General Health

What is Hormone Replacement Therapy?

Overview

Hormone replacement therapy also referred to as menopausal hormone treatment or postmenopausal hormone therapy, is a type of hormone therapy used to ease the symptoms related to female menopause. Hot flashes, vaginal shrinkage, rapid skin ageing, vaginal dryness, reduced muscle mass, sexual dysfunction, and bone loss (osteoporosis) are some of the symptoms. They are mainly driven by decreased sex hormone levels that develop with menopause.

Estrogens and progestogens are the most common hormonal drugs used in Hormone replacement therapy for menopausal symptoms, with progesterone being the most common naturally occurring female sex hormone as well as a synthetic medication used in menopausal hormone treatment. Though both types of hormones can help with symptoms, when the uterus is present, a progestogen is added to oestrogen regimens to reduce the risk of endometrial cancer. This is because uncontrolled oestrogen treatment increases endometrial thickness, which raises the risk of cancer, whereas progestogen lowers the risk. Testosterone and other androgens are sometimes employed. HRT is available in several various forms.

Individual schedules may differ substantially, making analysis difficult. The long-term effects of HRT on most organ systems vary by time and age since its last physiological exposure to hormones, and individual schedules may range greatly, making analysis difficult. The Women’s Health Initiative (WHI) is a long-term study involving almost 2.5 million women that began in 1991. Studies indicate that starting HRT within 10 years of menopause reduces all-cause mortality as well as the consequences of coronary disease, osteoporosis, and dementia; after 10 years, the benefits on mortality and coronary heart disease are no longer apparent, though there are lower risks of hip and vertebral fractures and a higher risk of venous thromboembolism disease.

Hormone replacement that is “bioidentical” to hormones produced in the human body is a 21st-century breakthrough that uses synthetic substances with “the same chemical and molecular structure as hormones produced in the human body.” These are primarily plant-derived steroids (phytosterols) that can be found in both registered pharmaceuticals and custom-made compounded medications, the latter of which is generally not advised by regulatory agencies due to a lack of standardisation and official control. As of 2017, there is insufficient clinical evidence to determine the safety and efficacy of bioidentical hormone replacement.

Short-term therapy of menopausal symptoms such as vasomotor hot flashes (commonly called hot flashes or flushes (HFs) and night sweats) or vaginal atrophy also referred to as atrophic vaginitis is thinning, drying and inflammation of the vaginal walls, as well as the prevention of osteoporosis, are among the Food and Drug Administration current indications for usage.

Side effects

Hormone replacement therapy has a variety of side effects, which include:

Common Side effects

  • Headache
  • Stomach cramps, bloating, or an upset stomach
  • Diarrhoea
  • Loss of appetite and weight
  • Changes in libido or libido performance
  • Nervousness
  • Patches of brown or black skin
  • Acne
  • Fluid retention causes swelling in the hands, feet, or lower legs.
  • Menstrual flow changes
  • Tenderness, enlargement, or discharge of the breasts
  • Wearing contact lenses becomes challenging all of a sudden.

Uncommon side effects 

  • Double vision, often known as diplopia, is a medical word for seeing things twice. Diplopia is a condition in which people perceive two images of the same item when they looked at it. Although double vision is usually a transitory problem, it can also be a sign of more significant health problems.
  • Abdominal discomfort
  • Skin or eye yellowness
  • Depression that is severe
  • Bleeding that is unusual
  • Appetite loss.
  • Lethargy is a feeling of exhaustion marked by low motivation, energy, and mental capacity
  • Fever
  • Urine with a dark colour.
  • Stool in a light colour
  • Chorea is an abnormal involuntary movement disease that is caused by the overactivity of the neurotransmitter dopamine in the parts of the brain that control movement. Chorea is one of a series of neurological disorders known as dyskinesias.

Contraindications

Hormone replacement treatment has the following absolute and relative contraindications:

  • Vaginal bleeding that hasn’t been diagnosed
  • Loss of liver function.
  • Gestation
  • Atherosclerotic heart disease is damage to the heart’s major blood vessels.
  • Breast, uterine, or ovarian cancer.
  • Migraines
  • Breast cancer history;
  • Ovarian cancer history
  • Deep vein thrombosis
  • Fibroids in the uterus are a common occurrence in women.
  • Breast ductal hyperplasia with atypical ductal hyperplasia
  • Gallbladder illness that is active (cholangitis, cholecystitis)
  • Once the disease has been treated, well-differentiated and early endometrial cancer is no longer an absolute contraindication.

References

  1. https://pubmed.ncbi.nlm.nih.gov/26444994/

  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6287288/

Author

 Yash Batra

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