Hormone replacement therapy (menopause)
Hormone replacement therapy (HRT) is a system of medical treatment for surgically menopausal, perimenopausal and postmenopausal women.
It is based on the idea that the treatment may prevent discomfort caused by diminished circulating estrogen and progesterone in menopausal symptoms.
It involves the use of one or more of a group of medications designed to artificially boost hormone levels.
The main types of hormones involved are estrogens, progesterone or progestins, and testosterone.
Attitudes towards HRT changed in 2002 following the announcement by the Women’s Health Initiative of the National Institutes of Health that those receiving the treatment (Prempro) in the main part of their study had a slightly larger incidence of breast cancer, heart attacks and strokes, and though they also had reduced incidence of colorectal cancer and bone fractures, the benefits did not outweigh the risks.
The WHI findings were reconfirmed in a larger national study done in the UK, known as The Million Women Study. As a result of these findings, the number of women taking hormone treatment dropped precipitously.
As a result of these findings, the Women’s Health Initiative recommended that women with normal rather than surgical menopause should take the lowest feasible dose of HRT for the shortest possible time to minimize these risks.
Hormone replacement therapy’s goal is to resolve discomfort caused by decreasing circulating estrogen and progesterone hormones in menopause. ]The main hormones involved are estrogen, progestertone and progestin. Some recent therapies include the use of testosterone as well
Data from numerous studies have consistently found that HRT leads to improvements in several aspects of menopausal symptomology, including aspects of sexual dysfunction.[ Sexuality is a critical aspect of quality of life for the large majority of menopausal women; therefore, any features of the menopausal transition that can negatively affect a woman’s sexuality have the ability to significantly alter her quality of life. The most prevalent of female sexual dysfunctions liked to menopause include lack of desire and low libido, both of which can be explained by changes in hormonal physiology.[
Improvements in sexual pain, vaginal lubrication and orgasm are found to be statistically significant in women using HRT. Estrogens have positive effects on mood, sexual function, bladder function, and mental acuity.
It has also been shown to prevent amyloid plaque formation, oxiadative stress, or deterioration of the cholinergic neurotransmitter system, all of which contribute to the etiology of Alzheimer’s Disease
There are many options of HRTs for women. These can include the use of estrogens alone (ERT), a combination of estrogens with one of several progestins as HRT, or the combination of estrogens, progestins, and testosterone as HRT.
At GyneMedic our doctors work on finding the right combination and formulation of HRT for each individual patient.
- Oral Estrogen and progesterone combination
- Topical estrogen and progesterone
- Bioidentical estrogen and progesterone
- Testosterone pellets for sexual health
- Testosterone creams for sexual health
HRT and sexuality
Menopause is the permanent cessation of menstruation resulting from loss of ovarian follicular activity. Menopause can be divided into early and late transition periods, also known as perimenopause and postmenopause.
Each stage is marked by changes in hormonal patterns, which can induce menopausal symptoms. It is possible to induce menopause prematurely by surgically removing the ovary or ovaries (oophorectomy).
Some of the side effects of the menopausal transition are lack of sexual desire or libido, lack of sexual arousal, and vaginal dryness.
A recent study of sexual activities among women aged 40-69 revealed that 75% of women are sexually active at this age; this indicates that the sexual health and satisfaction of menopausal women are an aspect of sexual health and quality of life that is worthy of attention by health care professionals.
At GyneMedic, our providers listen to you and try to find the best method of replacement for our patients.
Both HRT and estrogen replacement therapy (ERT) have been shown to enhance sexual desire in a significant percent of women
Estrogen restores vaginal cells, pH levels, and blood flow to the vagina, all of which are associated with the onset of menopause. Estrogen replacement helps with vaginal pain with intercourse (due to vaginal dryness).
Estrogen has also shown to have positive effects on the urinary tract and bladder function atrophy. Other improvements in areas such as sexual desire, arousal, fantasies, and frequency of coitus and orgasm have also been noted.
Testosterone, a hormone more commonly associated with males, is also present in women it is the hormone of sex drive. It peaks at age 30, but declines with age.
A number of studies have found that the combined effects of estrogen/testosterone replacement therapy can increase a woman’s motivational aspects of sexual behavior over and above what can be
Bio-Identical Hormone Pellets
Testosterone: Testosterone time-released pellets are bio-identical hormones. They have been used by many women to increase energy levels, increase sex drive, elevate mood, and strengthen bones. They can also help relieve menopausal symptoms. Side-effects can include acne, oily skin, facial hair growth, irritability, headache, nausea, and irreversible male pattern baldness and deepening of the voice. Testosterone can also cause birth defects and should not be used in women who are pregnant or could become pregnant.
Estrogen: Estrogen time-released pellets are bio-identical hormones. They have been used by many women to relieve menopausal symptoms, including, hot flashes, night sweats, and vaginal dryness. They can also help strengthen bones. Side-effects can include breast tenderness, bloating, and headache. If a woman has a uterus, she will need to use progesterone to protect the uterine lining from overstimulation.
Pellets should not be used in patients with a personal history of breast cancer or blood clots.
Pellets are inserted under the skin using a local anesthetic. The incision is very small and needs only a steri-strip to help with closure. Irritation is common at the incision site. Rarely, the pellet insertion site may become infected. The effects of pellets usually last for 2-3 months, but can last up to 6 months.
• Undiagnosed vaginal bleeding
• Severe liver disease
• Coronary artery disease (CAD)
• Venous thrombosis
• Well-differentiated and early endometrial cancer (once treatment for the malignancy is complete, is no longer an absolute contraindication.) Progestins alone may relieve symptoms if the patient is unable to tolerate estrogens.
• Personal history of breast cancer
• Personal history of uterine cancer
• Atypical ductal hyperplasia of the breast
• Active gallbladder disease
• Heart disease
For more information call our office for a consultation with a provider.