I don't know anything about Hormone Replacement Therapy before I take this topic. As I know something, I like to share my idea in the way of powerpoint to all us.

1. By:
S. Arunkumar,
IInd Pharm D,
JKKN College of Pharmacy,
Kumarpalayam.
Hormone Replacement Therapy:

4. What is the Hormone?
A Hormone is a class of signaling molecules produced by
glands in multicellular organisms that are transported by
the circulatory system to target distant organs to regulate
physiology and behavior.

11. Hormone Replacement Therapy:
Definition:
Hormone replacement therapy (HRT), also known as menopausal
hormone therapy (MHT) or postmenopausal hormone
therapy (PHT, PMHT), is a form of hormone therapy mostly used to
treat symptoms associated with female menospause.
Types:
Based on the different combinations and delivery of the
hormones, they are classified as
(i) Estrogen-only HRT:
Women who have had a hysterectomy where their uterus, or
womb, and ovaries have been removed do not need progesterone.

12. (ii) Cyclical, or sequential HRT:
Women who are still menstruating but have perimenopausal-like
symptoms can use this. Cycles may be monthly, with an estrogen
plus progestogen dose at the end of the menstrual cycle for 14 days,
or a daily dose of estrogen and progestogen for 14 days every 13
weeks.
(iii) Continuous HRT:
This is used during postmenopause. The patient takes a
continuous combination of estrogen and progestogen.
(iv) Long-cycle HRT:
This causes withdrawal bleeds every 3 months. Its safety has
been described as "questionable.“

13. (v) Local estrogen:
This includes vaginal tablets, creams, or rings. It can help with
urogenital problems, including dry vagina and irritations.
Most of the dosage form of HRT :
(i) Creams or gels
(ii) Vaginal rings
(iii) Tablets
(iv) Skin patches.
Benefits of HRT:
(i) Hormone replacement therapy is used to help balance
estrogen and progesterone in women around the time of menopause.
(ii) It can also reduce the risk of Oestoporosis.
(iii) Hormone replacement treatments are also used in male
hormonal therapy and treatment for individuals who undergo a sex

14. (iv) Past studies have suggested a link with Cancer, but this is still being
investigated.
(v) It may help keep skin young, but it cannot reverse or delay the overall
effects of aging.
(vi) Decreased incidence of colon cancer
(vii) Possible decreased incidence of Alzheimer’s disease
(viii) Possible improvement of glucose levels
Recent studies of HRT:
(i) A Report published in The BMJ in 2012 Concluded that HRT may or may
not increase the risk of breast cancer. “Recent studies have suggested that it may:
(ii) Improve muscle function
(iii) Reduce the risk of Heart Failure and Heart attack.

15. (iv) Lower Mortality in younger, postmenopausal women
(v) Be “ Quite Effective” in preventing skin aging.
(vi) Decreased risk of colorectal cancer by 37%.
(vii) Decreased age related tooth loss.
(viii) Decreased age related macular degeneration.
(ix) Delay of onset and progression of Alzheimer’s disease when
started early.
Indication:
(i) Premature ovarian failure.
(ii) Gonadal dysgenesis.
(iii) Surgical or radiation menopause.

17. benefit ratio is favorable, in fully informed women.
(v) For women with early menopause until the age of natural menopause
(around 51 years).
(vi) Active or past breast cancer gall bladder disease
(vii) Fibrocystic breast disease
(viii) Active liver disease
(ix) Endometrial cancer.
Effects of menopause:
(i) Vaginal dryness
(ii) Bone thinning,
(iii) Urinary problems

18. (iv) Thinning hair
(v) Sleep problems
(vi) Hot flashes and night sweats
(vii) Moodiness
(viii) Lower fertility
(ix) Irregular Periods
(x) Concentration and memory difficulties.
(xi) Smaller breasts and an accumulation of fat in the abdomen.
Contraindication:
(i) Hypertension Or High Blood Pressure.
(ii) Severe Migraines.
(iii) Thrombosis or blood clots

19. (iv) Stroke
(v) Heart Disease
(vi) Endometrial, ovarian or breast cancer.
Non – Pharmacological Symptoms:
A woman who is experiencing perimenopause can use alternative ways to
relieve symptoms.
(i) Reducing consumption of caffeine, alcohol, and spicy food
(ii) Not smoking
(iii) Exercising regularly
(iv) Wearing loose clothing
(v) Sleeping in a well ventilated, cool room
(vi) Adding a fan to the bedroom or cooling gel pad or pillows

21. What is the major cause to
administrated the Hormone
Replacement therapy?
Since estrogen deficiency is a major cause of the
long-term complications of the menopause,
estrogen replacement is the rational treatment to
address the cause of the problems after
menopause .But as there are limitations of
estrogen therapy as HRT, some other drugs are
also used besides estrogen

23. Estrogens:
Oral: -
Conjugated equine estrogen (CEE):
0.625 mg (Estrone Sulphate + equilin sulphate +17 d dihydro equilin)
Example:
(i) Estradiol valerate (1, 2, 4 mg).
(ii) Estrial succinate (1, 2 mg).
Transdermal : -
Estradiol Patches: 25 micro gm, 50 micro gm / 24 hour twice weekly.
Gel : 75 micro gm / 24 hours daily.
Sub cutaneous implant (estradiol): - 25 / 50 / 100 mg. - 6 monthly.
Vaginal: cream: Estrogens D

24. Progestins:
Oral route –.
Norgestrol: 150 mg /day.
Micronised progesterone: 200 mg /day.
Dydrogesterone: 20 mg / day.
Medroxy progesterone acetate: 10mg/day.
Norethisterone acetate : 0.7 – 2.5 mg/ day.
Hormone releasing intra uterine system –.
Levonorgestrel: 20 mcg / day.
Progestasert: 65mcg / day.
Vaginal:
Natural progesterone gel / pessary.
Transdermal :-
sequential / continuous patch

25. Tibolone :-
MOA:
Synthetic steroid, tissue specific HRT.2 hydroxy metabolites are
estrogenic D 4 isomer binds to progesterone & androgen receptors
Addition of progesterone not required .
Example:
Tibella - PO Adults - 2.5mg oral.
Androgen:-
Oral Tablets
Example:
Anadrol 50 (Pro) – PO Adult – 50mg – BD.
• Implants - Pellets of 100 mg testosterone.

26. Regimens :
Estrogen alone: in post hysterectomy cases
E + P :-
Cyclic sequential:
E on day 1-25; P on day 14 –25 (for climacteric patients with intact uterus )
Continuous sequential:
E daily; P for 12 days at 16 days interval (for post menopausal patients with
intact uterus) .
Continuous combined:
E + P taken daily
Progesterone alone:
Cyclic / continuous
Estrogen + Progesterone + Androgen

34. Reference:
1. https://www.slideshare.net/rajud521/harmone-replacement-therapy.
2. https://www.slideshare.net/obgymgmcri/hrt-60841680.
3. PEER GROUP DISCUSSION ON HORMONAL REPLACEMENT
THERAPY PRESENTED BY MS. SANTOSH KUMARI –
Slideshare.
4. https://www.slideshare.net/arshadchemist1/hormones-43307402.
5. https://slideplayer.com/slide/13515640/.
6. https://en.wikipedia.org/wiki/Hormone_replacement_therapy.
7. https://my.clevelandclinic.org/health/articles/16979-estrogen--
hormones
8. Used database Drugs.com, Micromedix.
9. Textbook of Pharmacotherapy: A Pathophysiologic Approach, 9
edition
Joseph T. Dipiro, Robert L. Talbert.
10. Textbook of Pharmacological approach of Therapeutics, Goodman
& Gilman's -12th edition.