What is Hormone Replacement Therapy (HRT)?
A woman’s oestrogen (or estrogen) and progesterone levels rise and fall with her menstrual cycle (peaking before and after ovulation, respectively) and levels of both hormones increase markedly during pregnancy.
- hot flashes (or flushes),
- night sweats,
- emotional lability and/or irritability,
- poor concentration,
- sleep disturbances,
- vaginal dryness,
- urinary incontinence,
- dizziness, and
Women who experience an early menopause (younger than about 45 years of age) may have increased risks of mortality and certain diseases compared with those who experience it at an older age.
Menopausal and post-menopausal women may be prescribed oestrogens (with or without progesterone) to boost their hormone levels and relieve symptoms. Such hormone replacement therapy (or HRT) also prevents osteoporosis and is thought to decrease the disease risks associated with early menopause.
Types of HRT
There are many forms of HRT, differing in the source of the hormones used (synthetic, natural, or conjugated equine), in whether or not a progestin is included, and in how the hormones are delivered – orally, injected, across the skin, absorbed from the mouth, or transvaginally.
This array of therapies complicate how one interprets the available studies on the benefits and risks of HRT. It is difficult, for example, to extrapolate regarding the safety of physiological human hormone supplementation when the majority of large studies have used synthetic or conjugated equine oestrogens and/or synthetic progestins (e.g., levonorgestrel or medroxyprogesterone acetate). The route of administration may also influence the risks of HRT, as dose forms that transfer oestrogens across the skin, mouth or vagina avoid oestrogenic overload effects on the liver (which may, for example, lead to an increased risk of abnormal blood clots).
The consensus medical opinion is that when delivered appropriately, HRT’s benefits exceed its risks.
Recently there has been interest in so-called “bioidentical” HRT, using only the chemical forms of hormones normally found in the human body, as these forms should have fewer undesirable side effects compared with synthetic or conjugated forms.
Another recent development in HRT is in custom-made bioidentical HRT: the supplementation of the range of biological oestrogens and progesterone as needed, with continual blood level monitoring supervised by a doctor, to maintain a woman’s measured hormone levels within the “normal” (or pre-menopausal) range. Some custom HRT combinations for women may also include the combination of an androgen (e.g., DHEA or testosterone), which may help with mood or libido.
Bioidentical HRT is delivered better and is more tolerable than many commercially-available HRT preparations. However it is important to maintain supply from a single supplier, since variations in product formulation between manufacturers or compounding practices may influence the dose of hormone received by the body.
Custom-made bioidentical HRT products
Custom-made bioidentical HRT usually consists of one or more normal physiological human hormones in a combination to suit your body, including:
- Oestrogens (oestradiol, oestriol, oestrone), often prescribed as Bi-est or Tri-est
- Dihydroepiandrosterone (DHEA) and 7-keto DHEA
These hormones may be taken or applied in a range of of dose forms including capsules, troches, creams, gels and pessaries. Creams and gels may be dispensed in metered applicators to ensure accurate dosing.
Everyone’s hormones are unique. By working closely with your doctor, your HRT can be as optimised and individualised as it should be.
Please contact us for further information.