Category Archives: Hormone Replacement Therapy

Hey ladies! Remember a few years ago when they said we shouldnt take hormone replacement therapy for menopause symptoms like hot flashes and night sweats? They said it was bad for you! It could give you cancer! Use guided imagery to power through those sweats and headaches and mood swings! Better to be safe than sorry.

Fun fact: Turns out the science wasnt nearly as sciency as we thought and some of us couldve skipped a decade of severe to moderate crazy-making unpleasantness. Now, they say its perfectly OK, and may even be better for you to take sensible doses of estrogen. (For the three men still reading, estrogen is Latin for Lord, dont let me kill my husband fore the house is paid for.)

Not only is hormone replacement making a comeback but also it turns out its GOOD FOR YOU. Your heart just loves it! When properly dosed, modern cocktails of HRT can swaddle your heart in protective goodness AND protect against bone loss!

Mmmmkay.

Ima need to speak to someone right now. RIGHT FRIKKIN NOW. Wheres Cousin Eddy when you need him? Remember how he kidnapped Clark Griswolds miserly boss in Christmas Vacation and brought him to the Griswold home just so Clark could yell at him in person? Yeah, that would be kind of perfect. Get me the researcher who said reports of cancer and strokes were flawed. Ill wait.

Im righteously angry. The kind of angry that makes the oft-maligned Karen complaining about the degree of wilt in her Cobb salad seem downright quaint by comparison.

Whats next? Smoking is good for you? The tar and nicotine meet up inside your lungs and knit tiny sweater vests you can cough out and give as holiday gifts to your loved ones?

What about asbestos? Should I return to the 1950s-built house I grew up in and lick the exterior shingles because it will give me great eyesight and, interestingly, a useful third hand?

What about lead pipes and paint? Are those going to be OK, too? Will we learn that rather than causing learning disabilities and life-altering physical ailments lead is the secret ingredient in the Barefoot Contessas irresistible crispy-skinned roast chicken?

Speaking of food, remember how they told us not to eat eggs? And then they were OK. And then they werent. And then they wereIm not even sure anymore.

The new guidelines of HRT Okie Dokie (my term, not theirs) applies to women under 60. While Im happy for my sister-girls in their 50s, I hope they know theres a whole bunch of us who still have to apologize to a clerk at TJ Maxx who had the wretched misfortune to ask, again, if wed like to apply for a store credit card. There was NO reason to scream. Let alone scream Sure because apparently I look like I cant even afford the stuff in this GODFORSAKEN sea of sign art, gallon jars of pink Himalayan sea salt and garlic presses. So many, many garlic presses

Yes, we acted ugly because we had no estrogen. The stuff that had once plumped our skin, hydrated our parts and made us look at our spouses with more desire and less homicide.

To be sure, theyve done some important tweaking over the years to make HRT safer, like using patches instead of pills (greatly reduces risk of stroke) and keeping the recommendation to women under 60. (Apparently, the bad study had too many older women and yall know how we can be.)

Todays HRTs benefits outweigh the risks, they say. And thats great news for millions of women. Yay you. My generation toughed it out and now find ourselves on the other side, newly obsessed with digging in the dirt and subscribing to something called Britbox.

Just you wait.

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Weekend humor from Celia Rivenbark: Oh, so NOW hormone replacement is ok NC Newsline - NC Newsline

New evidence suggests the use of hormone replacement therapy (HRT) may lead to benefits in certain women with pulmonary hypertension. The findings add to a long debate over the role of hormones like estrogen in the course of the disease.

During a presentation at the American Thoracic Societys 2024 International Conference in San Diego, investigators said HRT appeared to improve pulmonary vascular disease and right ventricular (RV) function in a cohort of 742 women who participated in the study

Corresponding author Audriana Hurbon, M.D., of the University of Arizona College of Medicine, explained along with colleagues that previous research has indicated women with World Symposium Group 1 pulmonary hypertension have improved preservation of RV function compared to men in the same disease group. Yet, Hurbon and colleagues said it was not clear whether the preservation of RV function was linked with endogenous and/or exogenous exposure to female hormones, and it was not known if the apparent benefits of female hormones applied to all groups of pulmonary hypertension or merely to Group 1.

While it is accepted that in World Symposium Group 1 pulmonary hypertension female sex is associated with preservation of right ventricular function, the role of estrogen in pulmonary hypertension has been controversial, Hurbon explained, in a press release. Additionally, we know that women are affected by pulmonary hypertension more often than men, but when compared to each other, women seem to present less severely than men.

The more than 700 participants in Hurbons research were part of the National Heart Lung and Blood Institute-funded Pulmonary Vascular Disease Phenomics (PVDOMICS) Study. The women represented all five World Symposium disease groups, along with healthy controls and comparators who had risk factors for pulmonary hypertension but had not been diagnosed with the disease.

The authors set out to compare participants using mean pulmonary artery pressure on right heart catheterization to measure pulmonary vascular disease related to pulmonary hypertension, and characterizing RV function based on RV fractional shortening and RV ejection fraction from echocardiography.

Endogenous hormone exposure was quantified based on self-reported lifetime duration of menses. Participants were considered to have exogenous exposure to hormones if they had ever received HRT.

Hurbon and colleagues found that people with greater lifetime duration of menses had decreased average pulmonary arterial pressure regardless of which pulmonary hypertension group they belonged in. Specifically, they found mean pulmonary arterial pressure was 4714 mmHg for participants with 20-30 years of menses, versus 3713 mmHg for participants with more than 50 years of menses.

Additionally, participants who had taken HRT had lower mean pulmonary artery pressure (3511 vs 4214, P = 0.002) and pulmonary vascular resistance (53 vs 74, P = 0.006) and higher RV fractional shortening (3711 vs 329, P = 0.001) and RV ejection fraction (4813 vs 4012 %, P < 0.0001). However, when broken out by subgroup, the investigators only found statistically significant impacts in patients with Group 1 pulmonary hypertension.

Hurbon said in the press release that further analysis also suggests that older age and HRT exposure may have a positive synergistic effect.

This could support a theory suggesting a threshold of estrogen exposure necessary for a protective effect, she said.

The authors described their findings as preliminary, but they said their data suggest more research is needed to better understand the potential impacts of HRT, both positive and potentially negative, on patients with pulmonary hypertension.

We hope this study will be a catalyst for further exploration of the mechanisms of female reproductive hormones to identify therapeutic targets for right ventricular preservation in pulmonary hypertension, Hurbon said.

Read this article:
Hormone Replacement Therapy May Benefit Some Women with Pulmonary Hypertension - Managed Healthcare Executive

If youve beenor are goingthrough menopause, you know it can be a doozy, between the acne, sleep difficulties, cognitive symptoms and lets not forget the hot flashes. One treatment for these symptoms is menopausal hormone therapy (MHT)which you might know by the name hormone replacement therapy, a treatment that replaces the hormones that your body isnt making enough of, thereby improving menopause symptoms like vaginal dryness and changes in mood. I checked in with Dr. Mary Jacobson, MD, to learn more about MHT, including benefits, risks and alternatives.

Dr. Mary Jacobson, MD, is the Chief Medical Officer of Hello Alpha, which aims to empower women to take control of their personal healthcare by providing patients with access to simple, everyday medical needs. Dr. Jacobson is an accomplished academic, board-certified obstetrician and gynecologist and minimally invasive surgeon with extensive experience in clinical care, medical education, hospital operations and research.

First things first, Dr. Jacobson tells me that hormone replacement therapy is an outdated phrase based on the mistaken belief that femalemenopausesignified a hormone deficiency. Instead, she says, The phrase, menopausalhormone therapy (MHT) or hormone therapy (HT),albeit nuanced, recognizesmenopauseas a natural stage of reproductive life.

Hormone therapy comes in many forms, including:

Per Dr. Jacobson, menopausal hormone therapy treats:

What Signals the End of Menopause? An OB/GYN on What to Expect at Every Stage

izusek/getty images

Dr. Jacobson tells me that MHT is FDA-approved for:

Moderate to severe VMS

Prevention of osteoporosis in postmenopausal women

Treatment of low estrogen levels due to hypogonadism (when your body does not produce enough sex hormones), removal of both ovaries, or primary ovarian insufficiency

Treatment of moderate to severe vulvovaginal symptoms

The risks of hormone therapy differ depending on type, dose, duration of use, route of administration, timing of initiation and whether a progestin is used, Dr. Jacobson explains. Risks of systemic estrogen therapy alone and combination estrogen and progestin include increased risk for venous thromboembolism and gallbladder disease. Additionally, she says, the combination estrogen and progestin carries a rare but increased risk for stroke and breast cancer. Patients with a uterus who take estrogen without an adequate amount of progestin are at increased risk of endometrial hyperplasia and endometrial cancer.

While MHT is appropriate for many symptomatic women, Dr. Jacobson says that there are some contraindications that would rule out hormone therapy as a treatment for menopause symptoms. These include a history of an estrogen-sensitive cancer (like breast cancer), coronary heart disease, heart attack, stroke and venous thromboembolism or inherited high risk of thromboembolic (blood clotting disease).

If you have one of these contraindications but are still looking for relief from menopause symptoms, dont fret; Dr. Jacobson tells me that there are a number of other medications that can help with symptoms, including the antidepressantsparoxetine (Brisdelle) and Venlafaxine (off-label), which provide mild to moderate improvements in vasomotor symptoms. Also, Gabapentin is associated with improvements in the frequency and severity of vasomotor symptoms. Fezolinetant (VEOZAH) is a novel, non-hormonal medication which treats moderate-severe vasomotor symptoms. Fezolinetant modulates neuronal activity in the thermoregulatory center of the hypothalamus in the brain.

Additionally, Dr. Jacobson says folks can try the below non-prescription based methods to manage their symptoms.

For VMS:

For Vaginal Symptoms:

Over the counter vaginal lubricants (e.g., Astroglide, OMy, K-Y Brand, Liquid Silk, Yes!, Pjur, Pink, Wet Platinum)

Menopausal hormone therapy is one of a number of treatmentsin addition to lifestylechanges, supplements, integrative therapies and prescription medicationsthat can ease vasomotor, vaginal and mood symptoms associated with menopause. While its helpful to read up on your options, only you and your doctor can determine what course of action is right for you.

10 Unusual and Lesser-Known Menopause Symptoms Every Woman Should Know About

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Everything You've Ever Wanted to Know (But Were Scared to Ask) About Menopausal Hormone Therapy - AOL

Menopause transition is a natural part of a womens life that is overwhelmingly viewed as taboo and stigmatized as it is associated with aging. Many suffer because they are embarrassed to talk about it and think they have to suffer with the side effects. But this isnt true, there is help available.

During Womens Health month we spoke with Dr. Maryanne McDonnell, OB/GYN UConn Health to shed some light on this topic:

What are the stages of menopause? Menopause is divided into three basic stages: perimenopause, menopause, and post menopause. During this time, ovarian function first decreases and then finally stops the production of the hormones that stimulate the menstrual cycle; estrogen and progesterone.

Tell us about perimenopause, when does it start and what are the symptoms? Perimenopause is the time which your body makes the natural transition to menopause, when women start to have symptoms and will notice changes in their menstrual cycles. It starts at different ages; the majority of women start in their 40s and it can last anywhere from six-to-eight years on average.

Perimenopause symptoms may include menstrual changes, mood changes, changes in sexual desire, depression, trouble concentrating, headaches, night sweats, hot flashes, and trouble with sleep.

Most perimenopause symptoms are manageable. But if you need help managing symptoms, medications and other treatments are available. Perimenopause ends when youve had no period for a full year.

What is menopause and when does it happen? Menopause is a natural process that occurs when a womans ovaries stop releasing eggs and stops producing estrogen and progesterone. It marks the end of menstrual cycles and is diagnosed after you have gone one year without a menstrual period.

Menopause usually happens between the ages of 45 and 55, but the average age is 51. It can happen earlier or later in some women.

Some women experience no symptoms, while others may experience a combination of symptoms. These can be similar to perimenopause including hot flashes, night sweats, menstrual changes, vaginal dryness, sleep issues, mood changes, decreased libido, weight gain and difficulty concentrating. These symptoms can sometimes last for years after menopause.

A medical professional can help manage menopause symptoms and may prescribe hormone therapy in some cases.

What does the last stage, post menopause entail? Post menopause is the final stage of menopause and begins after a woman hasnt had a period for 12 months in a row. During post menopause, the body learns to function with lower hormone levels, and reproductive years are over. You will no longer have periods but some women do continue to experience symptoms of menopause.

What are the treatments for the symptoms of menopause? Menopause symptoms and treatment options vary, and treatments include hormonal therapy, non-hormonal medications, and lifestyle changes. The goal is to decrease symptoms to allow for better quality of life.

Hormone replacement therapy (HRT) estrogen can help by replacing a small amount of the hormone lost at the time of Menopause. It can help with hot flashes, night sweats, and other side effects of menopause. When a patient is taking estrogen and still has a uterus, progesterone is added to prevent uterine cancer.

Antidepressants- Low doses of some types of antidepressants may help relieve certain menopause symptoms like hot flashes, night sweats, mood changes.

Gabapentin a drug that is sometimes prescribed off-label to reduce hot flashes during menopause. Instead of affecting hormones, experts think it may act on the hypothalamus, the part of the brain that regulates body temperature.

Treatments for vaginal dryness Postmenopausal vaginal dryness can cause pain during intercourse and/or recurrent urinary tract infections. There are several treatment options for vaginal dryness. Some, such as vaginal moisturizers or lubricants, are available without a prescription. Others require a prescription; these include a vaginal estrogen cream, tablet, capsule, or ring; an oral medication called ospemifene; and a non-estrogen vaginal tablet called Prasterone.

Lifestyle changes include wearing layers of clothing, keeping your bedroom cool at night, taking a cool shower, use a fan, try to reduce your stress level, avoid, or reduce potential triggers, such as spicy food, caffeine, hot drinks, smoking and alcohol, exercise regularly, and lose weight if youre overweight.

Eating a nutritious diet rich in fruits, vegetables, and protein, among other nutrients, and getting regular physical activity may provide relief from menopause symptoms.

There are many supplements and products on the internet and social media that claim to help with symptoms of menopause. Do these really help? We must remember that supplements and many of the products sold online are not regulated by the FDA and have not been researched enough to confirm their effectiveness or safety. Patients should talk to their doctor before taking any type of supplement to determine it is safe. For those looking for natural ways to control symptoms, eating a nutritious diet rich in fruits, vegetables, and protein, among other nutrients, and getting regular physical activity may provide relief from menopause symptoms.

Dr. McDonnell recommends women suffering from symptoms that may or may not be linked to menopause speak to their health-care provider. You can get help with many of these symptoms you are experiencing and there is no need to do it alone.

Its important to know that there isnt a one-size-fits-all approach to symptoms or treatments, but working with your practitioner, you can find one that works for you.

The Womens Center at UConn Health offers OB/GYN services for women at every stage of their lives, providing access to award-winning doctors at a location thats close to home. Keeping our patients in mind, weve brought together general obstetrics and gynecology with specialized services and imaging, making appointments even more convenient.

Follow this link:
Menopause Demystified - UConn Today - University of Connecticut

Dublin, May 24, 2024 (GLOBE NEWSWIRE) -- The "Global Hormone Replacement Therapy Market, Size, Forecast 2024-2032, Industry Trends, Share, Growth, Insight, Impact of Inflation, Top Companies Analysis" report has been added to ResearchAndMarkets.com's offering.

The global Hormone Replacement Therapy (HRT) market is experiencing significant growth, with an estimated value of US$ 20.91 Billion in 2023. A consistent compound annual growth rate (CAGR) of 6.18% is forecasted from 2024 to 2032, culminating in a market size of US$ 35.86 Billion by the end of the forecast period. This expansion is predominantly driven by an aging population, rising prevalence of menopausal symptoms, increased awareness, and advancements in hormone replacement products and therapies.

Women worldwide are increasingly experiencing menopausal symptoms and hormonal imbalances, compelling a growing need for effective HRT. The demand for HRT is bolstered by the projected worldwide population growth, indicating a substantial future market for hormone therapies. As reported by the NHSBSA Statistics and Data Science, England has seen a significant increase in prescribed HRT items, demonstrating the rising prominence of hormone replacement therapy in healthcare regimes.

Advancements and Trends

Continuous research and development, coupled with product approvals such as Ascendis Pharma A/S's SKYTROFA, are anticipated to further propel the hormone therapy market's growth. The increasing awareness of menopausal challenges in economies such as China and India is steadily translating into heightened market activity. Further, the surge in hormonal disorders is creating opportunities for market expansion, as effective treatments for symptoms like mood swings and reduced libido are sought after.

United States Market Analysis

The United States holds the leading position in the Hormone Replacement Therapy market, supported by an increase in therapy utilization among the target demographic and the continuous introduction of innovative drug delivery technologies. A significant portion of post-menopausal women in the US have utilized HRT, according to NIH. With a substantive patient population affected by conditions such as thyroid hormone imbalances, the market is set to maintain its robust growth trajectory.

Key Companies in the Market

The competitive landscape of the global Hormone Replacement Therapy market features key players including Abbott Laboratories, Bayer AG, Eli Lilly & Company, Novartis AG, Novo Nordisk A/S, Pfizer Inc., Abbvie Inc. (Allergan plc), Teva Pharmaceutical Industries Ltd, and Dr. Reddys Laboratories Ltd. Recent developments such as FDA approvals and strategic partnerships accentuate these companies' commitment to meeting the growing demand for advanced HRT solutions.

Segments and Regional Insights

The global Hormone Replacement Therapy market encompasses various product types, disease types, routes of administration, and distribution channels. The market analysis includes segments like estrogen, human growth hormone, thyroid hormone, testosterone hormone, and progestogen replacement therapies. Additionally, the market explores different disease types and administrative routes along with distribution via hospital pharmacies, retail stores, and online pharmacies. The comprehensive market division also offers a granular view of HRT adoption patterns across a global spectrum covering North America, Europe, Asia Pacific, Latin America, and the Middle East & Africa.

The insights presented reflect the growing significance of Hormone Replacement Therapy and illustrate the market's future outlook in relation to demographic shifts, scientific advancements, and healthcare awareness. The global interest in achieving enhanced quality of life post-menopause and managing hormonal disorders underlines the importance of HRT, ensuring its relevance and expansion in the coming years.

Key Attributes:

Companies Featured

For more information about this report visit https://www.researchandmarkets.com/r/8cg2rs

About ResearchAndMarkets.com ResearchAndMarkets.com is the world's leading source for international market research reports and market data. We provide you with the latest data on international and regional markets, key industries, the top companies, new products and the latest trends.

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Global Hormone Replacement Therapy Research Report 2024: A $35+ Billion Market by 2032 - Industry Trends, Share ... - GlobeNewswire

When a woman's body no longer makes estrogen, hormone therapy may be an option. But, hormone therapy (HT), in which estrogen and progestin (a synthetic progesterone) are used in combination, has been controversial over the years.

To learn more about women's health, and specifically hormone therapy, theNational Institutes of Health (NIH) did a study called the Women's Health Initiative (WHI)beginning in 1991. The studyinvolved more than 161,000 generally healthy postmenopausal women.

The study was designed to test the effects of postmenopausal hormone therapy, diet modification, and calcium and vitamin D supplements on heart disease, fractures, and breast and colorectal cancer in women.

The study had 2 arms:

Women with a uterus were given progestin in combination with estrogen, which is known to prevent endometrial cancer. All women were randomly assigned to either the hormone medicine being studied or to placebo (inactive substance).Compared with placebo, the estrogen plus progestin treatmentresulted in:

Small increase inrisk of heart attack (in women younger than 60 when combined hormone therapy is started in perimenopause, it may reduce risk of heart attack)

Small increase inrisk of stroke

Small increase inrisk of blood clots

Small increase in risk of breast cancer

Reduced risk of colorectal cancer

Fewer fractures

No protection against mild cognitive impairment and increased risk of dementia (study included only women 65 and older)

Compared with the placebo, treatment with estrogen alone resulted in:

No difference in risk for heart attack

Increased risk of stroke

Increased risk of blood clots

Reduced risk of breast cancer

No difference in risk for colorectal cancer

Reduced risk of fracture

The WHI recommends that women follow the FDA advice on hormone (estrogen-alone or estrogen-plus-progestin) therapy. It says that hormone therapy should not be taken to prevent heart disease.

These products are approved therapies for relief from moderate to severe hot flashes and symptoms of vaginal dryness. Although hormone therapy may be effective in preventing fractures, it should only be considered for women at high risk of osteoporosis who cannot take other medicines. The FDA recommends that hormone therapy be used at the lowest doses for the shortest time needed to achieve treatment goals. Postmenopausal women who use or are considering using hormone therapy should discuss the possible benefits and risks to them with their healthcare providers.

The National Heart, Lung, and Blood Institute offers the following suggestions for women who are deciding whether or not to use hormone therapy:

The most important thing a woman can do in deciding to continue hormone therapy is discuss the current research with her healthcare provider.

Women need to be aware that taking a combined progesterone and estrogen regimen or estrogen alone is no longer recommended to prevent heart disease. A woman should discuss other ways of protecting the heart with her healthcare provider.

Women should discuss with their healthcare providers the value of taking combined progesterone and estrogen therapy or estrogen to prevent osteoporosis. There may be other treatments based on a woman's health profile.

Always consult your healthcare provider for more information.

Asa woman approaches menopause, the production of estrogen and progesterone fluctuates and then decreases significantly. Symptoms such as hot flashes often result from the changing hormone levels. After a woman's last menstrual period, when her ovaries make much less estrogen and progesterone, some symptoms of menopause might disappear, but others may continue.

To help relieve these symptoms, some women use hormones. This is called menopausal hormone therapy (MHT). This approach used to be called hormone replacement therapy or HRT. MHT describes several different hormone combinations available in a variety of forms and doses.

Hormone therapycan be given in a variety of methods, including the following:

For women who are appropriate candidates, this type of therapy can often be customized to provide the most benefits with the least side effects. It is important for women to talk with their healthcare providers about any discomfort or menstrual symptoms experienced with hormone treatment, as treatment approaches and dosages can be adjusted.

More here:
Menopausal Hormone Therapy | Johns Hopkins Medicine

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Continuing Education Activity

Hormone replacement therapy (HRT) is supplementing women with hormones that are lost during the menopausal transition. To relieve the symptoms associated with menopause, conventional HRT includes an estrogen and progesterone component to mimic hormones created by the human ovary. Estrogen therapies are numerous, and include those indigenous to the human ovary, for example, estradiol and estriol. Other estrogenic compounds include conjugated equine estrogen (CEE), the most commonly prescribed estrogen in the United States. They are not identical in their effect on the human body but share the same FDA indications. This activity describes the indications for hormonal replacement therapy and highlights the role of the interprofessional team in managing patients with postmenopausal symptoms.

Objectives:

Identify the different formulas of hormones for replacement therapy.

Describe the adverse effects and contraindications of hormonal replacement therapy.

Summarize the indications of hormone replacement therapy.

Explain interprofessional team strategies for improving care coordination and communication to ensure the safe use of hormonal replacement therapy and improve outcomes.

Hormone replacement therapy (HRT) is supplementing women with hormones lost during the menopausal transition. To relieve the symptoms associated with menopause,conventional HRT includes an estrogen and progesterone component to mimic hormones created by the human ovary.

Estrogen therapies are numerous, and include those indigenous to the human ovary, for example, estradiol and estriol. Other estrogenic compounds include conjugated equine estrogen (CEE), the most commonly prescribed estrogen in the United States. They are not identical in their effect on the human bodybut share the same FDA indications, according to thePhysicians Desk Reference.[1][2][3]The indicationsfor menopausal issues include:

Treatment of vasomotor symptoms of menopause

Treatment of genitourinary syndrome of menopause ( previously known as vaginal and vulvar atrophy)

Prevention of osteoporosis

A progestogen is a term used to include not only progesterone made by the human ovarybut also progesterone-like substances, also known as progestins. A woman who desires HRT andhas an intact uterusmust have a progestogen with estrogen to protect her uterus from endometrial hyperplasia or malignancy. Estrogen alone will cause the endometrial lining to grow. Progestogens stabilize the lining from proliferating abnormally. It is assumed that if a woman has had a hysterectomy that she no longer needs a progestin. Progesterone, however, is different as it can provide symptom relief from sleep disturbance and mood instability, and increasing evidence supportthat it offers tissue protection to the breast.[4][5][6]

FDA-approved indications for progestogens include:

Amenorrhea, either primary or secondary

Assisted reproductive technology treatment

Endometrial hyperplasia

Dysfunctional uterine bleeding

There arenumerous estrogen and progestogen choices, and they may be administrated orally or transdermally either through cream, patch, vaginal inserts, or subdermalpellets. Each route of administration has unique benefits and risks.

Oral Estrogen: Any estrogen administered orally results in increased activated protein-C resistance, increasing the risk of ablood clot. Oral estradiol also induces thehepatic formation of matrix metalloprotease 9, which decreases the formation and rupture of atherosclerotic plaque.

Transdermal Estrogen: Bypasses the hepatic metabolism that produces activated protein-C resistance, and the risk for blood clotting is negated.

Progestin administration is usually via the oral route, although a few are available in combination with estrogen in patch forms. Progesterone is available in an oral form that can also be used vaginally for non-FDA-approved uses.

Specializedpharmacies make compounded estrogen and progesterone creams, sublingual troches, and vaginal inserts, but these are not FDA approved and are not included in this article.

When studying the potential adverse effects of HRT, the most referenced information in the United States comes from the Women's Health Initiative (WHI).[7][8][9]

WHI Trial

This was a multifaceted trial, including two double-blind, placebo-controlled, randomized trials of postmenopausal hormone therapy.[10]

The first arm included CEE at 0.625 mg per day with medroxyprogesterone acetate (MPA) 2.5 mg per day. The second arm studied patients who had prior hysterectomies and treated with CEE 0.625 mg only.

HRT and the Breast

The CEE/MPA arm was discontinued earlier than expected due to an increased incidence of invasive breast cancer of 24% (HR=1.24). The CEE-only arm was not discontinued early, completed in 2004, and extended follow-up of patients has continued for 11.8 years. CEE use for 5 to 9 years is associated with a statistically significant reduction in breast cancer by 23% (HR=0.77). Those in the CEE arm also had decreased mortality from breast cancer by 63% compared to those not on CEE, and 38% fewer died from all other causes after breast cancer was diagnosed.

When examining evidence from European studies which usually use estradiol derivatives rather than CEE, and non-MPA progesterone or progestins, the conclusions are vastly different and unequal. Transdermal estradiol alone increased the risk of breast cancer by 10%, but estradiol with progesterone decreased the risk of breast cancer by 10%.

HRT and the Heart

In the WHI CEE/MPA arm, the overall incidence of coronary heart disease (CHD) increased by 24% over five years of use, with the most substantial elevation in risk within the first year, with an increase of 81% (HR=1.81).[11][12] This evidence requires cautious interpretation due to the following:

The average age of the patient treated in this study was 62 years. In women who started on therapy within ten years of menopause, there was a risk reduction of CAD of 11% (HR=0.89), but this was not statistically significant.

In those women who continued CEE/MPA for over six years, the risk of CAD dropped by 30% (HR=0.70).

These risks do not apply to estradiol and progesterone based treatments. Basic science studies show several mechanisms through which estradiol (not CEE) is cardioprotective. These include stabilization of atherosclerotic plaques, reduction of carotid intima-mediathickness (CIMT), and decreasing coronary artery calcium (CAC) scores. Numerous subsequent studies both in Europe and the United States show that cardiovascular disease and death are prominently reduced when HRT commences within the first four years of the menopause transition. The "Timing Hypothesis" refers to the theory that when starting HRT closer to the time of the menopausetransition, a cardiovascular benefit is seencompared with later initiation.

HRT and Risk of Stroke[13]

Stroke incidence increased in both arms of the WHI trial by 31% in the CEE/MPA arm, and 39% in the CEE arm.

Studies using oral estradiol are conflicted, showing a similar stroke risk, but the incidence of fatal stroke is unchanged.

HRT and the Risk of Venous Thromboembolism (VTE)

VTE, comprised of deep venous thrombosis and pulmonary embolism, was increased by 2-fold (HR= 2.06) in the WHI CEE/MPA arm.

Transdermal estradiol does not confer the same thromboembolic risk, as is evidenced by numerous European studies. The ESTHER study from France showed an overall risk of 0.9 for ablood clot, which is a decreased risk.[14] Subsequent studies looking at other transdermal estradiol doses and routes confirm these findings, with at least a null effect for blood-clotting risk.

Contraindications for oral or transdermal estrogen-based therapies include:

Known, suspected, or history of breast cancer

Known or suspected history of other estrogen-basedcancer, i.e., uterine cancer. Women who have had a hysterectomy and have no remaining evidence of disease are still candidates for HRT

Activedeep venous thrombosis (DVT) or a history of DVT or pulmonary embolism (PE)

History of blood clotting disorder, the most common being Factor V Leiden mutation carriers

Active or history of arterial thrombotic diseases such as myocardial infarction or stroke

Chronic liver disease or dysfunction

Migraine with aura

These contraindications do not apply to transvaginal based estrogen therapies, as the serum concentration of estrogen from this route is extremely low. The North American Menopause Society (NAMS) has recommended that the black-box warning that applies to conventional HRT not be applied to transvaginal estrogen treatments.

Hormone levels of estradiol and progesterone are not traditionally measured for monitoring purposes. Instead, the relief of menopausal symptoms and the absence of adverse effects signify an adequate medical response.

Adverse side effects may include:

No scientific evidence links HRT with significant weight gain.

HRT, including androgen therapies such as testosterone, should be monitored with serum testingbut is not considered conventional HRT.

Patients undergoing menopause require management from an interprofessional team that also includes the pharmacist and nurse. To improve patient outcomes, clinicians should not empirically prescribe hormone replacement therapy. These hormones correlate with a variety of adverse effects, including an increased risk of breast cancer, stroke, heart disease, and deep vein thrombosis. The duration of treatment of these hormones should not be more than a few years, and close monitoring is required. If the female has mild symptoms of menopause, then education should be provided about the benefits and harm of these hormones. The pharmacist should consult with the prescriber on the exact agent and dosing, while also examining the patient's medication record. Nursing needs to be very aware of signs of adverse events, and monitor closely on subsequent visits, alerting the clinician of any concerns. This interprofessional team approach will drive the best outcomes with HRT. [Level 5]

Link:
Hormone Replacement Therapy - StatPearls - NCBI Bookshelf

Some people may have concerns about the potential side effects of conventional hormone replacement therapy (HRT). As such, they may be interested in trying natural, plant-based options.

This article outlines the different types of natural HRTs, along with their potential benefits and risks. It also provides some alternative methods for treating hormonal problems and offers advice on when to see a doctor.

Hormone replacement therapy (HRT) is a therapy that doctors may prescribe to treat hormonal imbalances or depletion, particularly following menopause.

Natural hormone replacement therapy (HRT) uses hormones derived from plants to treat hormonal conditions.

There are two main types of natural HRT: Bioidentical HRT, and traditional natural HRT.

Bioidentical hormone replacement therapy (BHRT) treats hormonal imbalances and depletion using synthetic hormones derived from plant estrogens.

Doctors refer to bioidentical hormones as hormones with the same molecular structure as ones that the human body produces naturally.

Most BHRTs contain plant hormones that mimic the following:

There are two types of BHRT. They are:

The manufacturers of bioidentical hormones claim that custom-compounded BHRTs have fewer side effects and associated health risks than conventional HRT medications. However, there is no scientific evidence to support these claims.

Traditional natural HRTs involve consuming plants or supplements containing compounds that may alleviate hormonal symptoms.

Some plants and supplements that people may take to treat hormonal symptoms include:

Typically, people take natural HRT to treat the following conditions:

According to the FDA, there are no established benefits of taking BHRT medications over conventional HRT medications.

Despite the manufacturers claims, the FDA also indicate that there is no evidence that BHRT medications help prevent or treat the following conditions:

The FDA has since corrected most false statements and claims about BHRTs efficacy in treating the above conditions.

Despite this, some doctors, pharmacists, and drug companies still promote misinformation about the benefits of BHRT.

However, a 2015 study in the Journal of Clinical Oncology suggests that BHRT may help reduce symptoms associated with cancer treatments, though research is ongoing.

According to the FDA Office of Womens Health, conventional hormone therapies may not be safe for people with a history of the following medical conditions:

To date, no credible, large-scale scientific studies have investigated the potential adverse health effects of BHRT. The FDA state that there is no evidence suggesting that BHRT medications carry fewer health risks than conventional HRTs.

Risks include:

It is also tricky for doctors to track side effects linked to BHRT medications because symptoms may take years to develop.

The FDA also state that compounded BHRT medications tend to carry greater risks than non-compounded forms.

Because pharmacists mix compounded BHRT medications, the FDA cannot approve them for quality or consistency. They also carry health risks because the precise dosage and formulation depend on a pharmacists precision and accuracy. As such, it is not possible to guarantee their safety.

It is important to note that pharmacists and drug companies are not obliged to report any side effects associated with compounded BHRT medications.

The chemicals in non-compounded BHRT may also cause side effects. These chemicals may differ across medication types and brands.

The FDA do not regulate natural supplements, meaning their quality, purity, and overall contents vary between brands and batches.

Some commonly recommended supplements for hormonal imbalances may cause side effects, especially if a person takes them incorrectly. These side-effects may include:

People should also consider that some supplements may interfere with certain medications. As such, a person who is taking any kind of medication should talk to their doctor before taking any supplement.

People should take BHRT medications according to the instructions of their doctor or pharmacist.

A person should take any natural supplements according to the packet instructions. However, they should only take such supplements after approval from their doctor.

BHRT medications are available as either oral or topical medications in the form of creams, lotions, and gels.

People typically take oral BHRT medications daily, ideally at the same time each day. People using topical BHRT products may need to apply them several times a day. A person should read the medication label for specific instructions.

According to the FDA, a person should take all forms of hormone therapy at the lowest effective dose for the shortest possible time.

Several alternative treatment options can help a person manage the psychological and physical symptoms associated with hormonal imbalances and depletion. We outline some examples below:

Some people may require prescription medications to ease symptoms of hormone depletion, such as:

The following complementary therapies may also help to alleviate hormonally-induced symptoms of depression:

The following lifestyle changes could help to prevent or treat symptoms of hormonal imbalances or depletion.

Anyone experiencing symptoms of a hormonal change or imbalance should see a doctor as soon as possible. Early intervention may help prevent complications.

People should also see a doctor if their condition does not improve while taking a medication or herbal supplement, or if they experience side effects associated with these treatments.

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

Some experts do not think that BHRTs are any safer or more effective than traditional HRT medications.

People should be aware that certain medications and supplements can cause side effects and interact with other medications.

As such, a person who wants to try natural HRTs should talk to their doctor about the potential risks and benefits of doing so.

See original here:
Natural hormone replacement therapy: How it works - Medical News Today

Ways of taking HRT

HRT comes in several different forms. Talk to a GP about the pros and cons of each option.

Tablets are 1 of the most common forms of HRT. They are usually taken once a day.

Both oestrogen-only and combined HRT are available as tablets. For some women this may be the simplest way ofhavingtreatment.

However,it's important to be aware that some of therisks of HRT, such as blood clots, are higher with tablets than with other forms of HRT (although the overall risk is still small).

Skin patches are also a common way of taking HRT. You stick them to your skin and replace them every few days.

Oestrogen-only and combined HRTpatches are available.

Skin patchesmay be a better option than tablets if you find it inconvenientto take a tablet every day.

Using patches can also help avoid some side effects of HRT, such as indigestion, and unlike tablets, they do notincrease yourrisk of blood clots.

Oestrogen gel is an increasinglypopular form of HRT. It's rubbed onto your skin once a day.

Like skin patches, gel can be a convenient way of taking HRT and does not increase your risk of blood clots.

Butif you still have your womb, you'll need to take some form of progestogen separately too, to reduce your risk of womb cancer.

HRT also comes as small pellet-like implants that are inserted underyour skin (usually in thetummy area) after your skin has been numbed with local anaesthetic.

The implantreleases oestrogen gradually and lasts for several months before needing to be replaced.

This may be a convenient option if you do not want to worry about taking your treatment every day or every few days. But if you still have your womb, you'll need to take progestogen separately too.

If you're taking a different form of oestrogen and need to take progestogen alongside it,another implant option is theintrauterine system (IUS). An IUS releasesa progestogen hormone into the womb.It can stay in place for 3 to 5 years and also acts as a contraceptive.

Implants of HRT are not widely available and are not used very often.

Oestrogen is also available as a cream, pessary or ring that is placed inside your vagina.

This can help relieve vaginal dryness, but will not help with other symptoms such as hot flushes.

It does not carry the usual risks of HRT and does not increase your risk of breast cancer, so you can use it without taking progestogen, even if you still have a womb.

Testosterone is available as a gel that you rub onto your skin. It is not currently licensed for use in women, but it can be prescribed after the menopause by a specialist doctor if they think it might help restore your sex drive.

Testosterone is usually only recommended for women whose low sex drive (libido) does not improve after using HRT. It is used alongside another type of HRT.

Possible side effects of using testosterone include acne and unwanted hair growth.

Ask a GP for more information on testosterone products.

Your treatment routine for HRT depends on whether you're in the early stages of the menopause or have had menopausal symptoms for some time.

The 2 types of routines arecyclical (or sequential) HRT and continuous combined HRT.

Cyclical HRT, also known as sequential HRT, is often recommended for women taking combined HRT whohave menopausal symptoms but still have theirperiods.

There are 2 types of cyclical HRT:

Monthly HRT is usually recommended for women having regular periods.

3-monthly HRT is usually recommended for women having irregular periods. You shouldhavea period every 3 months.

It's useful to maintain regular periods so you know when your periods naturally stop and when you're likely to progress to the last stage of the menopause.

Continuous combined HRT is usually recommended for women who are postmenopausal. A woman is usually saidtobe postmenopausal if she has not had a period for 1 year.

Continuous combined HRT involves taking oestrogen and progestogen every day without a break.

Oestrogen-only HRT is also usually taken every day without a break.

Excerpt from:
Hormone replacement therapy (HRT) - Types - NHS