Hormone replacement therapy is medication containing one or more female hormones, commonly estrogen plus progestins. Some time only estrogen only therapy is given in women whose uterus has been removed.

It is the use of hormones, synthetic or natural to treat the woman who lacks them. Estrogen and progestin are usually given together because estrogens alone increase the risk of endometrial cancer.

It can be in the form of pill, patch or cream.

Uses

• Menopause: HRT is commonly used to treat the symptoms of menopause as hot flashes, vaginal dryness, mood swings, sleep disorders etc.
• Osteoporosis
• Breast cancer.
• Colorectal cancer.
• Heart disease: Estrogen can decrease the risk of heart disease.

• Surgical menopause: Woman who has undergone hysterectomy.

Forms of HRT

• Cyclical hormonal therapy: In this therapy, estrogen is taken in pill form for 25 days, with progestin added somewhere between 10-14. The estrogen and progestin are taken together for the remainder of the 25 days. Then, no pills are taken for 3-5 days. There may be monthly bleeding with cyclic therapy.
• Continuous combined therapy is where estrogen and progestin are taken together every day. When the therapy is started, or when switching from cyclic to continuous therapy, women may experience irregular bleeding. Most women stop bleeding within 1 year after starting this therapy.
• An HRT patch can be applied to the thigh. The patch allows the estrogen to be absorbed through the skin in to the blood stream.
• Vaginal cream containing estrogen may be given to women for vaginal dryness.
  

Risks of HRT

• Long term HRT increases the risk of development of
• Ovarian cancer.
• Uterine/endometrial cancer.
• Strokes.
• Increased risk of developing gall stones.
• Blood clots. Venous thromboembolism.
  

Side-effects of hormone replacement therapy

• Weight gain, bloating.
• Water retention.
• Nausea.
• Breast tenderness.
• Headache.
• Mood swings.
• Heavy menstrual bleeding.
• Menstrual cramps.
• Migraine headache.
• Varicose veins.
• Dark brown facial pigmentation.
• Abnormal vaginal bleeding.
• Liver disease.
• Seizures.
  

How to limit the side effects of hormone therapy

• Start hormone therapy early. Hormone therapy caused no significant increase in heart disease risk in women under age 60.
• Minimize the amount of medication you take. Use the lowest effective dose for the shortest amount of time needed to treat symptoms.
• Try a form of hormone therapy with limited systemic side-effects like skin patches, vaginal creams and slow-releasing form.
• Make a healthy life style changes like avoiding smoking. Get regular exercises. Eat healthy diet containing fruits, vegetables, grains, low fat. Maintain a healthy weight. Get regular health screenings to check blood pressure and cholesterol levels to detect early signs of heart disease.
  

HRT remains most effective treatment for symptoms of menopause and should be used under following three conditions

• If a woman is experiencing early menopause (before the age of 45).
• If hot flashes interfere with sleep.
• For the treatment of osteoporosis with especially woman with hot flashes.