Hormonal Replacement Therapy

Hormone Replacement Therapy(HRT) is indicated in menopausal women to overcome the short-term and long-term consequences of estrogen deficiency.HRT can be administered orally( in pill form), vaginally( as a cream), or transdermally ( in patch form) because it replaces female hormones produced by the ovaries, hormone replacement therapy minimize menopause symptoms. It can be used before, during and after menopause.

1. DEEPIKA RANA HORMONAL REPLACEMENT THERAPY

2. HORMONE REPLACEMENT THERAPY Hormone Replacement Therapy(HRT) is indicated in menopausal women to overcome the short-term and long-term consequences of estrogen deficiency.HRT can be administered orally( in pill form), vaginally( as a cream), or transdermally ( in patch form) because it replaces female hormones produced by the ovaries, hormone replacement therapy minimize menopause symptoms. It can be used before, during and after menopause.

3. INDICATION OF HRT Relief of menopausal symptoms Prevention of osteoporosis To maintain the quality of life in menopausal years. special group of women to whom HRT should be prescribed. Premature ovarian failure Surgical or radiation menopause

4. TYPES OF HRT Estrogen and progesterone :The most common type of HRT involves both estrogen and progesterone . More than 8 million women are currently taking combination HRT and it is designed specifically for women who have a uterus . During this therapy, estrogen is given regularly while progesterone is added in on a supplementary basis These two hormones are given in combination in order to prevent the overgrowth of uterine lining . Estrogen alone may irritate this lining which could lead to endometrial cancer.

5. Estrogen only : Estrogen therapy alone is usually given to women who have lost their uterus due to surgical menopause . Because no uterus is present , the need for progesterone is not as great. Progestin only : Progestin-only therapy is not prescribed very often. Progestin does seem to provide excellent relief for women plagued with hot flashes.

6. AVAILABLE PREPARATIONS FOR HRT The principle hormone used in HRT is estrogen . This is ideal for a women who had her uterus removed already. But, a women with intact uterus , only estrogen therapy leads to endometrial hyperplasia and even endometrial carcinoma. Addition of progestin for last 12-14 days each month can prevent this problem.

7. Commonly used estrogen are conjugated estrogen (0.625-1.25 mg/day). Progestin used are medroxyprogesterone (100-300 mg/day).Considering the risks, hormonal therapy should be used with the lowest effective dose and for a short period of time. Low dose of oral conjugated estrogen 0.3 mg daily is effective and has got minimal side effects.

8. Oral estrogen regime estrogen –conjugated equine estrogen 0.3 mg or 0.625 mg is given daily for woman who had hysterectomy. estrogen and cyclic progestin For a women with uterus estrogen is given continuously for 25 days and progestin is added for last 12 -14 days. Continuous estrogen and progestin therapy Continued combined therapy can prevent endometrial hyperplasia.

9. Sub dermal implants Implants are inserted subcutaneously over the anterior abdominal wall using local anaesthesia.17β oestradiol implants 25 mg , 50 mg or 100 mg are available and can be kept for 6 month. Percutaneous estrogen gel 1 gm applicator of gel delivering 1 mg of oestradiol daily is to be applied onto the skin over the anterior abdominal wall or thigh..Effective blood level of oestradiol (90-120 g/ml) can be maintained.

10. Transdermal patch It contains 3.2 mg of 17β oestradiol releasing about 50µg of oestradiol in 24 hrs.It should be applied below the waist line and changed twice a week. Vaginal cream Conjugated equine vaginal estrogen cream 1.25 mg daily is very effective specially when associated with atrophic vaginitis . Women with symptoms of urogenital atrophy and urinary symptoms and do not like to have systemic HRT, are suitable for such treatment.

11. Progestin Patient with history of breast carcinoma or endometrial carcinoma , progestin may be used It may be effective in suppressing hot flushes and it prevent osteoporosis. Medroxy progesterone acetate 2.5 -5 mg/day can be used.

12.   Tibolone Tibolone is a steroid having weakly oestrogenic , progestogenic and androgenic properties. It prevents osteoporosis , atrophic changes of vagina and hot flashes. It increases libido. A dose of 2.5 mg per day is given.

13. DURATION OF HRT Generally, use of HRT for a short period of 3-5 years have been advised. Reduction of dosage should be done as soon as possible .

14. RISKS OF HRT Endometrial cancer : when estrogen is given alone to a women with intact uterus , causes endometrial proliferation , hyperplasia and carcinoma. Breast cancer : combined estrogen and progestin replacement therapy , increases the risk of breast cancer slightly . Venous thromboembolic disease (VTE) : It has been found to be increased with the use of combined oral estrogen and progestin.

15. 4 . Lipid metabolism : An increased incidence of gallbladder disease has been observed following ERT due to rise in cholesterol (in bile). 5. Dementia, Alzheimer disease are increased.

16. DISADVANTAGES OF HRT Estrogen and progesterone over a long periods is known to stimulate cell division, and this seem to increase the risk for breast cancer by upto 9% . HRT also appears to increase your risk of heart disease by 24% . Women taking HRT to reduce the risk of Alzheimer’s disease actually increased their risk by small percentage In order to prevent increasing your risk of certain disease , it is suggested that you use HRT for not more than 5 years.

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