Hormone replacement therapy (HRT) is used in menopausal women to alleviate symptoms of estrogen deficiency and may be administered in various forms, including pills, creams, and patches. Types of HRT include estrogen-only, progestin-only, and combinations aiming to prevent osteoporosis and maintain quality of life, but it carries risks such as endometrial cancer and venous thromboembolism. Nurses play a crucial role in monitoring patients for these risks and assessing their medical history prior to starting HRT.

1. HORMONE REPLACEMENT
THERAPY
Presented by:-
KHUSHBOO SINGH

2. INTRODUCTION

3. DEFINITION
• 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.

5. INDICATION
• 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
Gonadal dysgenesis
Surgical or radiation menopause

6. TYPES OF HRT

7. CONT……
• 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.

8. AVAILABLE PREPARATIONS FOR HRT
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.

9. • 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

11. CONT…..
• 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
pg/ml) can be maintained.

12. CONT…
• 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.

13. LUTEAL PHASE/
SECRETORY PHASE
• During ovulation, the egg bursts from its follicle, but
the ruptured follicle stays on the surface of the ovary.
• For the next two weeks or so, the follicle transforms
into a structure known as the corpus luteum.
• This structure starts releasing progesterone, along with
small amounts of oestrogen.
• The cells of the corpus luteum produce estrogen and
large amounts of progesterone. Progesterone
stimulates your uterine lining to prepare for a fertilized
egg.

14. CONT…..
• 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.
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.

15. DURATION OF HRT
• Generally, the use of HRT for a short period of
3-5 years have been devised. Reduction of
dosage should bed done as soon as possible.

16. RISK 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.
• 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.

17. NURSES ROLE IN HRT
Prior to administration:
• Obtain a complete history including personal or familial history of breast
cancer, gallbladder disease, diabetes mellitus, liver or kidney disease.
• Obtain a drug history to determine possible drug interactions and allergies.
• Assess cardiovascular status including hypertension, history of MI,
cerebrovascular accident, or thromboembolic disease.
During HRT:
Monitor for thromboembolic disease. (Estrogen increase risk for
thromboembolism). Monitor for abnormal uterine bleeding. (If undiagnosed
tumor is present, these drugs can increase its size and cause uterine bleeding.
Monitor breast health. ( Estrogen promote the growth of certain breast cancer).
Monitor for vision changes. ( These drugs may worsen myopia or astigmatism and
cause intolerance of contact lenses).
Encourage client not to smoke. ( Smoking increases risk of cardiovascular disease)
Encourage client to avoid caffeine. ( Estrogens and caffeine may lead to increased
CNS stimulation).