Hormone Replacement Therapy(HRT) is indicated in menopausal women to overcome the short-term and long-term consequences of estrogen deficiency.HRT can be administered orally( in pill form), vaginally( as a cream), or transdermally ( in patch form) because it replaces female hormones produced by the ovaries, hormone replacement therapy minimize menopause symptoms. It can be used before, during and after menopause.

1. DEEPIKA RANA
HORMONAL REPLACEMENT
THERAPY

2. HORMONE REPLACEMENT
THERAPY
 Hormone Replacement Therapy(HRT) is
indicated in menopausal women to overcome the short-
term and long-term consequences of estrogen
deficiency.HRT can be administered orally( in pill form),
vaginally( as a cream), or transdermally ( in patch form)
because it replaces female hormones produced by the
ovaries, hormone replacement therapy minimize
menopause symptoms. It can be used before, during and
after menopause.

3. INDICATION OF HRT
1. Relief of menopausal symptoms
2. Prevention of osteoporosis
3. To maintain the quality of life in menopausal years.
special group of women to whom HRT should be
prescribed.
 Premature ovarian failure
 Surgical or radiation menopause

4. TYPES OF HRT
 Estrogen and progesterone :The most common type of
HRT involves both estrogen and progesterone . More than
8 million women are currently taking combination HRT
and it is designed specifically for women who have a
uterus . During this therapy, estrogen is given regularly
while progesterone is added in on a supplementary basis
These two hormones are given in combination in order to
prevent the overgrowth of uterine lining . Estrogen alone
may irritate this lining which could lead to endometrial
cancer.

5.  Estrogen only : Estrogen therapy alone is usually given to
women who have lost their uterus due to surgical
menopause . Because no uterus is present , the need for
progesterone is not as great.
 Progestin only: Progestin-only therapy is not prescribed
very often. Progestin does seem to provide excellent relief
for women plagued with hot flashes.

6. AVAILABLE PREPARATIONS FOR
HRT
 The principle hormone used in HRT is estrogen . This is
ideal for a women who had her uterus removed already.
But, a women with intact uterus , only estrogen therapy
leads to endometrial hyperplasia and even endometrial
carcinoma. Addition of progestin for last 12-14 days each
month can prevent this problem.

7.  Commonly used estrogen are conjugated estrogen (0.625-
1.25 mg/day). Progestin used are medroxyprogesterone
(100-300 mg/day).Considering the risks, hormonal
therapy should be used with the lowest effective dose and
for a short period of time. Low dose of oral conjugated
estrogen 0.3 mg daily is effective and has got minimal side
effects.

8.  Oral estrogen regime
estrogen –conjugated equine estrogen 0.3 mg or 0.625 mg
is given daily for woman who had hysterectomy.
 estrogen and cyclic progestin
For a women with uterus estrogen is given continuously
for 25 days and progestin is added for last 12 -14 days.
 Continuous estrogen and progestin therapy
Continued combined therapy can prevent endometrial
hyperplasia.

9.  Sub dermal implants
Implants are inserted subcutaneously over the anterior
abdominal wall using local anaesthesia.17β oestradiol
implants 25 mg , 50 mg or 100 mg are available and can
be kept for 6 month.
 Percutaneous estrogen gel
1 gm applicator of gel delivering 1 mg of oestradiol daily
is to be applied onto the skin over the anterior abdominal
wall or thigh..Effective blood level of oestradiol (90-120
g/ml) can be maintained.

10.  Transdermal patch
It contains 3.2 mg of 17β oestradiol releasing about 50µg
of oestradiol in 24 hrs.It should be applied below the waist
line and changed twice a week.
 Vaginal cream
Conjugated equine vaginal estrogen cream 1.25 mg daily
is very effective specially when associated with atrophic
vaginitis . Women with symptoms of urogenital atrophy
and urinary symptoms and do not like to have systemic
HRT, are suitable for such treatment.

11.  Progestin
Patient with history of breast carcinoma or endometrial
carcinoma , progestin may be used It may be effective in
suppressing hot flushes and it prevent osteoporosis.
Medroxy progesterone acetate 2.5 -5 mg/day can be used.

12.  Tibolone
Tibolone is a steroid having weakly oestrogenic ,
progestogenic and androgenic properties. It prevents
osteoporosis , atrophic changes of vagina and hot flashes.
It increases libido. A dose of 2.5 mg per day is given.

13. DURATION OF HRT
 Generally, use of HRT for a short period of 3-5 years have
been advised. Reduction of dosage should be done as soon
as possible.

14. RISKS OF HRT
1. Endometrial cancer: when estrogen is given alone to a
women with intact uterus , causes endometrial
proliferation , hyperplasia and carcinoma.
2. Breast cancer: combined estrogen and progestin
replacement therapy , increases the risk of breast cancer
slightly .
3. Venous thromboembolic disease (VTE): It has been
found to be increased with the use of combined oral
estrogen and progestin.

15. 4. Lipid metabolism: An increased incidence of gallbladder
disease has been observed following ERT due to rise in
cholesterol (in bile).
5. Dementia, Alzheimer disease are increased.

16. DISADVANTAGES OF HRT
 Estrogen and progesterone over a long periods is known
to stimulate cell division, and this seem to increase the risk
for breast cancer by upto 9% . HRT also appears to
increase your risk of heart disease by 24% . Women taking
HRT to reduce the risk of Alzheimer’s disease actually
increased their risk by small percentage In order to
prevent increasing your risk of certain disease , it is
suggested that you use HRT for not more than 5 years.