Hormone replacement therapy (HRT) is used to supplement hormones when the body is not producing adequate amounts. This commonly occurs during perimenopause and menopause in women as estrogen and progesterone levels decline, but HRT may also be used in men with low testosterone. HRT can help alleviate bothersome menopausal symptoms like hot flashes, night sweats, vaginal dryness, mood changes, and sleep disturbances. It may also help prevent bone loss and fracture.
The main forms of HRT for women contain estrogen. Estrogen-only therapy is used in women who have had a hysterectomy. Women with an intact uterus need progesterone or a progestin (synthetic progesterone) combined with estrogen to prevent overgrowth of the uterine lining which can lead to endometrial cancer. The progesterone protects the uterus.
There are many different FDA-approved products and formulas for HRT. The route of administration, dosages, and specific hormones or combinations can be customized to each patient's needs. HRT is available in pills, skin patches, gels, sprays, creams, vaginal rings, and suppositories. Balance Hormone Clinic has extensive experience in HRT and provides personalized care.
Ideal candidates for HRT are women experiencing moderate to severe menopause symptoms that impact quality of life. Symptoms are typically most bothersome in the 1-5 years after menopause begins but some women struggle with symptoms lasting over a decade. HRT is very effective at relieving hot flashes and night sweats. It also improves vaginal dryness and discomfort with intercourse. Mood disruptions, sleep disturbances, and cognitive issues related to menopause often improve with HRT.
Women in early menopause, especially those under 45 years old, are excellent candidates for HRT since they stand to benefit for a longer duration before the natural age of menopause. Premature ovarian insufficiency or surgical menopause before age 45 confer greater risks of cardiovascular disease, cognitive decline, and osteoporosis. HRT helps mitigate these health risks.
HRT may be appropriate for women in their 50s and 60s experiencing significant symptoms. The benefits tend to outweigh the risks in this age group for healthy nonsmokers within 10 years of menopause onset. Continuing HRT beyond age 60 should be evaluated on an individual basis.
Women who have osteopenia or osteoporosis are candidates for HRT since estrogen therapy reduces bone loss. Fracture risk is lowered with HRT. For women at very high risk of fracture, combination therapy with a bisphosphonate medication and HRT may be recommended.
HRT is sometimes prescribed short-term for women with severe hot flashes and night sweats after breast cancer treatment. Estrogen and progesterone receptors in breast cancer cells often drive tumor growth, so HRT is approached cautiously after breast cancer. However, the quality of life benefits may outweigh risks in select patients. This decision requires expert input.
HRT is generally not recommended for women with a history of blood clots, stroke, heart attack, liver disease, or breast cancer. Safer alternatives for symptom management are first considered. Careful evaluation of benefits vs risks may warrant HRT use in some cases.
Low-dose vaginal estrogen is appropriate for women not candidates for systemic HRT but need treatment for genitourinary syndrome of menopause (vaginal dryness, irritation, burning, recurrent urinary tract infections). Low-dose vaginal therapy minimizes systemic absorption and does not elevate blood estrogen levels much.
Testosterone replacement is considered for men with symptoms of low testosterone (low libido, erectile dysfunction, reduced muscle mass, fatigue, mood changes). Confirmation of low or borderline low blood levels guides therapy. Topical gels, injections, and pellets are options for testosterone replacement. Monitoring for side effects like polycythemia (elevated red blood cell count) is needed.
The decision to start HRT is highly individualized between a patient and their provider. Lifestyle measures, non-hormonal prescription therapies, herbal remedies, and the latest data on risks are considered. Balance Hormone Clinic specializes in customizing HRT regimens with cutting edge therapies. Our compassionate providers partner with patients to optimize their care, safety and quality of life. Contact us today to schedule a consultation.
