Hormone Replacement Therapy

For many years, women have preferred Hormone Replacement (HRT) Therapy to manage menopausal symptoms. HRT is a form of medical treatment used by peri-menopausal, post menopausal and women whose uterus is surgically removed in hysterectomy (‘Health Canada’ pr. 1).  It was developed in the 1960s aimed at controlling menopausal symptoms and safeguard women against post menopausal risks. Menopause in women compromises hormone levels followed by undesirable symptoms. Estrogen for instance is produced at low levels in postmenopausal women, a factor that is attributed to weak bones hence osteoporosis. The medications comprises of female hormones to restore those that are not produced in postmenopausal women. These symptoms include night sweats, decreased sexual drive, poor fat distribution, hot flashes, mood swings, virginal dryness, painful sex, sleep disorders, osteoporosis, among others (Dennerstein & Shelly 12).

HRT is administered in form of a patch, vaginal ring, or gels and in most cases pill. These pills contain estrogen together with progestin or just estrogen alone (‘Health Canada’ pr. 2). Progestin is incorporated in HRT as a preventative measure to prevent endometrial cancer, where uterus is not yet surgically removed (hysterectomy). Dosage of HRT varies cyclically, where estrogen may be used daily while progestin are used for two weeks in a month and this treatment is known as sequentially combined HRT. Alternatively, a constant dosage may be taken where combined hormones are used every day and this treatment is known as continuous combined HRT (‘Health Canada’ pr. 3). Initially, studies indicated that HRT could be essential in preventing heart illnesses in the post menopausal individuals. All the same, declined incidence of these illnesses such as stroke, cardiovascular illnesses and heart attack is now attributed to lifestyle changes and dietary improvement and not on HRT. In the past, HRT was routinely administered by physicians. However, it is not until recent studies in 2002 that HRT has been attributed as a risk factor to some health conditions, thus changing the medical practice where prescriptions of HRT stopped while those under HRT discontinued. Through clinical trials it was evidenced the HRT is even more detrimental to the health of post menopausal women (‘Health Canada’ pr. 1).

Some women complain of nausea, water retention, and headache among other side effects after taking HRT. Incase of unusual symptoms patients are recommended to contact their doctors who may guide them on switching to another form of HRT (Watkins 187). Regardless of the health risks, Short term use of HRT is essential when: a person has extreme hot flashes or severe symptoms, has osteoporosis which cannot be managed by any other way due to treatment failure. According to studies, amenorrhea in premenopausal women i.e. premature menopause or ovarian failure, which cause health problem, HRT administration benefits may counteracting the risks (Meikle 401).  HRT has recently been applied in transgender, intersex, cis-gendered as well as transsexual persons to alter their reproductive hormonal balance. As a result, secondary sex traits develop of the preferred gender but it is unable to reverse the changes of puberty unless combined with procedures like surgery, apilation and laser hair exclusion (Watkins 32).

Benefits of HTR

The procedure is preferred by women when natural menopause strikes. Synthetic hormones, progestin and estrogen are taken in to manage symptoms in menopause. It is not recommended to take HRT for extended periods of time. The benefits that arise as a result of HRT administration art a bit controversial in the present time but they were thought to prevent Osteoporosis. HRT was indicated to avoid bone loss which is prevalent in menopausal women thus reduced hip fractures. Additionally, colorectal cancer is reduced when HRT is administered according to research. Moreover, Heart diseases are decreased as a result of estrogen especially when used early on the onset of menopause. Natural menopause estrogen is combined with progestin to prevent uterine cancer. However, women whose menopause is induced through hysterectomy are recommended to use estrogen unaccompanied (Meikle 405).

NIH Clinical Trials

The Women’s Health Initiative (WHI) initiated in nineteen ninety one by the  U.S. National Institutes of Health (NIH)   in the US Department of Health and Human Services comprises research on premenopausal women in forty health care service provided in the U.S.  The aim of the study was to gather evidence on postmenopausal women’s health by analyzing effects of HRT. NIH conducted clinical trials to analyze the pros and cons associated with the two HRT types administered as a pill (‘Health Canada’ pr. 5). Having categorized the trial into two, the first being over 16,000 postmenopausal women, fifty to seventy nine years of age and had not carried out hysterectomy. Having administered with the daily uptake of estrogen and progestin combined (Prempro) or just estrogen pills (placebo). The second group had over 10,000 postmenopausal women, who had undergone hysterectomy and given placebo or estrogen pill alone.

The research had over five years of follow-up and in July 2002, NHI stopped the category of estrogen and progestin combined pill prematurely. After monitoring, the board assessed the outcome they concluded that risks outweighed the benefits of combined HRT category in comparison with the group of estrogen alone. Out of the ten thousand women on combined HRT studied, it was seen that per a single year, there was 7 greater coronary disease cases i.e. 37 for combined HRT and 30 for Estrogen alone; 8 greater stroke cases i.e. 29 vs. 21; 18 greater invasive breast cancer incidences i.e. 38 vs. 30; 6 less colorectal cancer incidences i.e. 10 vs. 16; 5 less hip fracture cases i.e. 10 vs. 15. The figures are however minimal but are very important since many women were under HRT and their cumulative effect over several years are amplified and therefore, a need for public health concern. Since then, more findings have been found: “in a subgroup of more than 4500 women aged 65 or older, an additional 23 cases of dementia in 10,000 women per year were reported among women on combined HRT, as compared to placebo (45 vs. 22). As well, combined HRT did not prevent mild cognitive impairment among women who used it and there was a small increased risk of cognitive decline in the combined HRT group” (‘Health Canada’ pr. 7). In addition,   “Compared to non-use of HRT, the use of combined HRT increases breast density and was shown to compromise the interpretation of mammography results” (‘Health Canada’ pr. 7).

From the study, it is clear that estrogen and progestin combined is not good for extended periods of time to be used by post menopausal women except on incidences where there are minimal therapeutic options. Extended use of HRT causes risks such as breast cancer, stroke, dementia, and coronary heart disease.  These out weigh the benefits such as fracture reduction and minimal colorectal cancer in women over sixty five years.

In March 2004, the placebo category was stopped after close to 7 years follow-up. From this study, NHI concluded that estrogen therapy did not affect coronary disease risk, did not elevate breast cancer, elevated stroke cases, and caused a decline of hip fracture for women who carried out hysterectomy. In addition, estrogen was attributed to the trend of elevated cases of dementia as well as moderate cognitive impairment. It should be noted that other HRT dosage levels and varieties e.g. vaginal ring, injections,  nasal sprays, implants,  gel or the patch were not part of this research.

Risk Reduction

 The choice of whether or not to use HRT should be founded on heath issues and should be carried out after thorough medical evaluation. It is necessary to consider doctor’s advice on the benefits as well as the risks surrounding the procedure in relation to dosage levels and medical history. Other alternative methods of managing post menopausal symptoms should be considered with the help of a doctor.  These alternatives may include use of virginal estrogen ointments, herbal supplements, antidepressants and osteoporosis medication. Post menopausal women should engage in healthy eating habits, engage in physical exercises, moderate alcohol intake and avoid smoking. These are essential as preventive measures of coronary heart disease and osteoporosis (Goulden 123). It is important to note that HRT should not be used to prevent or manage neither stroke nor coronary heart disease. However, HRT is beneficial in managing hot flashes, vaginal dryness as well as night sweats (‘Health Canada’ pr. 10).

However time HRT is used, it causes the risks discussed above and therefore should be administered only when symptoms are extreme and when awareness is created of the risks being followed up with regular medical assessments. From the study, NHI recommend that women with natural and not surgical menopause could use the lowest possible HRT dose for the most minimal periods possible so as to keep away from the above risks

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