Hormone Replacement Therapy - HRT

Q. what is HRT?
Ans. Menopause, which occurs for most women around the age of 50, prompts a decline in hormone production as the ovaries stop producing eggs and menstruation ends. During and after this period, the health risks for certain conditions can increase because as the estrogen level decreases so does its protective function. To help their bodies adjust to this change, some women use hormone replacement therapy (HRT). HRT involves taking synthetic estrogen and progesterone (progestin) hormones.

Q.What are the prerequisites for starting HRT?
Ans. A woman should have complete physical examination for assessment of cardiovascular status, B.P., and respiratory diseases. Breast, abdominal and pelvic examination should be done and Pap smear should be taken to rule out the existnece of cervical malignancy and various blood tests should be done like - hormone and lipid profile, Liver function test, mammoography,etc

Q. What all, the doctor should be told before taking HRT?
Ans. Doctor should be informed about any history of liver disease, previous treatment, past psychological disturbances, past history of thromboembolic phenomenon, family history of ovarian corciroma.

Q. What are the absolute contraindications for HRT?
Ans. Absolute Ccontraindications for HRT are:
(a) Vaginal bleeding of unknown origin
(b) Active severe liver disease
(c) Acute thromboembolic disease / deep vein thrombosis
(d) Recent carcinoma of breast.
(e) Recent carcinoma of uterus (endometrium)
(f) Any congenital lipid metabolism disease.

Q. How frequent the visits to the doctor should be?
Ans. Patient on HRT should have the next visit (after starting the HRT) 6 months later and then yearly. Mammography is done every 3 years. Pap smear every 3 years - Breast and pelvic examination every 12 months.

Q. In what form HRT can be taken and which is the best?
Ans. HRT can be given in Oral preparations, Injections, Transdermal patches, Subcutaneous implants, Vaginal creams and suppositories and as Intrauterine device.
All routes of administration of HRT are beneficial. For most women the oral route will be the simplest, cheapest and most suitable form.

Q. What are the various drugs and preparations and how they should be taken?
Ans.Oral tablets containing low dose of estrogen are given. They are Premarin (0.3, 0.625 mg of conjugated estrogen), Evalon (0.5 mg Estrace (0.5 mg), etc.

Transdermal Patches like Estraderm TTS and Estraderm Mx are available in these doses of 25, 50 and 100 mg / 24 hours. The patch is placed on hairless skin over the buttocks or lower abdomen and fixed by palm pressure for 5-10 seconds. It is waterproof and stays in position for 3-4 days.

Subcutaneous implants like estradiol implant (Organon) contains 17 B-Estradiol in a cholesterol base in silastic rods of 3-6 mm length which can be introduced in subcutaneous fat of lower abdomen or buttock under local anaesthesia and the effect last for 6 months. It is useful in women whom the uterus has been removed.

Intrauterine device contains both estrogens and progesterone.

Transvaginal creams and suppositoryy like Dienesteral cream, Premarin cream, etc.

Q. In what persons transdermal patches are preferable?
Ans. It is useful in women with hypertension, hepatobiliary disorders, Increased triglycerides and venous thrombosis.

Q. How transvaginal creams are useful?
Ans. They help in curing symptoms due to atrophic changes in vagina leading to dyspareunia(pain during intercourse) and dysuria (painful urination).

Q. What are disadvantages of various drugs for HRT?
Ans. Oral tablets lead to nausea, vomiting and poor compliance. It contains higher doses.
Trans dermal patch can lead to local allergic reactions in some women.
Subcutaneous implants can lead to breakthrough bleeding in some patients Intrauterine devices may lead to infections.

Q. What are the risks associated with prolonged HRT treatment and what can be done for it?
Ans. When estrogens alone are taken for long time as HRT, there is a risk of uterine cancer and breast cancer. So progesterone is added for about 10-12 days in each month. But addition of progesterone leads to withdrawal bleeding every month which is not acceptable to most patients. It is given in woman whose uterus has been removed.