HRT (hormone replacement therapy)

Going through menopause? Should we take the risk with hormone replacement therapy or HRT, when we know so much about the effects on women suffering from night sweats, hot flashes, and all the other symptoms of menopause. What effects will HRT have on the body in the long term or do we really know, could it be breast cancer or some other form of cancer. What are the alternatives for hormone replacement therapy  and what about  hormone replacement therapy for men . Before you start searching for hormone replacement therapy clinics, you should learn the alternative. Are there other answers to the dilemma of night sweats. study this page and you are bound to find some.

What is HRT

Hormone replacement therapy (HRT) is a system of medical treatment for postmenopausal women, based on the assumption that it may prevent discomfort and health problems caused by diminished circulating estrogen hormones. The treatment involves a series of drugs designed to artificially boost hormone levels. The main types of hormones involved are estrogens, progesterone or progestins, and sometimes testosterone.

HRT is also used by transgendered or transsexual people to aid them in attaining the secondary sex characteristics of their desired sex. See Hormone replacement therapy (trans). It is also given to some intersex people (depending on the precise intersex condition), either starting in childhood to confirm the gender they were assigned, or later, if this gender assignment has proven to be incorrect.

HRT is available in various forms. It generally provides a low dosages of one or more estrogens, and often also provides either progesterone or a chemical analogue, called a progestin. Testosterone may also be included. In women who have had a hysterectomy an estrogen compound is usually given without any progesterone, a therapy referred to as unopposed estrogen therapy. HRT may be by tablets, creams, or ointment. Dosage is often varied cyclically, with estrogens taken daily and progesterone or progestins taken for about two weeks every month; a method called sequentially combined HRT or scHRT. An alternate method, a constant dosage with both types of hormones taken daily, is called continuous combined HRT or ccHRT. Sometimes an androgen, generally testosterone, is added to help reduce osteoporosis and to treat reduced energy and sexual desire (libido) after menopause.

HRT is seen as either a short-term relief (often one or two years, usually less than five) from menopausal symptoms (hot flashes, irregular menstruation, fat redistribution etc.) or as a longer term treatment to reduce the risk of osteopenia leading to osteoporosis.

Historically the most commonly prescribed forms of HRT has been proprietary mixtures. These combinations have been composed of equine estrogens rather than bio-identical human estrogens, and have favored the use of progestins, rather than the human form of progesterone. With the passage of time, an increasing number of studies have shown that certain risks are associated with these combinations of progestins and equine estrogens.

Apart from a few studies funded by the U.S. National Institute of Health, the overwhelming majority of research on hormone supplementation has been financed by manufacturers and has used their products combining progestins and equine estrogens. Bioidentical forms of human estrogen and progesterone have been very little studied. This distinction is important, because the adverse biological effects of xenoestrogens and progestins revealed by the studies do not necessarily generalize to supplementation with human forms of estrogen and progesterone. For example, a pilot study reported in JAMA. 2004;292:1581-1587, Vol. 292 No. 13, October 6, 2004 by Smith, Heckbert, et al. found clinical evidence that the adverse effects from oral conjugated equine estrogens were in fact not generalizable to the other estrogen compound tested in the same study. Conjugated equine estrogen, but not esterified estrogen, was associated with increased venous thrombotic risk. The study found that users of esterified estrogen had no increase in venous thrombotic risk, in sharp contrast to the users of equine estrogens.

Studies finding adverse health effects of equine estrogens and progestins have often been reported, inaccurately, as revealing effects of "estrogen" and "progesterone." It is important to keep this habitual inaccuracy in mind in reviewing press reports. The overwhelming majority of studies which have found adverse health effects were studies of equine estrogens and progestins which have nonetheless been uncritically reported in the media as studies of estrogen or progesterone.

It has become increasingly clear that oral progestin and equine estrogen pills can increases a number of risks, including the risks of exacerbation of existing liver or gallbladder problems and of dangerous blood clots. Long term use of equine estrogens probably also increases the risk of breast cancer. In women with a uterus, therapy with equine estrogen, unopposed by progesterone, may also increase the risk of uterine cancers. This combination can also effect blood triglyceride levels and so may increase the risk of cardiovascular problems. Although HRT with progestins and equine estrogens was once widely thought to promote cadiovascular health in women, on February 4, 2004, the American Heart Association released guidelines stating that it should no longer be considered as an agent to increase heart health or to decrease the chances of cardiovascular disease.

Due to the risks and potential problems of progestins and equine estrogens, a number of alternative therapies have been developed, including lifestyle changes, non-hormone drug therapy, and bioidentical hormone replacement. To reduce the risk of osteoporosis without hormones, dietary changes that increase calcium uptake, exercise, and drugs such as biphosphates, selective estrogen receptor modulators or calcitonin have been tried. As the risks of equine estrogens and progestins have become more evident, interest has intensified in the use of HRT formulated to contain the naturally occurring human estrogens estradiol and estriol, as well as bioidentical human progesterone and sometimes testosterone. This method of HRT is often called bioidentical hormone replacement therapy(BHRT)[1]. BHRT is often delivered via topical administration of a cream or gel solution of the hormones to the skin, reducing concerns about liver effects. Favorable attention to BHRT has included reports of positive personal experiences by celebrities such as Suzanne Somers, Robin Strasser, Patti LaBelle, and Valerie Harper.

What you should know about HRT

Sep 20 2005 (Reuters Health) - The use of estrogen-progestin hormonal therapy increases the risk of breast cancer among postmenopausal women regardless of racial differences, according to results of a study of more than 55,000 American women of different racial and ethnic backgrounds reported in the International Journal of Cancer September 16th.

"The most important finding in this paper," Dr. Malcolm Pike of the University of Southern California in Los Angeles told Reuters Health, "is that the increased risk of breast cancer from menopausal estrogen/progestin replacement therapy is found in all ethnic groups we studied -- African Americans, Hawaiians, Japanese Americans and Latinas (mainly Mexican-Americans) as well as in whites."

"The result in whites confirms earlier reports," he noted

Millions of women have relied on hormone replacement therapy for many years, but recent research has suggested that the benefits of the treatment -- alleviating hot flashes, mood swings and other bothersome symptoms of the menopause and preventing osteoporosis -- may be outweighed by its risks, specifically, breast cancer, heart attack and strokes.

Most previous studies that have shown a link between menopausal hormone therapy and increased breast cancer risk have been conducted in white women and few have considered prognostic factors such as weight (body mass index). The current study provides some of the first results comparing breast cancer risk among different racial and ethnic groups in relation to hormone therapy use.

Among the 55,000+ women in the study, 1615 cases of breast cancer were diagnosed over an average of 7.3 years.

Current users of estrogen-progestin therapy had a 29 percent higher risk of developing breast cancer after 5 years of treatment, while users of estrogen-only therapy had only a 10 percent increased risk.

The increase in breast cancer risk with combined estrogen-progestin therapy was seen in all five ethnic groups and the increase with estrogen-only therapy was seen in four of the five groups.

The data also hint that the risk of breast cancer for estrogen-progestin users is somewhat higher for lean women -- those with a body mass index below 25 -- compared with heavier women. The authors emphasize, however, "data on this aspect of the relationship between hormone therapy use and risk are scarce and it is too early to draw a firm conclusion."

They also note there was "still a clear increase in risk in heavier women."

Summing up, Pike noted that "menopausal estrogen-alone therapy is much safer as regards breast cancer, but can only be used for a short time without increasing a woman's risk of endometrial cancer."

"A proposed solution to this dilemma," he offered, "is to still add some progestin to the estrogen replacement therapy but to add it much less frequently than monthly or to use an intrauterine device that contains a progestin, but that effectively provides progestin only to the uterus."

SOURCE: International Journal of Cancer September 16, 2005.