HRT involves taking estrogen and progestogen (combined HRT) or simply taking estrogen (estrogen-only HRT).
Even after you've decided to undergo estrogen replacement therapy (ERT), decision-making isn't over.
There are many types of estrogen therapy in many different forms: pills, patches, suppositories, and more. The best type of hormone replacement therapy (HRT) depends on your health condition, your symptoms, your personal preferences, and what you need to finish the treatment. For example, if you still have a uterus, estrogen will be given in combination with the hormone progestin.The type of hormone your healthcare provider prescribes may depend on your menopausal symptoms. For example, pills or patches can treat night sweats. Vaginal rings, creams, or tablets help alleviate vaginal dryness. Hormone replacement therapy (HRT) is an effective treatment for menopausal symptoms.
For many years, doctors used systemic hormone therapy to treat menopausal women, believing that hormone therapy could benefit cardiovascular health, prevent osteoporosis and help women live longer and healthier lives. However, in 2002, the Women's Health Initiative (WHI) changed this practice. The trial was discontinued prematurely because the results showed that the risks of hormone replacement with estrogen and progesterone in women with a uterus outweighed the potential health benefits. Subsequent research has further clarified the risks associated with HRT, as critics felt that the results of the WHI trial could not be generalized because the participants were older (mainly 60 and 70 years old) and used only oral estrogen and progesterone preparations.
Hormone replacement therapy is the most effective treatment for vasomotor and vaginal symptoms associated with menopause. Research shows that estrogen-only therapy reduces coronary heart disease and the risk of breast cancer in women younger than 60 when started within 10 years of the onset of menopause. Both treatment with estrogen alone and treatment with estrogen plus progesterone decrease the risk of hip fracture. The body produces three types of estrogen that can complement each other.
Estrone (E), which is primarily produced in adipose tissue, is the main type of estrogen found in the body after menopause. Estradiol (E) is the strongest estrogen and is present in the body before menopause. Estradiol is produced by the ovaries and its level decreases considerably after menopause. Estriol (E) is the weakest estrogen and is present in the body primarily during pregnancy.
Conjugated equine estrogen (CEE) is the most commonly prescribed oral estrogen substitute. It mainly contains estrone (E) and is derived from the urine of pregnant mares. Estradiol (E) is also available in the form of oral, topical, and vaginal preparations. Some doctors recommend combinations of different types of estrogens, made in compounding pharmacies, because they may better represent the proportions of estrogen found naturally in the body.
Some doctors believe that higher levels of estriol (E), or the weakest estrogen, may protect women against estrogen-caused cancers, such as breast and uterine cancer, although research has not yet been done. Hormonal hormone therapy is contraindicated in women with unexplained vaginal bleeding, estrogen-sensitive breast and endometrial cancers, a history of blood clots, coronary artery disease and high triglyceride levels, or chronic liver disease. HRT should be an individual decision that each woman makes with the help of her doctor, based on her quality of life and her attitude to menopause, the time since menopause and menopausal symptoms, medical history and factors of risk. According to the Global Consensus Statement on Hormone Therapy for Menopause, the benefits are more likely to outweigh the risks for symptomatic women before age 60 or within 10 years after menopause.
In the case of combined estrogen-progesterone therapy, continued use should be re-evaluated for 3 to 5 years, as the risk of breast cancer increases slightly. In the case of estrogen-only therapy, the duration of use may be longer. Consider vaginal administration of hormone therapy if symptoms are limited. to vaginal dryness.
Consider the use of transdermal or topical estrogens, which avoid the first-pass liver effect and reduce the risk of venous thromboembolism compared to oral preparations. Consider using oral micronized progesterone instead of synthetic progestins to minimize the risk of breast cancer. Prescribe a progestogen along with estrogen if there is still a uterus to reduce the risk of endometrial cancer. According to the North American Menopause Society, progestin must be administered together with systemic estrogens or transdermal.
Progestin is unnecessary if only intravaginal estrogens are prescribed in appropriate doses. The levonorgestrel IUD is sufficient to protect against this risk, although it is not approved by the FDA for this indication. The FDA has approved bioidentical formulations of estrogen and progesterone. Products include oral, transdermal and vaginal 17-estradiol (from the FDA) and oral progesterone.
These products are carefully controlled and regulated, improving safety and known risks. If women are interested in using bioidentical hormone therapy, consider these products. As with patches, this type of estrogen treatment is absorbed through the skin directly into the bloodstream. Even if hormone therapy isn't right for you, there are other treatment options that your healthcare provider may recommend to help treat menopausal symptoms.
As researchers learn more about menopausal hormone therapy and other menopausal treatments, recommendations may change. Bioidentical hormones are derived from plants, animals, or chemical synthesis and are very similar to the hormones that the body produces naturally. Talk to your healthcare professional about these risks when deciding if menopausal hormone therapy might be an option for you. Compound hormones aren't well studied and healthcare providers aren't sure about their long-term effects.
Given the increased risk of breast cancer recurrence, especially for people with estrogen receptor-positive disease, most experts generally advise against the use of systemic HRT in breast cancer survivors. Because early estrogen loss increases the risk of many diseases, including cardiovascular disease, people who lose estrogen before age 40 are at risk of heart disease if they don't use hormone replacement therapy (HRT). This risk may be related to age, existing medical conditions, and the time a woman begins receiving hormone therapy. This activity for health professionals is designed to help students better understand the indications of hormonal hormonal therapy, the risk-benefit ratio, individualized treatment, including treatments and methods of administration with estrogen and progesterone, and the implementation of an appropriate interprofessional treatment approach to improve the outcomes of patients.
Some research suggests that combination hormone therapy may protect against heart attacks in women who start combination therapy within 10 years of menopause and who are younger than 60. It's important to make the decision to take hormone therapy after talking to your healthcare provider. The risks of hormonal hormone therapy vary depending on the type, dosage, route of administration, duration of use, and age of onset. They found that the use of estrogen-only hormone replacement therapy in people over 65 years of age was associated with a significant reduction in mortality (19%) and in the risk of suffering from several conditions, such as breast, lung and colorectal cancer, congestive heart failure, VTE, atrial fibrillation, myocardial infarction and dementia.
However, migraine with or without aura is not a contraindication for HRT in symptomatic menopausal patients.
