Hormone replacement therapy (HRT)
Hormone replacement therapy (HRT) is a group of drugs that act in a similar way to female sex hormones and that are used to reduce symptoms associated with the menopause.
At the menopause, there is a decline in the levels of the sex hormone oestrogen. Hormone replacement therapy (HRT) can be used to restore oestrogen to premenopausal levels. Reduced oestrogen levels may lead to symptoms such as hot flushes and vaginal dryness. In the long term, low levels of oestrogen may increase the risk of osteoporosis and heart disease. Menopausal symptoms may be particularly severe after surgical removal of the ovaries or following radiotherapy of the pelvic area in the treatment of cancer. Whether they occur naturally or after surgery or radiotherapy, the symptoms of the menopause are usually relieved by HRT.
HRT usually consists of a combination of oestrogen and a progestogen (a synthetic form of the hormone progesterone). Oestrogen that is taken alone is associated with a higher than normal risk of cancer of the uterus. For this reason, most women are also prescribed a progestogen, which gives protection against uterine cancer. In the case of women who have had a hysterectomy, usually oestrogen alone is prescribed. Tibolone combines the action of both oestrogen and progestogen in a single preparation.
|Oestrogens: Conjugated oestrogens, Estradiol, Estrone, Estropipate, Ethinylestradiol||Progestogens: Levonorgestrel, Medroxyprogesterone, Norethisterone, Norgestrel|
|Other drugs: Tibolone|
How is hormone replacement therapy (HRT) used?
HRT is usually given in the form of tablets, skin patches, or as a combination of the two. Tablets are taken daily; patches are usually changed twice a week and should be placed on a different area of skin each time. Other forms of HRT include a gel that is rubbed into the skin daily. Oestrogen creams, applied to the vagina for several weeks to treat vaginal dryness, may also be used. Courses of treatment with creams can be repeated if necessary, but if creams are used in the long term, you will need to take an oral progestogen as protection against cancer of the uterus.
If you are still having periods or if it is less than one year since your last period, HRT will be given in a dose that mimics the monthly cycle of natural hormones. As a result, you should have regular monthly bleeding, although it may be irregular initially. After taking HRT for a year, you may be given oestrogen and a progestogen continuously, which should stop further periods.
Women who are taking HRT during the menopause may need to continue using contraception (Combined oral contraceptive pill) if they wish to avoid becoming pregnant.
Whether or not treatment with HRT is appropriate is a complicated issue and varies according to the particular woman concerned. For this reason, it is important to discuss with your doctor the risks and benefits of HRT that may apply in your specific case. However, in general, HRT is usually only advised for short-term use around the menopause to treat symptoms such as hot flushes and vaginal dryness. HRT is no longer recommended for long-term use for the relief of menopausal symptoms nor for the treatment of osteoporosis because of the increased risk of disorders such as breast cancer, stroke, and thromboembolism (see Thrombosis and embolism). The increased risk of breast cancer is related to duration of HRT use; the risk reduces to its previous level within about 5 years of stopping HRT.
What are the side effects of hormone replacement therapy (HRT)?
If you are taking oestrogen, you may experience some side effects. These include nausea, headaches, and mood swings. Oestrogen may also cause breast tenderness, fluid retention, fluctuating weight, and eye irritation when wearing contact lenses. Progestogens can produce similar side effects to oestrogen, and occasionally cause acne and skin rashes. Such side effects are usually temporary and disappear after 1-2 months of treatment.
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