Hormone Replacement Therapy: Good or Bad?

As women enter their menopause stage between the ages of 50 – 55 years, they start having mild to severe symptoms including hot flashes, vaginal dryness, sleeping problems, mood swings etc. HRT was introduced to alleviate these symptoms that are mainly caused due to lowered production of estrogen. During the initial days of introduction of HRT, Hormone Replacement Therapy was advocated to majority of women. But, evaluating the long term health risks that this therapy posed, the therapy was changed for some and stopped for some others.  Hormone Replacement Therapy involves putting a woman with menopausal symptoms on hormones including estrogen and progesterone. The dosage varies based on the severity of the symptoms and the type of symptoms the person may be having. Similarly, the risks posed by this treatment also depend on the therapy used.

Basic types of hormone therapies:

1. Systemic Hormone Therapy – Where higher doses of estrogen will be prescribed. The intake of estrogen can be in any form such as pills, skin patches, ring, gel, creams, spray etc. This method is advocated when the estrogen has to be absorbed by the complete body.
2. Low-dose Vaginal Therapy – Lower doses of estrogen comes in the form of cream, tablet or ring. Only a minimum amount of estrogen will be absorbed by the body and this therapy is prescribed in women with vaginal dryness and urinary problems.

Usually, in women who have not undergone hysterectomy (removal of uterus), progesterone (or progestin) will be prescribed along with estrogen. For women who do not have uterus, estrogen treatment should be good enough. Reason being, putting women with uterus under estrogen alone increases the risk of Endometrial Cancer.

Risks associated with Hormone Therapy:

HRT involving only estrogen resulted in some serious conditions such as:

1. Heart disease
2. Heart Stroke
3. Breast Cancer
4. Blood clots

The risks that are posed depend on different factors including:

1. Age of the person: The sooner the better we can say. If the hormone replacement therapy is started within 10 years of menopause, the risks are less than the benefits achieved.  If the therapy is started after 10 years of menopause, the risks increase drastically.
2. Type of Therapy: This is the most important factor. What combinations of hormones are prescribed and at what levels determines the risk. As said, just estrogen alone can increase the risk of cancer in women with uterus.
3. Medical history of the family: If there is anyone in your family suffering from cancer or a heart disease, then the chances of you acquiring the same are higher. If anyone in your family has liver disease or osteoporosis, it is important that you must put this across to your doctor.

When you present yourself to the gynaecologist, he/she has to be informed about your condition, if you are taking any medication and your family history to determine the right therapy for you. Hormone therapy has to be tailored for each individual depending on these factors.

To who is Hormone therapy beneficial?

1. If you are suffering from moderate to severe hot flashes, systemic estrogen therapy will prove to be effective. Estrogen administration can also help in reducing vaginal dryness, itching and reduce pain during intercourse.
2. Women with Osteoporosis: Osteoporosis is a medical condition where the bones become thin, weak and break easily. Hormone therapy may be tried by your gynaecologist if other medications are of little help.
3. Lack of estrogen or early menopausal state: If your body is not producing enough estrogen, you may reach menopause state sooner than normal. This can also result in other problems such as vaginal dryness, pain during intercourse etc. In this case also, your gynaecologist may suggest hormone therapy after determining cause with some tests.

Alternatives to hormone therapy

If you are looking for alternative therapies or solutions for hormone therapy, it is better to start from a younger age instead of waiting till menopause stage. Changes in lifestyle, eating habits, keeping cool, having less caffeine, alcohol etc can help you alleviating some symptoms of lack of necessary hormones.

For vaginal issues such as dryness and painful intercourse, you may use water based lubricants, moisturizers as prescribed by your gynaecologist.

Is hormone therapy good?

Hormone therapy is neither good nor bad. It depends on when you start the treatment and also depends on the experience of your gynaecologist and his/her prescription of the hormones for you based on the factors mentioned in this article. If you are put on hormone therapy, make sure that you stay in touch with your gynaecologist, keep him/her updated with your symptoms and side effects if any. Based on the feedback, your gynaecologist may let you continue or change the medication.