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HRT: An Option with Caveats

HFN 044 HRTanOption 2 F27266964There was once a time when doctors helped women deal with menopausal symptoms with a universal easy answer. That answer was hormone replacement therapy, or, HRT. It was considered a safe and reliable way to replenish the diminishing levels of estrogen in menopausal women's bodies.

Things changed, however, when it was discovered that for some women, HRT posed a serious health risk. HRT is still used today, but the way in which it is administered has evolved.

Dangers
Researchers have discovered that extended exposure to HRT consisting of doses of estrogen and progestin increases the risk of cancer, strokes, heart disease, and blood clots in some women.
For this reason, many doctors no longer prescribe HRT for longer than two and sometimes three years, and then only in women with the most severe menopausal symptoms.

Benefits
Since HRT replaces the hormones your body no longer produces, it can help ease the symptoms caused by a lack of hormones. This means relief from hot flashes, insomnia, night sweats, fatigue, and many of the additional symptoms of menopause. It can also help with other problems associated with estrogen leaving the body, such as osteoporosis and colorectal cancer. HRT can also promote sexual health by offering relief from vaginal dryness and the burning and itching during sexual intercourse. Generally, taking estrogen seems to help a woman look, and therefore often feel, younger, so estrogen replacement was widely accepted by millions of women until reports of serious side effects surfaced.

Alternative Forms of HRT
One alternative form of HRT is bioidentical HRT. This method is different in the fact that the medication itself is derived from plant-based materials instead of synthesized in a lab. The end result is hormones that are chemically identical to the ones that occur naturally within your body. Potential users should be aware that bioidentical HRT products are generally not approved by the FDA. For more information on this subject, please visit our section on Bioidentical HRT.

Another way of administering HRT is through the use of topicals, which are designed to deliver hormones directly to a specific part of the body. They can be applied using sprays, creams, patches, lotions, and gels and are primarily used to alleviate the vaginal dryness so common to menopause. One advantage is that the medication is absorbed into the bloodstream directly through the skin, thus bypassing the GI tract and liver. The result is a diminished risk of blood clots and the avoidance of the ingestion of the additional materials that oral medications must contain in order to be absorbed by the body.

Estrogen cream applied directly into the vagina should not be used just before intercourse, since repeated exposure to estrogen is not recommended for men. For a more extensive look at topicals, please visit HFN's section on Topical Treatments.

Vaginal tablets with low-dose estradiol are also available and are inserted into the vagina twice weekly.

There are also low-dose estrogen "rings," which are inserted into the vagina the same way you would insert a diaphragm and have approximately the same diameter as a diaphragm. The ring is fairly stiff, with just enough flex to allow insertion. It releases a low dose of estradiol daily for three months, at which time you would discard it and insert a new one. There does not seem to be the same risk of estrogen exposure to men as the cream has if their partner uses one of these.

The good news about these alternative methods of estrogen administration is not only the low dose of drug they provide, but also the localized effect of the estrogen, which is only absorbed into the bloodstream in very small amounts. Yet there is no guarantee that any estrogen product is without side effects.

Before considering or pursuing any form of treatment for your symptoms of menopause, schedule a visit with your doctor. Every woman is different, and there is no single medication, method, or therapy that works best for everyone. Estrogen products are sold by prescription only, and only your health care provider can evaluate the needs of your body and prescribe an appropriate, safe, and effective plan for treating your condition.♀

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