Ovaries are the primary genital organs of female and they are the major site of production of hormones necessary for the normal reproductive functions of a woman. When the ovaries fail to produce adequate amount of estrogen and progesterone, menopause is said to have set in. This is the usual time when Hormone Replacement Therapy (HRT) is instituted. Hormone replacement therapy aims at substituting the physiological absence of estrogen and progesterone in the body by providing the hormones from outside.
The most important thing about HRT is that it is not always required for every woman. The therapy is instituted only in those who develop symptoms of menopause like hot flushes, sexual disturbances and urinary problems, or are at high-risk of developing cardiovascular disease, osteoporosis and Alzheimer’s disease. HRT is also necessary for women in whom the ovaries have been removed by any surgery for any diseases of the ovaries. It is also required for those in whom menopause have set in prematurely.
In most cases, HRT is prescribed for a short period of 3-6 months. There is improvement in the health of the patient by the end of 6 months and usually the therapy is discontinued as the woman gets well adjusted to this post-menopausal period of her life. But for women in high risk category for previously mentioned disease conditions, HRT is required on a long-term basis for 8-10 years. It is available as pills, transdermal patch, implants and for local application to vagina in form of gels and creams. Choice of route of administration of HRT depends on the woman herself as each route has its advantages and disadvantages.
Many a times women demand for HRT even if they are healthy. Also such women are generally not at risk for developing any cardiovascular disease or Alzheimer’s disease. But, they have a feeling that they will have a better living by taking these replacement hormones. The pros and cons of the therapy should be well considered while opting for HRT. Pros of the therapy include-
- Relief of symptoms of menopause- hot flushes do not occur, sexual functions normalize and urinary symptoms resolve,
- prevent or delay osteoporosis, cardiovascular diseases, Alzheimer’s disease, atherosclerosis,
- feeling of well-being results in improvement in mental health and less of irritability and depression ,
- HRT improves the lipid profile of a patient by lowering harmful Low Density Lipoproteins (LDL) and raises High Density Lipoproteins (HDL),
- Side effects of the therapy,
- before institution of therapy proper screening for potential contraindications should be done,
- cost of therapy,
- periodic check-up,
- risk of developing breast cancer, genital cancers, endometrial cancer, and thromboembolism,
Women having liver and gall bladder diseases, cancers of breast, genitalia or uterus, previously suffered from deep vein thrombosis, stroke, heart attack or pulmonary embolism should not opt for HRT. Also those women having family members who have suffered from breast cancer, cancer of the genitalia or endometrial cancer should not be prescribed HRT. Diabetes mellitus , high blood pressure, high cholesterol or triglycerides, smoking, alcohol intake and cardiac diseases are no contraindications for HRT, but require regular monitoring.
HRT aims at improving the quality of living of a post-menopausal woman and should be taken by a woman only under the able guidance of a specialist in Gynaecology or endocrinology as this requires continuous monitoring of potential health risks.
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