Hormone Replacement Therapy (HRT)
HRT is medication that contains hormones taken to replace the estrogen that your ovaries stop producing during menopause. HRT is most often used to treat common menopausal symptoms, including hot flashes, night sweats, mood swings, sleep issues, joint pain, fatigue, reduced libido, vaginal dryness. HRT has also been proved to prevent bone loss and reduce fractures in postmenopausal women.
The 3 common hormones that our clinic uses and prescribes include: Estrogen, Progesterone and Testosterone.
Estradiol
There are two main types of estrogen therapy:
1.) Systemic hormone therapy - options include oral pill, skin patch, cream, gel, implantable pellets. Typically contains a higher dose of estrogen that is absorbed throughout the body to treat common menopausal symptoms.
2.) Low dose vaginal products - options include vaginal cream, tablet/suppository, ring. Typically, a lower dose of estrogen is absorbed by the body. These medications are usually used only to treat vaginal dryness, dyspareunia due to dryness, and urinary symptoms since it also has positive effects on the bladder.
Patients can use both systemic hormone therapy and low dose vaginal products together.
Estradiol is usually covered by most patient insurances in pill and patch forms. Creams and implantable pellets are not covered by insurance.
Progesterone
Patients that still have a uterus will also be prescribed progesterone to take along with estradiol. Estradiol use in the absence of progesterone can stimulate growth of the lining of the uterus and can increase the risk of a person developing endometrial cancer. These patients MUST take progesterone if on estrogen therapy.
Patients that have had a hysterectomy can take estrogen without progesterone.
Progesterone comes in oral pill, cream, troche or IUD forms.
Progesterone is usually covered by insurance in pill and IUD forms. Creams and troches are not usually covered by insurance.
Testosterone
Testosterone use in women is considered investigational by the FDA. However, Testosterone is often used with women to treat decreased libido (decreased sex drive), fatigue, improve muscle tone and bone density, along with overall wellbeing and increase energy.
Testosterone comes in 3 different forms: cream, injections, and implantable pellets. Side effects of testosterone include hair growth on face/body, acne, more aggressive behavior, hair loss on head. We closely follow patients’ labs during treatment to minimize adverse side effects.
Any form of testosterone is not usually covered by insurance for women.
Implantable Pellets
Implantable pellets are placed in the office by a provider. We use lidocaine to numb up the area, make a small incision and place the pellet/s under the skin and then place steri-strips over the incision. Patients can expect some soreness and bruising to the area. Patients should not submerge area in water or do strenuous exercises and activities for 4-5 days after pellets are placed. Patients should contact the office if they notice any redness, warmth, drainage from the incision site or fever.
Cost of pellets and insertion are noncovered. Patients will usually have labs drawn every 10 weeks and an insertion every 12 weeks. The provider will determine the dosage of pellets depending on patient’s symptoms, if they are having any side effects and lab levels.
Risks of HRT use includes abnormal bleeding, strokes, blood clots, and cancer. It is important to give your provider a good family history or personal history of any of these conditions. Also notify your provider if any of these conditions occur while you are on HRT.
How you can reduce your risks:
Find the best product and delivery method for you. Minimize the amount of medication you take. Take the lowest effective dose for the shortest amount of time needed to treat your symptoms. Seek regular follow up care. See your provider regularly to ensure that the benefits of HRT continue to outweigh the risks, and for screenings such as mammograms and pelvic exams. Make healthy lifestyle choices. Include physical activity and exercise in your daily routine, eat a healthy diet, maintain a healthy weight, don’t smoke, limit alcohol, manage stress and manage chronic health problems, such as high cholesterol, hypertension, and diabetes.
Options for patients who cannot take HRT
You may be able to manage menopausal symptoms with healthy lifestyle approaches such as keeping cool, limiting caffeinated beverages and alcohol, and practicing paced relaxed breathing or other relaxing techniques. There are also several nonhormonal prescription medications that may help relieve menopausal symptoms such as Veozah and Effexor.
The bottom line: HRT isn’t all good or all bad
Talk to your provider about your individual symptoms and health risks to determine if HRT is a good treatment option for you. Be sure to keep the conversation going throughout your menopausal years.