Who needs a Hormonal Replacement Therapy (HRT)?

Why is HRT required after hysterectomy?

Only after a total hysterectomy with a bilateral salpingo-oopherectomy i.e. the uterus and both the ovaries and tubes are removed a woman may need HRT .This condition is called as surgical menopause.

This is because she does not have any ovaries as they have been removed during the hysterectomy and so requires replacement /supplement of the female sex hormones (i.e. estrogen and progesterone ) which the ovaries produce usually.

What is hormonal replacement therapy (HRT) ?

HRT is a treatment that can relieve the symptoms many women have during menopause. Regular doses of FEMALE SEX HORMONES are taken to replace some of the natural hormones that decrease at menopause. The 2 main female hormones are estrogen and progesterone.

Menopause is the time when menstruation stops permanently. It is often a gradual process. Menstrual periods become irregular and then end completely. After menopause, your ovaries no longer produce eggs. Your body also produces less of the female hormones.

Menopause is part of a natural aging process and not a disease. For many women menopause is an easy change. Some women have problems caused by the decrease in hormones, particularly by the lack of estrogen. These problems may be helped by treatment that replaces some of the lost hormone.

If your uterus has been removed, you may take estrogen alone. If you still have your uterus, taking estrogen alone increases your risk of cancer of the uterus. Your provider will recommend taking progesterone with estrogen to reduce this risk.

The hormones can be taken as tablets. They are also available in skin patches, creams, vaginal suppositories, vaginal rings, shots, or pellets placed under the skin.

When can HRT be used?

Hormone therapy may be used before, during, or after menopause.

There are 2 kinds of menopause:

• Physiologic menopause is menopause that occurs naturally for most women between ages 45 and 55; the average age when periods stop completely is 51.
  
• Surgical menopause refers to when your menstrual periods stop because the ovaries have been removed by surgery. i.e. hysterectomy.

Symptoms of menopause may occur for a few weeks, for a few months, or sometimes over several years. HRT is useful to relieve the following symptoms:

• hot flashes
  
• night sweats
  
• trouble sleeping
  
• vaginal dryness, which can cause discomfort or pain during sexual intercourse.

Hormone therapy may be prescribed if you are at significant risk for osteoporosis.

Sometimes hormone therapy is recommended for women who go through menopause early (before the age of 40). Symptoms caused by a sudden lack of hormones may be severe after an early menopause resulting from removal of the ovaries or the uterus and the ovaries.

You and your doctor should discuss the risks and benefits of hormone therapy for you. Factors such as your age, race, family history, and health history must be considered.

What are the benefits of HRT ?

• Relief of menopausal symptoms, such as hot flashes and vaginal dryness
  
• Prevention and treatment of osteoporosis
  
  Osteoporosis is a skeletal disorder that reduces the density of bone. This makes it easier for your bones to break. Bone loss begins around age 35. You start losing bone more rapidly at menopause.
  
  Hormone therapy can slow down bone loss if it is begun soon after menopause.
  
  Calcium supplements with vitamin D can also help to reduce bone loss, especially when taken with estrogen or other medicines.
  
  
• Colon cancer Hormone therapy may lower your risk of colon cancer.

What are the risks of HRT?

The risks of HRT include:

• Uterine cancer
  
  Exposure of the uterus to estrogens without progesterone increases the risk of cancer of the uterus. To lessen this risk, estrogens is prescribed combined with progesterone if you have not had your uterus removed.
  
  
• Breast cancer
  
  Women taking estrogens combined with progesterone showed an slight increase in the risk of breast cancer. Talk to your doctor about this possible risk. Many doctors recommend that women be checked thoroughly for any tumours and have a mammogram before beginning hormone therapy. If you have a family history of breast cancer, it is especially important to discuss this with your doctor.
  
  
• Cardiovascular disease, strokes, and blood clots in the legs and lungs
  
  Women taking a combination of estrogens and progesterone showed an increased risk of heart attack, strokes, and blood clots.

The risks of all forms of HRT are continuing to be studied. The risks described above for breast cancer and cardiovascular disease may be different for hormone therapy that involves lower doses of estrogen and progesterone or progesterone only. Be sure that you discuss the risks and benefits of hormone therapy with your doctor.

What are the side effects of HRT?

The side effects of hormone therapy may include:

• uterine bleeding and vaginal discharge if your uterus has not been removed
  
• vaginal discharge
  
• bloating, fluid retention, and weight gain
  
• breast tenderness and enlargement
  
• nausea
  
• symptoms like those of premenstrual tension (PMS), such as headaches and mood swings
  
• abnormal blood clotting.

If your therapy includes both estrogen and progesterone, you will usually have some vaginal bleeding when you stop hormone therapy or if there are days in the cycle when you are not taking hormones. Not a menstrual period, the bleeding typically lasts 2 or 3 days. Usually you will not have any cramps or bloating with the bleeding.

If you take both estrogen and progesterone in low doses every day, the hormones will not cause vaginal bleeding except perhaps some spotting of blood for the first 2 to 3 months.

Who should not take HRT?

Hormone therapy is not recommended for women who have any of these conditions, diseases, or medical history:

• recent history of a heart attack
  
• uncontrolled high blood pressure
  
• history of stroke
  
• recent blood clots or a history of blood clots
  
• cancer of the breast or uterus
  
• unexplained vaginal bleeding
  
• liver disease
  
• a history of porphyria (a metabolic disorder that causes severe abdominal pain).

You should not take hormones if you are or suspect you may be pregnant.

Smokers should avoid hormone therapy. Smoking may increase your risk of heart attack or stroke while you are taking hormones. The risk increases with age and the number of cigarettes smoked a day.

If you have any of the following diseases or conditions, you should discuss with your doctor effect of hormone therapy on these conditions:

• Uterine fibroids (These benign tumours may grow in response to estrogens. They begin to shrink at menopause unless a woman takes estrogens. Taking progesterone with estrogens does not prevent the growth of uterine fibroids.)
  
• endometriosis
  
• fibrocystic breast disease
  
• migraine headaches
  
• gallbladder disease.