Category Archives: Hormone Replacement Therapy

Some people may have concerns about the potential side effects of conventional hormone replacement therapy (HRT). As such, they may be interested in trying natural, plant-based options.

This article outlines the different types of natural HRTs, along with their potential benefits and risks. It also provides some alternative methods for treating hormonal problems and offers advice on when to see a doctor.

Hormone replacement therapy (HRT) is a therapy that doctors may prescribe to treat hormonal imbalances or depletion, particularly following menopause.

Natural hormone replacement therapy (HRT) uses hormones derived from plants to treat hormonal conditions.

There are two main types of natural HRT: Bioidentical HRT, and traditional natural HRT.

Bioidentical hormone replacement therapy (BHRT) treats hormonal imbalances and depletion using synthetic hormones derived from plant estrogens.

Doctors refer to bioidentical hormones as hormones with the same molecular structure as ones that the human body produces naturally.

Most BHRTs contain plant hormones that mimic the following:

There are two types of BHRT. They are:

The manufacturers of bioidentical hormones claim that custom-compounded BHRTs have fewer side effects and associated health risks than conventional HRT medications. However, there is no scientific evidence to support these claims.

Traditional natural HRTs involve consuming plants or supplements containing compounds that may alleviate hormonal symptoms.

Some plants and supplements that people may take to treat hormonal symptoms include:

Typically, people take natural HRT to treat the following conditions:

According to the FDA, there are no established benefits of taking BHRT medications over conventional HRT medications.

Despite the manufacturers claims, the FDA also indicate that there is no evidence that BHRT medications help prevent or treat the following conditions:

The FDA has since corrected most false statements and claims about BHRTs efficacy in treating the above conditions.

Despite this, some doctors, pharmacists, and drug companies still promote misinformation about the benefits of BHRT.

However, a 2015 study in the Journal of Clinical Oncology suggests that BHRT may help reduce symptoms associated with cancer treatments, though research is ongoing.

According to the FDA Office of Womens Health, conventional hormone therapies may not be safe for people with a history of the following medical conditions:

To date, no credible, large-scale scientific studies have investigated the potential adverse health effects of BHRT. The FDA state that there is no evidence suggesting that BHRT medications carry fewer health risks than conventional HRTs.

Risks include:

It is also tricky for doctors to track side effects linked to BHRT medications because symptoms may take years to develop.

The FDA also state that compounded BHRT medications tend to carry greater risks than non-compounded forms.

Because pharmacists mix compounded BHRT medications, the FDA cannot approve them for quality or consistency. They also carry health risks because the precise dosage and formulation depend on a pharmacists precision and accuracy. As such, it is not possible to guarantee their safety.

It is important to note that pharmacists and drug companies are not obliged to report any side effects associated with compounded BHRT medications.

The chemicals in non-compounded BHRT may also cause side effects. These chemicals may differ across medication types and brands.

The FDA do not regulate natural supplements, meaning their quality, purity, and overall contents vary between brands and batches.

Some commonly recommended supplements for hormonal imbalances may cause side effects, especially if a person takes them incorrectly. These side-effects may include:

People should also consider that some supplements may interfere with certain medications. As such, a person who is taking any kind of medication should talk to their doctor before taking any supplement.

People should take BHRT medications according to the instructions of their doctor or pharmacist.

A person should take any natural supplements according to the packet instructions. However, they should only take such supplements after approval from their doctor.

BHRT medications are available as either oral or topical medications in the form of creams, lotions, and gels.

People typically take oral BHRT medications daily, ideally at the same time each day. People using topical BHRT products may need to apply them several times a day. A person should read the medication label for specific instructions.

According to the FDA, a person should take all forms of hormone therapy at the lowest effective dose for the shortest possible time.

Several alternative treatment options can help a person manage the psychological and physical symptoms associated with hormonal imbalances and depletion. We outline some examples below:

Some people may require prescription medications to ease symptoms of hormone depletion, such as:

The following complementary therapies may also help to alleviate hormonally-induced symptoms of depression:

The following lifestyle changes could help to prevent or treat symptoms of hormonal imbalances or depletion.

Anyone experiencing symptoms of a hormonal change or imbalance should see a doctor as soon as possible. Early intervention may help prevent complications.

People should also see a doctor if their condition does not improve while taking a medication or herbal supplement, or if they experience side effects associated with these treatments.

There are two main types of natural hormone replacement therapy (HRT):

Some experts do not think that BHRTs are any safer or more effective than traditional HRT medications.

People should be aware that certain medications and supplements can cause side effects and interact with other medications.

As such, a person who wants to try natural HRTs should talk to their doctor about the potential risks and benefits of doing so.

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Natural hormone replacement therapy: How it works - Medical News Today

Continuing Education Activity

Hormone replacement therapy (HRT) is supplementing women with hormones that are lost during the menopausal transition. To relieve the symptoms associated with menopause, conventional HRT includes an estrogen and progesterone component to mimic hormones created by the human ovary. Estrogen therapies are numerous, and include those indigenous to the human ovary, for example, estradiol and estriol. Other estrogenic compounds include conjugated equine estrogen (CEE), the most commonly prescribed estrogen in the United States. They are not identical in their effect on the human body but share the same FDA indications. This activity describes the indications for hormonal replacement therapy and highlights the role of the interprofessional team in managing patients with postmenopausal symptoms.

Objectives:

Identify the different formulas of hormones for replacement therapy.

Describe the adverse effects and contraindications of hormonal replacement therapy.

Summarize the indications of hormone replacement therapy.

Explain interprofessional team strategies for improving care coordination and communication to ensure the safe use of hormonal replacement therapy and improve outcomes.

Hormone replacement therapy (HRT) is supplementing women with hormones lost during the menopausal transition. To relieve the symptoms associated with menopause,conventional HRT includes an estrogen and progesterone component to mimic hormones created by the human ovary.

Estrogen therapies are numerous, and include those indigenous to the human ovary, for example, estradiol and estriol. Other estrogenic compounds include conjugated equine estrogen (CEE), the most commonly prescribed estrogen in the United States. They are not identical in their effect on the human bodybut share the same FDA indications, according to thePhysicians Desk Reference.[1][2][3]The indicationsfor menopausal issues include:

Treatment of vasomotor symptoms of menopause

Treatment of genitourinary syndrome of menopause ( previously known as vaginal and vulvar atrophy)

Prevention of osteoporosis

A progestogen is a term used to include not only progesterone made by the human ovarybut also progesterone-like substances, also known as progestins. A woman who desires HRT andhas an intact uterusmust have a progestogen with estrogen to protect her uterus from endometrial hyperplasia or malignancy. Estrogen alone will cause the endometrial lining to grow. Progestogens stabilize the lining from proliferating abnormally. It is assumed that if a woman has had a hysterectomy that she no longer needs a progestin. Progesterone, however, is different as it can provide symptom relief from sleep disturbance and mood instability, and increasing evidence supportthat it offers tissue protection to the breast.[4][5][6]

FDA-approved indications for progestogens include:

Amenorrhea, either primary or secondary

Assisted reproductive technology treatment

Endometrial hyperplasia

Dysfunctional uterine bleeding

There arenumerous estrogen and progestogen choices, and they may be administrated orally or transdermally either through cream, patch, vaginal inserts, or subdermalpellets. Each route of administration has unique benefits and risks.

Oral Estrogen: Any estrogen administered orally results in increased activated protein-C resistance, increasing the risk of ablood clot. Oral estradiol also induces thehepatic formation of matrix metalloprotease 9, which decreases the formation and rupture of atherosclerotic plaque.

Transdermal Estrogen: Bypasses the hepatic metabolism that produces activated protein-C resistance, and the risk for blood clotting is negated.

Progestin administration is usually via the oral route, although a few are available in combination with estrogen in patch forms. Progesterone is available in an oral form that can also be used vaginally for non-FDA-approved uses.

Specializedpharmacies make compounded estrogen and progesterone creams, sublingual troches, and vaginal inserts, but these are not FDA approved and are not included in this article.

When studying the potential adverse effects of HRT, the most referenced information in the United States comes from the Women's Health Initiative (WHI).[7][8][9]

WHI Trial

This was a multifaceted trial, including two double-blind, placebo-controlled, randomized trials of postmenopausal hormone therapy.[10]

The first arm included CEE at 0.625 mg per day with medroxyprogesterone acetate (MPA) 2.5 mg per day. The second arm studied patients who had prior hysterectomies and treated with CEE 0.625 mg only.

HRT and the Breast

The CEE/MPA arm was discontinued earlier than expected due to an increased incidence of invasive breast cancer of 24% (HR=1.24). The CEE-only arm was not discontinued early, completed in 2004, and extended follow-up of patients has continued for 11.8 years. CEE use for 5 to 9 years is associated with a statistically significant reduction in breast cancer by 23% (HR=0.77). Those in the CEE arm also had decreased mortality from breast cancer by 63% compared to those not on CEE, and 38% fewer died from all other causes after breast cancer was diagnosed.

When examining evidence from European studies which usually use estradiol derivatives rather than CEE, and non-MPA progesterone or progestins, the conclusions are vastly different and unequal. Transdermal estradiol alone increased the risk of breast cancer by 10%, but estradiol with progesterone decreased the risk of breast cancer by 10%.

HRT and the Heart

In the WHI CEE/MPA arm, the overall incidence of coronary heart disease (CHD) increased by 24% over five years of use, with the most substantial elevation in risk within the first year, with an increase of 81% (HR=1.81).[11][12] This evidence requires cautious interpretation due to the following:

The average age of the patient treated in this study was 62 years. In women who started on therapy within ten years of menopause, there was a risk reduction of CAD of 11% (HR=0.89), but this was not statistically significant.

In those women who continued CEE/MPA for over six years, the risk of CAD dropped by 30% (HR=0.70).

These risks do not apply to estradiol and progesterone based treatments. Basic science studies show several mechanisms through which estradiol (not CEE) is cardioprotective. These include stabilization of atherosclerotic plaques, reduction of carotid intima-mediathickness (CIMT), and decreasing coronary artery calcium (CAC) scores. Numerous subsequent studies both in Europe and the United States show that cardiovascular disease and death are prominently reduced when HRT commences within the first four years of the menopause transition. The "Timing Hypothesis" refers to the theory that when starting HRT closer to the time of the menopausetransition, a cardiovascular benefit is seencompared with later initiation.

HRT and Risk of Stroke[13]

Stroke incidence increased in both arms of the WHI trial by 31% in the CEE/MPA arm, and 39% in the CEE arm.

Studies using oral estradiol are conflicted, showing a similar stroke risk, but the incidence of fatal stroke is unchanged.

HRT and the Risk of Venous Thromboembolism (VTE)

VTE, comprised of deep venous thrombosis and pulmonary embolism, was increased by 2-fold (HR= 2.06) in the WHI CEE/MPA arm.

Transdermal estradiol does not confer the same thromboembolic risk, as is evidenced by numerous European studies. The ESTHER study from France showed an overall risk of 0.9 for ablood clot, which is a decreased risk.[14] Subsequent studies looking at other transdermal estradiol doses and routes confirm these findings, with at least a null effect for blood-clotting risk.

Contraindications for oral or transdermal estrogen-based therapies include:

Known, suspected, or history of breast cancer

Known or suspected history of other estrogen-basedcancer, i.e., uterine cancer. Women who have had a hysterectomy and have no remaining evidence of disease are still candidates for HRT

Activedeep venous thrombosis (DVT) or a history of DVT or pulmonary embolism (PE)

History of blood clotting disorder, the most common being Factor V Leiden mutation carriers

Active or history of arterial thrombotic diseases such as myocardial infarction or stroke

Chronic liver disease or dysfunction

Migraine with aura

These contraindications do not apply to transvaginal based estrogen therapies, as the serum concentration of estrogen from this route is extremely low. The North American Menopause Society (NAMS) has recommended that the black-box warning that applies to conventional HRT not be applied to transvaginal estrogen treatments.

Hormone levels of estradiol and progesterone are not traditionally measured for monitoring purposes. Instead, the relief of menopausal symptoms and the absence of adverse effects signify an adequate medical response.

Adverse side effects may include:

No scientific evidence links HRT with significant weight gain.

HRT, including androgen therapies such as testosterone, should be monitored with serum testingbut is not considered conventional HRT.

Patients undergoing menopause require management from an interprofessional team that also includes the pharmacist and nurse. To improve patient outcomes, clinicians should not empirically prescribe hormone replacement therapy. These hormones correlate with a variety of adverse effects, including an increased risk of breast cancer, stroke, heart disease, and deep vein thrombosis. The duration of treatment of these hormones should not be more than a few years, and close monitoring is required. If the female has mild symptoms of menopause, then education should be provided about the benefits and harm of these hormones. The pharmacist should consult with the prescriber on the exact agent and dosing, while also examining the patient's medication record. Nursing needs to be very aware of signs of adverse events, and monitor closely on subsequent visits, alerting the clinician of any concerns. This interprofessional team approach will drive the best outcomes with HRT. [Level 5]

Link:
Hormone Replacement Therapy - StatPearls - NCBI Bookshelf

Ways of taking HRT

HRT comes in several different forms. Talk to a GP about the pros and cons of each option.

Tablets are 1 of the most common forms of HRT. They are usually taken once a day.

Both oestrogen-only and combined HRT are available as tablets. For some women this may be the simplest way ofhavingtreatment.

However,it's important to be aware that some of therisks of HRT, such as blood clots, are higher with tablets than with other forms of HRT (although the overall risk is still small).

Skin patches are also a common way of taking HRT. You stick them to your skin and replace them every few days.

Oestrogen-only and combined HRTpatches are available.

Skin patchesmay be a better option than tablets if you find it inconvenientto take a tablet every day.

Using patches can also help avoid some side effects of HRT, such as indigestion, and unlike tablets, they do notincrease yourrisk of blood clots.

Oestrogen gel is an increasinglypopular form of HRT. It's rubbed onto your skin once a day.

Like skin patches, gel can be a convenient way of taking HRT and does not increase your risk of blood clots.

Butif you still have your womb, you'll need to take some form of progestogen separately too, to reduce your risk of womb cancer.

HRT also comes as small pellet-like implants that are inserted underyour skin (usually in thetummy area) after your skin has been numbed with local anaesthetic.

The implantreleases oestrogen gradually and lasts for several months before needing to be replaced.

This may be a convenient option if you do not want to worry about taking your treatment every day or every few days. But if you still have your womb, you'll need to take progestogen separately too.

If you're taking a different form of oestrogen and need to take progestogen alongside it,another implant option is theintrauterine system (IUS). An IUS releasesa progestogen hormone into the womb.It can stay in place for 3 to 5 years and also acts as a contraceptive.

Implants of HRT are not widely available and are not used very often.

Oestrogen is also available as a cream, pessary or ring that is placed inside your vagina.

This can help relieve vaginal dryness, but will not help with other symptoms such as hot flushes.

It does not carry the usual risks of HRT and does not increase your risk of breast cancer, so you can use it without taking progestogen, even if you still have a womb.

Testosterone is available as a gel that you rub onto your skin. It is not currently licensed for use in women, but it can be prescribed after the menopause by a specialist doctor if they think it might help restore your sex drive.

Testosterone is usually only recommended for women whose low sex drive (libido) does not improve after using HRT. It is used alongside another type of HRT.

Possible side effects of using testosterone include acne and unwanted hair growth.

Ask a GP for more information on testosterone products.

Your treatment routine for HRT depends on whether you're in the early stages of the menopause or have had menopausal symptoms for some time.

The 2 types of routines arecyclical (or sequential) HRT and continuous combined HRT.

Cyclical HRT, also known as sequential HRT, is often recommended for women taking combined HRT whohave menopausal symptoms but still have theirperiods.

There are 2 types of cyclical HRT:

Monthly HRT is usually recommended for women having regular periods.

3-monthly HRT is usually recommended for women having irregular periods. You shouldhavea period every 3 months.

It's useful to maintain regular periods so you know when your periods naturally stop and when you're likely to progress to the last stage of the menopause.

Continuous combined HRT is usually recommended for women who are postmenopausal. A woman is usually saidtobe postmenopausal if she has not had a period for 1 year.

Continuous combined HRT involves taking oestrogen and progestogen every day without a break.

Oestrogen-only HRT is also usually taken every day without a break.

Excerpt from:
Hormone replacement therapy (HRT) - Types - NHS

October is recognized as Breast Cancer Awareness Month. During this time, health care systems and organizations aim to provide education, resources, support and prevention information regarding the disease.

The American Cancer Society (ACS), offers these statistics about breast cancer:

Early detection is important because there are more treatment options available and a better chance of survival when breast cancer is caught early, said Charissa Williams, APN, a ThedaCare Hematology & Oncology Specialist. Studies show theres a more than 90% survival rate, if the tumor is caught early.

Regular self-breast exams are one way to detect a cancerous tumor. A breast cancer screening is another way. Mammograms can spot tiny tumors, making it more likely to catch the disease at an earlier stage.

For most women, screening mammography is a safe and effective way to detect breast cancer early, Williams added.

Medical organizations vary on the best age to start screening mammograms (some say as early as age 40) and how often to repeat them. The Centers for Disease Control and Prevention (CDC) has a comparative chart, Breast Cancer Screening Guidelines for Women, to better sort out the timing and frequency of mammogram screening based on your particular situation.

It is important to discuss your individual screening guidelines with your primary care provider, said Williams. For example, those who have a strong family history or certain genetic mutations (BRCA1 or BRCA2) often have earlier screening guidelines than the general population.

Women might also help minimize their chances of developing the disease by modifying their lifestyle. However, Williams notes there are some risks factors that cannot be changed: your age, family history, genetics, race, and being a woman.

There are several modifiable factors that can increase your breast cancer risk, including obesity, poor diet, lack of physical activity, alcohol and tobacco use, and certain types of hormone replacement therapy, she said.

To reduce your risk of breast cancer, Williams suggests you form these habits:

There are more than 3.8 million breast cancer survivors in the United States.

For more information on breast cancer prevention tips, screenings and treatments, visit thedacare.org/breast-cancer.

About ThedaCare

For more than 110 years, ThedaCare has been committed to improving the health and well-being of the communities it serves in Northeast and Central Wisconsin. The organization delivers care to more than 600,000 residents in 17 counties and employs approximately 7,000 health care professionals. ThedaCare has 180 points of care, including eight hospitals. As an organization committed to being a leader in Population Health, team members are dedicated to empowering people to live their unique, best lives. ThedaCare also partners with communities to understand needs, finding solutions together, and encouraging health awareness and action. ThedaCare is the first in Wisconsin to be a Mayo Clinic Care Network Member, giving specialists the ability to consult with Mayo Clinic experts on a patients care. ThedaCare is a not-for-profit health system with a level II trauma center, comprehensive cancer treatment, stroke and cardiac programs, as well as primary care.

For more information, visit thedacare.org or follow ThedaCare on social media. Members of the media should call Cassandra Wallace, Public and Media Relations Consultant at 920.442.0328 or the ThedaCare Regional Medical Center-Neenah switchboard at 920.729.3100and ask for the marketing person on call.

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Helping Reduce Your Risk of Breast Cancer ThedaCare - ThedaCare