Hormone replacement therapy (HRT) is the use of a synthetic or natural hormone to treat a hormone deficiency. Most commonly, the term HRT refers to the use of female hormones to replace those lost after the menopause. This loss may occur naturally or as a result of treatment such as radiotherapy or the removal of the ovaries.

HRT BENEFITS AND RISKS

HRT relieves symptoms of oestrogen withdrawal, particularly night sweats, hot flushes, and vaginal dryness. Minor adverse effects of HRT include nausea, breast tenderness, fluid retention, and leg cramps.

HRT for menopausal symptoms is given only for short-term use around the menopause. It is no longer recommended for long-term use because of the increased risk of developing disorders such as breast cancer, stroke, and thromboembolism; it may also increase the risk of coronary artery disease. The increased risk of breast cancer is related to the duration of HRT use; the risk reduces to its previous level within about five years of stopping HRT.

In the long term, HRT may give protection against osteoporosis (loss of bone density that can lead to fractures). However, it is now only used for this purpose in women who are unable to take other treatments, such as bisphosphonate drugs; when other treatments have been unsuccessful; or in women who have gone through a premature menopause (before the age of 40).

Whether or not HRT is appropriate depends on the individual woman concerned. Women who are considering HRT should consult their doctor, who will discuss their specific circumstances. Once it has been started, hormone replacement therapy should be reviewed regurlarly by a doctor.

TYPES OF HRT

In women with a uterus, HRT involves taking a continuous dose of an oestrogen drug, which is combined with an additional progestogen drug for 10 to 13 days of the 28-day cycle. The progestogen drug provokes bleeding which is similar to that of menstruation. This is necessary to prevent excessive thickening of the lining of the uterus and the risk of it becoming cancerous.

Alternatively, in cases in which more than one year has passed since the woman’s last menstrual period, continuous bleed-free HRT, or a single drug with both oestrogenic and progestogenic effects (such as tibolone), can be used. Women who have had a hysterectomy need only take oestrogen drugs. Oestrogen drugs can be administered in the form of tablets, skin patches, gels, or implants; progestogen drugs are administered as tablets, skin patches, or vaginal gel.

HRT COMMON DRUGS

• OESTROGEN DRUGS – Conjugated oestrogens, Estradiol, Estriol, Estrone, Estropipate
• PROGESTOGEN DRUGS – Dydrogesterone, Levonorgestrel, Medroxyprogesterone, Norethisterone, Norgestrel
• OTHERS – Tibolone

Source: A-Z family medical encyclopedia by BMA

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