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Hormone Replacement Therapy (HRT)

by | Oct 28, 2021 | Info | 0 comments

Hormone Replacement Therapy (HRT) Overview

Hormone replacement therapy (HRT) is a medication that contains female hormones, these are used to boost the hormone levels and relieve some of the symptoms of menopause. HRT can help balance estrogen and progesterone levels during or near menopause.

Some types of HRT contain both progesterone and estrogen, while others contain only estrogen. Sometimes they contain testosterone.

Also known as menopausal hormone therapy, HRT can help relieve sweating, hot flashes, and other symptoms of menopause. It can also reduce the risk of osteoporosis.

During menopause, the estrogen levels fall. Some women get uncomfortable symptoms like hot flashes and vaginal dryness. HRT  is the most effective treatment for menopause symptoms.

Hormones and Hormone Receptors

Hormones are substances that function as chemical messengers in the body. They affect the actions of cells and tissues at various locations in the body, often reaching their targets through the bloodstream.

The hormones estrogen and progesterone are produced by the ovaries in normal healthy (premenopausal) women and by some other tissues, including fat and skin, in both premenopausal and postmenopausal women and in men. Estrogen promotes the development and maintenance of female sex characteristics and the growth of long bones. Progesterone plays a role in the menstrual cycle and pregnancy.

Estrogen and progesterone also promote the growth of some breast cancers, which are called hormone-sensitive (or hormone-dependent) breast cancers.

Hormone-sensitive breast cancer cells contain proteins called hormone receptors estrogen receptors (ER) and progesterone receptors (PR) that become activated when hormones bind to them. The activated receptors cause changes in the expression of specific genes, which can stimulate cell growth.

To determine whether breast cancer cells contain hormone receptors, doctors test samples of tumor tissue that have been removed by surgery. Approximately 67%–80% of breast cancers in women are ER positive

If the tumor cells contain estrogen receptors, the cancer is called estrogen positive (ER positive), estrogen sensitive, or estrogen responsive.

Similarly, if the tumor cells contain progesterone receptors, the cancer is called progesterone receptor positive (PR positive). Majority of the ER-positive breast cancer cases are also PR positive. 

Estrogen plays a role in many body functions, including:

  • Thickens the lining of your uterus, preparing it for the possible implantation of a fertilized egg.
  • Influences how the body uses calcium, an important bone-building mineral.
  • Helps maintain healthy blood cholesterol levels.
  • Keeps the vagina healthy.
  • Helps prevent osteoporosis.

What does progesterone do?

Progesterone plays a role in many body functions, including:

  • Helps prepare the uterus for the implantation of a fertilized egg and maintains the pregnancy.
  • Regulates blood pressure.
  • Improves mood and sleep.

Hormone Therapy

Hormone therapy, which is also known as hormonal therapy or endocrine therapy, slows or stops the growth of hormone-sensitive tumors by blocking the body’s ability to produce hormones or by interfering with effects of hormones on breast cancer cells.

Tumors that are hormone insensitive do not have hormone receptors and do not respond to hormone therapy.

Hormone therapy for breast cancer should not be confused with menopausal hormone therapy (MHT), treatment with estrogen alone or in combination with progesterone to help relieve symptoms of menopause.

These two types of therapy produce opposite effects: hormone therapy for breast cancer blocks the growth of HR-positive breast cancer, whereas MHT can stimulate the growth of HR-positive breast cancer.

Types of Hormone Replacement Therapy (HRT)

There are two main types of hormone replacement therapy (HRT):

  • Estrogen Therapy: Estrogen is taken alone. Doctors most often prescribe a low dose of estrogen to be taken as a pill or patch every day. Estrogen may also be prescribed as a cream, vaginal ring, gel or spray. You should take the lowest dose of estrogen needed to relieve menopause symptoms and/or to prevent osteoporosis.

  • Estrogen Progesterone/Progestin Hormone Therapy (EPT): Also called combination therapy, this form of HT combines doses of estrogen and progesterone (or progestin, a synthetic form of progesterone).

There are various ways of delivering hormone therapy, and the different types provide different combinations and amounts of hormones. Following are some of the common types of hormone replacement therapy (HRT):

Estrogen-only HRT: A doctor may recommend this if a person has had their uterus and ovaries removed, in which case progesterone is not necessary.

Cyclical, or sequential, HRT: This may be a good option if symptoms occur before menopause; the dosage can align with the menstrual cycle.

Continuous HRT: After menopause, a doctor may prescribe a continuous combination of estrogen and progesterone.

Local estrogen: Vaginal tablets, creams, or rings can help with urogenital symptoms, including vaginal dryness and irritation.

Benefits of Hormone Replacement Therapy (HRT)

Hormone therapy (HT) is prescribed to relieve menopausal symptoms including:

  • Hot flashes.
  • Vaginal dryness that can result in painful intercourse.
  • Other problematic symptoms of menopause, such as night sweats and dry, itchy skin.

Other health benefits of taking hormone replacement therapy (HRT) include:

  • Reduced risk of developing osteoporosis and reduced risk of breaking a bone
  • Improved mood and overall sense of mental well-being in some women
  • Decreased tooth loss
  • Lowered risk of colon cancer
  • Lowered risk of diabetes
  • Modest improvement in joint pains
  • Lower death rate for women who take hormone therapy in their 50s

Side Effects of Hormone Replacement Therapy (HRT)

Like almost all medications, hormone therapy has side effects. The most common side effects are:

  • Monthly bleeding (if you have a uterus and take cycled progestin [estrogen for 25 days of estrogen/month, progesterone for last 10 to 14 days/month, 3 to 6 days of no therapy]).
  • Irregular spotting.
  • Breast tenderness.
  • Mood swings.

Less common side effects of hormone therapy include:

  • Fluid retention.
  • Headaches (including migraine).
  • Skin discoloration (brown or black spots).
  • Increased breast density making mammogram interpretation more difficult.
  • Skin irritation under estrogen patch.

Risk Factors of Hormone Replacement Therapy (HRT)

Research has shown that the benefits can be greater than the risks for many women. But HRT may still raise your chances of developing the following conditions:

  • Endometrial cancer, if you take estrogen without progestin and you still have your uterus
  • Blood clots
  • Stroke
  • Breast cancer

Side effects and  problems maybe less if you do the following:

  • Start HRT within 10 years of menopause or before age 60
  • Take the lowest dose that works for you for the shortest possible time
  • Take progesterone or progestin if you still have your uterus
  • Ask about other forms of HRT besides pills, like patches, gels, mists, vaginal creams, vaginal suppositories, or vaginal rings
  • Get regular mammograms and pelvic exams

 

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