About Hormone Replacement Therapy (Hormone Therapy)
Learn about the disease, illness and/or condition Hormone Replacement Therapy (Hormone Therapy) including: symptoms, causes, treatments, contraindications and conditions at ClusterMed.info.
Hormone Replacement Therapy (Hormone Therapy)
|Hormone Replacement Therapy (Hormone Therapy)|
Hormone Replacement Therapy (Hormone Therapy) Information
Hormone therapy facts
Does menopause cause bone loss?
The lower estrogen levels of menopause can lead to progressive bone loss that is especially rapid in the first five years after menopause. Some bone loss in both men and women is normal as people age. Lack of estrogen after menopause adds another strain on the bones in addition to the usual age-related bone loss. When bone loss is severe, a condition called osteoporosis weakens bones and renders them susceptible to breaking.
How is hormone therapy (HT) prescribed?
Doctors usually prescribe hormone therapy (HT) as a combination of estrogen and another female hormone, progesterone. Synthetic progesterone compounds are referred to as progestins. Long term estrogen use without progesterone increases the risk of uterine cancer (endometrial cancer), whereas addition of progesterone counteracts this risk. Therefore estrogen without progestin is usually only recommended for women who have had their uterus removed (hysterectomy). Estrogen is available as pills, tablets, patches, creams, mist sprays, or vaginal preparations (vaginal rings, vaginal tablets, or vaginal cream). The choice of estrogen preparation recommended by the doctor depends on the women's symptoms. For instance, vaginal creams, vaginal tablets, and vaginal rings are used for vaginal dryness, while pills or patches are used to ease hot flashes. Estrogen pills are also useful for vaginal dryness and are sometimes used along with vaginal creams, tablets, or rings.Although progestin is usually taken in pill form, it is also available, together with estrogen, in patch form.Doctors may prescribe different schedules for taking hormone therapy (HT). Every woman's hormone therapy (HT) treatment and schedule should be individualized based on her particular situation. Below are some standard forms of hormone therapy (HT) that are used:Pills (Oral Therapy)In order to avoid monthly vaginal bleeding, some women choose to take small doses of estrogen and progesterone together every day. This is called daily continuous therapy. Sometimes, daily continuous therapy can cause some irregular, unexpected vaginal bleeding for the first several months of treatment, especially in younger women entering menopause. For these women, and for some other women, planned cyclic bleeding is more acceptable. In these women, progesterone is usually added to estrogen for the first 12 calendar days of the month.Patches and spray mists (Transdermal Therapy)Hormone therapy (HT) skin patches are to be worn on a continuous basis. Newer patches need to be changed once or twice per week. Combination estrogen/progesterone patches are available for women who have not undergone hysterectomy to prevent cancer of the uterus. Patches are as effective as oral hormone therapy (HT) for controlling hot flashes. Spray mists for ET are available as a transdermal spray used once daily.Vaginal Tablets rings, and CreamsEstrogen vaginal tablets and creams are generally prescribed nightly for 2 weeks, and then reduced to twice per week as a long-term "maintenance therapy." There is a low level of absorption of estrogen into the body with the use of vaginal preparations as directed. Circulating blood levels of estrogen are slightly increased from vaginal estrogen use, and the long-term safety of vaginal estrogen rings, creams and tablets has not been clearly established (for example risk of uterine cancer, heart disease, or breast cancer). For this reason, occurrence of vaginal bleeding during any type of vaginal estrogen use should be promptly evaluated.Vaginal estrogen rings are approved to treat genital dryness and irritation that can occur due to the lack of estrogen in women after menopause. A higher dose vaginal ring is available to treat hot flashes, so the hormone released from this higher dose ring clearly reaches sufficient levels to affect other parts of the body besides the genital area. The vaginal ring remains in place for 12 weeks, after which it can be changed by either the woman herself or her physician. The long-term safety of estrogen rings is not yet clear, but there is a low level of absorption of the hormone into the bloodstream with use of the vaginal estrogen ring.Bioidentical hormone therapyThere has been increasing interest in recent years in the use of so-called "bioidentical" hormone therapy for perimenopausal women. Bioidentical hormone preparations are medications that contain hormones that have the same chemical formula as those made naturally in the body. The hormones are created in a laboratory by altering compounds derived from naturally-occurring plant products. Some of these so-called bioidentical hormone preparations are U.S. FDA-approved and manufactured by drug companies, while others are made at special pharmacies called compounding pharmacies, which make the preparations on a case-by-case basis for each patient. These individual preparations are not regulated by the FDA, because compounded products are not standardized.Advocates of bioidentical hormone therapy argue that the products, applied as creams or gels, are absorbed into the body in their active form without the need for "first pass" metabolism in the liver, and that their use may avoid potentially dangerous side effects of synthetic hormones used in conventional hormone therapy. However, studies to establish the long-term safety and effectiveness of these products have not been carried out.
What are estrogen therapy and hormone therapy (HT)?
Estrogen, in pill, patch, or gel form, is the single most effective therapy for suppressing hot flashes. The term estrogen therapy, or ET, refers to estrogen administered alone. Because ET alone can cause uterine cancer (endometrial cancer) (see below), a progestin is administered together with estrogen in women who have a uterus (those who have not undergone a hysterectomy) to eliminate the increased risk. Thus, the term estrogen/progestin therapy, or EPT, refers to a combination of estrogen and progestin therapy, as is given to a woman who still has a uterus. This method of prescribing hormones is also known as combination hormone therapy. The term hormone therapy (HT) is a more general term that is used to refer to either administration of estrogen alone (women who have had a hysterectomy), or combined estrogen/progestin therapy (women with a uterus). All forms of hormone therapy (HT) that are FDA-approved for therapy of hot flashes are similarly effective in suppressing hot flashes.
What are the side effects and risks of hormone therapy (HT)?
Women can experience side effects during hormone therapy; these can be divided into more minor side effects, and more serious side effects. The more minor side effects are more common than the serious side effects, and are generally perceived by women as "annoying." These symptoms include:
What if a woman decides against hormone therapy (HT)?
If a woman decides against hormone therapy (HT), there are other methods to deal with the symptoms of menopause. Although hormone therapy (HT) is by far superior to other medications in relieving hot flashes, other prescription non-hormonal medications can also reduce hot flashes. Likewise, personal lubrication products such as a water-soluble jelly (not petroleum jelly) can be applied to the vagina to reduce dryness.A woman may also want to ask her doctor about non-hormonal prescription osteoporosis medications. These new treatments appear safe and effective in preventing fractures.
What is menopause?
Menopause is the stage in a woman's life when menstruation stops and she can no longer bear children. During menopause, the body produces less of the female hormones, estrogen and progesterone. After menopause, the lower hormone levels cause the monthly menstrual periods to stop and gradually eliminate the possibility of becoming pregnant. These fluctuations in hormone levels can also cause troublesome symptoms, such as hot flashes (a sudden sensation of warmth, sometimes associated with flushing, and often followed by sweating) and sleep disturbance. Sometimes women experience other symptoms, such as vaginal dryness and mood changes. While many women encounter little or no trouble during menopause, others endure moderate to severe discomfort.
What medical checkups are advised for women on hormone therapy (HT)?
All women receiving hormone therapy (HT) should undergo a medical checkup every year. At that time, the doctor or nurse will perform a breast exam and order a mammogram (a special X-ray picture of the breasts) to check for masses in the breasts that might possibly be cancer. At, or even prior to these check-ups, a woman should discuss her bleeding pattern with her physician to be sure it is within the expected pattern for her specific type of hormone therapy (HT). Other routine screening evaluations may also be performed at this annual check-up.
Who should not take hormone therapy (HT)?
Who should take hormone therapy (HT)?
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