a dry vagina even when they take the oral or patch forms of HRT.

There are a number of advantages and disadvantages to taking vaginal cream HRT:


Vaginal rings (estring)

A vaginal ring is a silicon device which contains a small amount of oestrogen that is slowly released. The vaginal ring is inserted high in the vagina (as close to the cervix as possible) where it stays for three months and can be used up to two years.

Since the vaginal ring only provides oestrogen locally, to the vaginal area (to treat vaginal dryness or atrophy), many doctors believe that it is safe to use on women who have had breast cancer. The ring can be removed before sexual intercourse and replace against afterwards if it causes any discomfort if it is while in place.

There are a number of advantages and disadvantages to taking vaginal ring (estring) HRT:

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Advantages of HRT

There are a number of advantages of hormone replacement therapy (HRT) for women who try this for menopause symptoms (but the disadvantages of using HRT may be greater than the advantages):

While hormone replacement therapy is one way to alleviate symptoms of menopause, HRT is not suitable for all women in any case.

 

Disadvantages of HRT

While there are a number of advantages for women using HRT, there are also a great number of disadvantages.

A number of major studies looking at the effects of hormone replacement therapy (HRT) on menopausal women have been discontinued because there was an increased amount of women that developed the following conditions: coronary heart disease, stroke, thrombosis (DVT), breast cancer, ovarian cancer. The amount of women that developed these conditions was quite a lot higher than the control group of women that were not taking HRT.

The results of this study (which was aborted before completion) has been a concern to many women who were (or are condidering) taking HRT for their menopause symptoms.

There are a number of scientifically proven alternative treatments for menopause which can be used to help treat symptoms very effectively (and without many side effects at all).

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Is HRT suitable for all menopausal women?

Hormone replacement therapy (HRT) is definitely not suitable for all menopausal women.

Women with following conditions will be advised against trying HRT to relieve menopausal symptoms (these women should seek medical advice about alternatives to HRT):


Women with at least one (or more) of the following conditions should discuss HRT in depth with their doctor to determine if they really are a suitable candidate for using HRT (and most will not be):

 

Side effects of HRT

Some women experience no side effects when taking HRT, while a great number of others do experience numerable side effects from those which are very mild and are generally not too bothersome, to side effects which can be literally dangerous to their health.

Initial side effects that can be experienced while on HRT (which usually go away after a short while):

More serious side effects, that are usually more infrequently experienced, but if they occur, need to be reported to your doctor:

 

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Ways to alleviate side effects of HRT

The best way to alleivate side effects when taking hormone replacement therapy (HRT) is to treat the symptoms that occur individually.

Some of the main symptoms and the way to alleviate them:

 

How to stop taking HRT

Women who want to stop taking their current hormone replacement therpay (HRT) medication need to consult their doctor on the best way to gradually cease these medications.

HRT should not be stopped suddenly, as symptoms may suddenly get much worse, but rather treatment doses should be taperd over a period of about 1 month for each year on HRT.

Once off HRT there are three possible scenarios that can happen:

 

Alternatives to HRT

There are a number of scientifically proven alternatives to hormone replacement therapy (HRT) that will be of benefit to most women with menopausal symptoms:

Soya foods

Soya beans are an excellent complete protein food which has been used as part of everyday cooking in many Asian countries, such as Japan and China for centuries.

Very few women from Japan or China have severe menopause symptoms (unlike their Western sisters in countries such as Australia, USA, Canada and UK) and researchers believe this is directly related to the amount of soy foods they consume on a regular basis all their life. The higher soy intake in their diet is attributed to the relatively easier passage into menopause (up to 80% less symptoms) than Western women.

Researchers believe the reason for the relatively low incidence of menopause symptoms in Japanese and Chinese women is because of the phytoestrogens in soya, which are chemically similar to the natural oestrogen that is produced in the body (and especially to estradiol, which is the most active form of oestrogen produced during menopause). The bacteria in the stomach / intestines act on the phytoestrogens to enable them to bind to oestrogen receptors in the body and help to "trick" the body into thinking there is adequate oestrogen in the body for normal function.

The phytoestrogens are: lignans, flavones and isoflavone (the strongest acting) and they exist in a number of plant-based foods, such as legumes (peas, beans, chickpeas, lentils) and flaxseeds. There are a number of foods high in phytoestrogens which should be incorporated into the diet.

The oestrogenic effect of soy (and other legumes) is much weaker than the oestrogen produced within the body and very much weaker than synthetic oestrogen hormone. The issue with the oestrogens produced by the modern diet is that they are too strong (and allow too much of oestrogen to be circulating through the body as there is no fibre or other beneficial substances to help remove the excess oestrogen) and have the potential to increase the risk of conditions such as oestrogen-dependent cancers.

In addition to this, there are the xenoestrogens which are found in many environmental chemicals, cosmetics, plastics, household clearners, paints, floor varnish, pesticides, as well as hair, body and face care products. These xenoestrogens have a similar molecular structure to natural oestrogen, so they can trigger oestrogen-like activity in the body, or they can disrupt the natural oestrogen activity in the body, with adverse results - they can trigger oestrogen-dependent cancers of the breast, ovaries or uterus.

Soy isoflavones compete with the oestrogens produced naturally in the body as well as with xenoestrogens and the isoflavones attach themselves to the oestrogen receptors on the cells of the body and prevent the excess oestrogen-like activity that could otherwise occur.


Diet

In order to provide the most nutritional value to help a woman have relief from symptoms (or prevent them altogether), the following are some recommendations on diet:


Physical therapy

Physical activity is important for relief of menopause symptoms and the following are recommended on a daily basis:


Vitamins and Minerals

There are a number of vitamins and minerals that are especially needed during menopause:


Other nutrients

There are a number of other nutrients that are useful for dealing with menopause symptoms and they are as follows:


Herbs

Many herbs have been successfully used for centuries to help women overcome severe symptoms associated with menopause symptoms and some of these are:

Only a qualified herbalist can prescribe a herbal remedy for a woman's individual menopausal symptoms - all individual factors need to be taken into consideration when herbs are prescribed - what is suitable for one woman may not be suitable for another. Never self-prescribe herbs. Always seek the advice of a naturopath, in conjunction with your doctor.

 

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  Last reviewed: 26 January 2009 || Last updated: 12 January 2014

 

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NOTE: Mega doses of vitamins, minerals, amino acids, or other supplements cannot cure illnesses and in fact can be very dangerous and produce toxic side effects and interfere with medicine you are taking. Always ensure you consult your doctor before taking any type of nutrient supplement.
Disclaimer: This guide is not intended to be used for diagnostic or prescriptive purposes. For any treatment or diagnosis of illness, please see your doctor.