Hormone Replacement Therapy is a therapeutic option for managing menopausal symptoms that involves restoring hormones that become low as women approach menopause and during the post-menopausal period. Menopause symptoms include hot flashes, nocturnal sweats, v@ginal dryness, mood swings, and bone loss. HRT can help relieve these symptoms while also lowering the risk of osteoporosis and possibly heart disease in some women.
Types of Hormone Replacement Therapy
There are two main types of HRT:
1. Estrogen-only therapy (ET): This type of HRT contains only estrogen and is usually prescribed for women who have had a hysterectomy (surgical removal of the uterus). Estrogen-only therapy can effectively relieve menopausal symptoms and help prevent osteoporosis. However, it is associated with an increased risk of endometrial cancer (cancer of the lining of the uterus) in women who still have their uterus.
Note: Estrogen therapy, whether oral or topical, may not be suitable for individuals with a history of breast or uterine cancer, blood clots, stroke, heart attack, or blood clotting disorders. Duphaston Tablet, containing dydrogesterone, is an alternative hormone replacement therapy option for post-menopausal women, particularly when estrogen therapy alone is not recommended.
2. Combined estrogen-progestogen therapy (EPT): This type of HRT contains both estrogen and progestogen (a synthetic form of the hormone progesterone). It is prescribed for women who have not had a hysterectomy. Progestogen is added to this therapy to protect the uterine lining from overgrowth, which can reduce the risk of endometrial cancer associated with estrogen-only therapy. Combined HRT is effective in relieving menopausal symptoms and also offers protection against osteoporosis.
Ways of Hormone Replacement Therapy
Various ways of taking Hormone Replacement Therapy (HRT):
1. Tablets: Tablets are a common form of HRT. They are taken orally once a day. They are available in both estrogen-only and combined estrogen-progestogen forms.
2. Patches: HRT patches are directly applied to the skin, usually on the lower part of the body. They gradually release hormones into the body. Patches are changed every few days, and both estrogen-only and combined HRT options are available. Patches can be a good option for those who have difficulty swallowing tablets or want to avoid certain side effects associated with oral tablets.
3. Gel: Oestrogen gel is directly applied to the skin once a day, where it is absorbed gradually. It is important to note that the woman hasn't had a hysterectomy; the gel is used with a progestogen. Gel application may take some time to dry and does not increase the risk of blood clots associated with oral tablets.
4. Spray: Oestrogen spray is applied once a day onto the inner side of the arm or thigh. Like gel, the woman hasn't had a hysterectomy; the spray is used with a progestogen.
5. Intrauterine system (IUS): This is also known as the Mirena coil. It is inserted into the womb and releases progestogen gradually. It can be a suitable option for women who need progestogen along with other forms of estrogen-based HRT. These coils can stay in place for up to 5 years and also act as contraception.
6. V@ginal Oestrogen: Low-dose estrogen is available in various forms such as cream, gel, v@ginal tablet, pessary, or ring. These are inserted into the v@gina to alleviate symptoms such as v@ginal dryness and pain during intercourse. Unlike systemic HRT, v@ginal estrogen doesn't carry the same risks. It can be used without progestogen, even in women with a uterus.
7. Testosterone: While not typically prescribed for menopausal symptoms, testosterone can be used in some cases where there are problems with low s€x drive and other symptoms not alleviated by traditional HRT. Testosterone gel is a common form of administration.
8. Tibolone: Tibolone is a prescription medicine similar to combined HRT but also has a testosterone effect. It is taken orally once daily and may help relieve symptoms like hot flashes and low mood. However, its effectiveness compared to traditional HRT is still under study.
Hormone Replacement Therapy treatment routines
1. Oestrogen-only HRT for women who had a hysterectomy: If a woman has had a hysterectomy (surgical removal of the uterus), she will typically take estrogen-only HRT every day. This helps to replace the estrogen that her body no longer produces.
2. Sequential Combined HRT for women still having periods (perimenopause): For women who are still experiencing periods but also have menopausal symptoms, sequential combined HRT is often recommended. This type of HRT involves taking both estrogen and progestogen, but cyclically, to mimic the menstrual cycle.
3. Continuous Combined HRT for postmenopausal women: Continuous combined HRT is typically recommended for women who have not had a period for one year or more, indicating they are in postmenopausal. This type of HRT involves taking both estrogen and progesterone every day without any breaks.
Continuous combined HRT helps to provide a steady level of hormones to alleviate menopausal symptoms and protect the uterus lining without the need for a menstrual cycle.
Conclusion
To conclude, alongside Hormone Replacement Therapy (HRT), adopting a balanced diet rich in fruits, vegetables, and calcium, staying hydrated, exercising regularly, managing stress, ensuring quality sleep, and avoiding smoking can enhance overall well-being during menopause. Routine check-ups with your doctor are essential for monitoring health and discussing concerns. By incorporating these lifestyle adjustments, individuals can better manage pre and post-menopausal symptoms and promote overall health and vitality.
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