Hormone replacement therapy: what is it and when is it recommended

Did you know a treatment exists and is available to help you reduce menopause symptoms and even prevent some illnesses? It is hormone replacement therapy or more commonly known as HRT. Here, we are going to explain in an easy, straightforward manner its benefits (Harper & Shanahan, 2022; NCI, 2018).

What is hormone replacement therapy?

It is a specialised treatment typically used to balance out hormone levels during or close to menopause (Harper & Shanahan, 2022; NCI, 2018). Overall, it involves administering synthetic hormones - specifically oestrogen and progesterone (NCI, 2018). There are four types of hormone replacement therapy (Riggins, 2020):

• Oestrogen-only: this process is usually reserved for women that do not have a uterus or ovaries.
• Cyclical or sequential: in this therapy, hormone doses adapt to menstrual cycle phases. It is commonly used in women experiencing perimenopause.
• Continuous therapy combines oestrogen and progesterone.
• Local oestrogen: this process consists of creams, pills, or rings that carry the hormone. They are applied locally in the genital area and help ease vaginal symptoms of menopause.

Who are ideal candidates for hormone replacement therapy?

It can be a suitable option for many women. The main criteria taken into consideration to start taking it includes (Mayo Clinic, 2021; Harper & Shanahan, 2022):

• Having hot flushes and/or moderate or severe vaginal dryness.
• Needing to prevent osteoporosis.
• Being younger than 60 years of age.
• Being in the first ten years of menopause –even the perimenopause period, and early menopause, which happens before the age of 40-years-old.

Benefits of the treatment

By stabilising hormone levels, this therapy offers physical and mental health benefits, such as (Genazzani et al., 2021; Langer et al., 2021. NCI, 2018):

• Helping reduce hot flushes and night sweats.
• Contributing to improving genital and urinary-related symptoms, like vaginal dryness, genital burning, urine leakage, and discomfort during sexual relations.
• It may help to improve mood by providing a sense of wellness.
• Evidence suggests that this therapy may aid in preventing osteoporosis and reducing the risk of broken bones.
• Assists in reducing mortality, some heart disease, and dementia if implemented before 60-years-old or during the first ten years of menopause.
• Eliminating the need to take multiple treatments to alleviate menopause symptoms.

Moreover, having healthy habits in everyday life can complement such benefits. Specifically, a healthy diet and weight, exercising regularly, and avoiding smoking (AAFP, 2020). The central premise of this treatment is to use the lowest doses during the shortest time possible. However, women with severe symptoms, a high risk of osteoporosis, and colon or rectal cancer can benefit from extending it. Speak to your Doctor to learn more (AAFP, 2020).

Side effects of hormone replacement therapy

Even though this therapy helps reduce many menopause signs and symptoms, it can also have some side effects, such as (MedLine Plus, 2018):

• Acne.
• Leg cramps.
• Abdominal, back, or lumbar pain.
• Digestive issues, including nausea and vomiting.
• Excessive breast soreness or tenderness.
• Headaches.
• Mood swings.
• Depression.
• Swelling, particularly in areas like the breasts or the legs.
• Vaginal bleeding.

Usually, side effects are mild and short-lived. Plus, they tend to disappear within a few weeks of starting the therapy. However, some people may experience them more severely. In case they fail to improve, please consult your Doctor (MedLine Plus, 2018).

General contraindications

This type of therapy may have adverse effects as with any medical treatment. A 2002 study by the Women’s Health Initiative (WHI) found some of its risks. Therefore, women with the following conditions should avoid it (Langer et al., 2021):

• High blood pressure.
• Heart disease.
• High triglycerides levels in the blood.
• A breast cancer precedent, or an ongoing diagnosis.
• Gallbladder disease.
• Blood clot precedents.

Hormone replacement therapy is a useful treatment for women experiencing menopause symptoms. It can help to ease many of the signature symptoms of this stage. Always consult with a Doctor. References American Academy of Family Physicians (AAFP). (2020, abril 14). Terapia de reemplazo hormonal. https://es.familydoctor.org/terapia-de-reemplazo-hormonal/?adfree=true Genazzani, A. R., Monteleone, P., Giannini, A., & Simoncini, T. (2021). Hormone therapy in the postmenopausal years: considering benefits and risks in clinical practice. Human reproduction update, 27(6), 1115–1150. https://doi.org/10.1093/humupd/dmab026 Harper G, Shanahan MM. (2022, febrero 17). Terapia de reemplazamiento de hormonas. Treasure Island. https://www.ncbi.nlm.nih.gov/books/NBK493191/ Instituto Nacional del Cáncer. (NCI). (2018, julio 17) Terapia hormonal para la menopausia y el cáncer. Cancer.gov. https://www.cancer.gov/espanol/cancer/causas-prevencion/riesgo/hormonas/hoja-informativa-hormonas-menopausia#:~:text=La%20terapia%20hormonal%20para%20la%20menopausia%20(THM)%E2%80%94tambi%C3%A9n%20llamada,disminuci%C3%B3n%20de%20la%20masa%20%C3%B3sea%2C Langer, R. D., Hodis, H. N., Lobo, R. A., & Allison, M. A. (2021). Hormone replacement therapy - where are we now?. Climacteric : the journal of the International Menopause Society, 24(1), 3–10. https://doi.org/10.1080/13697137.2020.1851183 Mayo Clinic. (2021, julio del 29). Terapia hormonal: ¿Es adecuada para ti? https://www.mayoclinic.org/es-es/diseases-conditions/menopause/in-depth/hormone-therapy/art-20046372 MedLine Plus. (2018, diciembre 15). Estrógeno y progestina (Terapia de reemplazo hormonal). https://medlineplus.gov/spanish/druginfo/meds/a601041-es.html Riggins V. (2020, abril 13). What you need to know about HRT. Medicalnewstoday. https://www.medicalnewstoday.com/articles/181726