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  HRT - Hormone Replacement Therapy
Hormone Replacement Therapy (HRT) is the use of synthetic or natural female hormones to make up for the decline or lack of natural hormones produced in a woman's body.

HRT is sometimes referred to as estrogen replacement therapy (ERT), because the first medications that were used in the 1960s for female hormone replacement were estrogen compounds.

Estrogens

In order to understand how HRT works and the controversies surrounding it, women should know that there are different types of estrogen medications. These drugs are given in a variety of prescription strengths and methods of administration. There are at present three estrogen compounds used in Western countries.

  • Estrone. Estrone is the form of estrogen present in women after menopause. It is available as tablets under the brand name Ogen.
  • Estradiol. This is the form of estrogen naturally present in premenopausal women. It is available as tablets (Estrace), skin patches (Estraderm), or vaginal creams (Estrace).
  • Estriol. Estriol is a weaker form of estrogen produced by the breakdown of other forms of estrogen in the body, under the brand name Estriol. It is the only form that is thought not to cause cancer.
 

In addition to pills taken by mouth, skin patches, and vaginal creams, estrogen preparations can be given by injection or by pellets implanted under the skin. Estrogen implants, however, are used less and less frequently.

Progestins

Most HRT programs include progestin treatment with estrogen compounds. Progestins—sometimes called progestogens—are synthetic forms of progesterone that are given to reduce the possibility that estrogen by itself will cause cancer of the uterus. Progestins are commonly prescribed under the brand names Provera and Depo-Provera. Other common brand names are Norlutate, Norlutin, and Aygestin.

Estrogen / Testosterone combinations

Women's ovaries secrete small amounts of a male sex hormone (testosterone) throughout their lives. Women who have had both ovaries removed by surgery are sometimes given testosterone along with estrogen as part of HRT. Combinations of these hormones are available as tablets under the brand name Estratest or as vaginal creams. Women who cannot take estrogens can use 1% testosterone cream by itself for problems with vaginal soreness.

Estrogen / Tranquilizer Combinations

There are several medications that combine estrogen with a tranquilizer like chlordiazepoxide (sold under the trade name Menrium) or meprobamate (sold under the trade name PMB). Many doctors warn against these combination drugs because the tranquilizers can be habit-forming.

HRT medications come in several different forms, including tablets, stick-on patches, injections, and creams that are worn inside the vagina. The form prescribed depends on the purpose of the hormone replacement therapy. Women who want relief from vaginal dryness, for example, would be given a cream or vaginal ring. Women using HRT to relieve hot flashes or to prevent osteoporosis and heart disease often prefer oral medications or patches. All HRT medications used are available only with a doctor's prescription.

HRT Treatment Regimens

One of the complications of HRT is the number of treatment options, including combinations of types of estrogen; dosage levels; forms of administration; and whether or not progestins are used with the estrogen to offset the risk of uterine cancer. This variety, however, means that a woman who wants to use HRT while minimizing side effects can try different forms of medication or dosage schedules when she consults her doctor. It is vital, however, for women to follow their doctor's directions exactly and not change dosages themselves.

At present, women who are taking a combination of estrogens and progestins are placed on one of three dosage schedules:

  • Estrogen pills taken daily from the first through the 25th day of each month, with a progestin pill taken daily during the last 10–14 days of the cycle. Both drugs are then stopped for the next five to six days to allow the uterus to shed its lining.
  • Estrogen pills taken on a daily basis with low-dose progestin pills, also on a daily basis. Both medications are taken continuously with no days off.
  • Estrogen pills and low-dose progestins taken on a daily basis for five days each week, with both medications stopped on the last two days of each week.
 

Controversies over HRT

It is important to know that there is still considerable disagreement over the advantages and disadvantages of HRT. Further research is ongoing and intensive concerning the benefits and/or risks.

  • INCREASED RISK OF BREAST CANCER. The most important controversy over HRT is whether it increases a woman's risk of developing breast cancer.
  • TIMING AND LENGTH OF TREATMENT. One of the disagreements about HRT concerns the best time to begin using it. Some doctors think that women should begin using HRT while they are still in perimenopause. One study found that the average length of time that women stay on HRT is 23 months.
  • UNWANTED SIDE EFFECTS. Many women who find that estrogen relieves hot flashes and other symptoms of menopause have the opposite experience with progestin. Progestin frequently causes moodiness, depression, sore breasts, weight gain, and severe headaches.
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