HRT stands for Hormone replacement therapy supplementing women with hormones that are most lost during menopausal transition. It help to relieve symptoms with menopause.
2. Presented by: Hajira Ali
Roll no# UOC-BSZOL-F2020/018
Department of Zoology
Session: 2020-2024
Subject: Endocrinology
Instructor Name: Dr. Syeda Nadia Ahmad
4. Introduction
• Any therapeutic intervention that
involves the administration of
hormones (Hormone Therapy).
• Supplementing women with
hormones that are lost during
menopausal transition (Hormone
Replacement Therapy).
• To relieve symptoms associated
with menopause. (Caretto, &
Simoncini, 2020).
5. History
• Controversial history
• Two peaks of utilization
• First rise in 1960
• Second rise in 1999
• Data published by WHI in 2002 dramatically lowered the use of HRT
• Panic among users and doctors
• And also more physicians were not even trained regarding this realm
(Cagnacci, & Venier, 2019).
7. Estrogen Therapy
• Only estrogen
• For women with hysterectomy or saplingoophorectomy
• In the form of pills, patches, creams, gels, sprays etc.
Combination Therapy
• Estrogen and progestin
• For women who still have uterus
• In the form of pills or intrauterine devices (Wigneswaran, &
Hamoda, 2022).
8. 1
• Is HRT appropriate?
2
• What preparation and regime is required?
3
• What is the most appropriate route and dose of HRT to
start on?
4
• Is testosterone or vaginal estrogen required?
Key considerations
(Chakrabarti, & Chakrabarti, 2023).
11. Maintain muscle strength
• Estrogen deficiency accelerates loss of muscle mass.
• Also postmenopausal women experience a diminished anabolic response to
resistance exercise.
• Use of estrogen therapy enhances the increase in muscle mass. (Dam, et al 2021).
Prevent osteoporosis
• Lack of estrogen results in swift reduction of bone density.
• It safeguards against bone loss and lowers the risk of fractures across all bone sites
by 20 to 40%. (Gosset, et al 2021).
12. Relieving menopause symptoms
• HRT is effective at relieving menopause symptoms such as: hot flushes,
night sweats, insomnia, anxiety, vaginal dryness, etc. (Pinkerton, 2020)
Prevent gastric cancer
• Use of MHT lowers the risk of gastric cancer by 28%. (Deli, et al 2020).
Reduction of all-cause mortality and CVD
• In women <60 years of age, HRT significantly reduces all-cause mortality
and cardiovascular diseases. (Hodis, & Mack, 2022).
13. Increase in survival probability
• Benefiting from it enhances the likelihood of survival.
Figure. 1.2. Increase in
survival probability by
using HRT
https://www.ncbi.nlm.nih.gov/
pmc/articles/PMC9178928/
14. Headaches
Breast pain or
tenderness
Nausea Diarrhea
Feeling tired or
dizzy
Mood swings
Rashes or itchy
skin
Acne
Unexpected
vaginal bleeding
Leg cramps Hair loss
Side effects
16. Breast cancer
• Exposure to HRT drugs is linked with breast cancer.
• Women having BRCA1 and BRCA2 mutations are at higher risk.
• It depends on the time, HRT is taken. (Vinogradova, et al 2020).
Endometrial cancer
• Estrogen-only therapy elevates the risk of EC development.
• Combined regimens can lower it. (Liang, et al 2020).
17. Venous thromboembolism
• Long term use of HRT leads to hypercoagulability (leads to VTE).
• BMI also affects it. (Skeith, et al 2021).
Stroke
• Highest risk of stroke during first year of use due to instant alteration in
hemostatic equilibrium.
• Long term use can lower the risk. (Johansson, et al 2022).
19. Conclusion
• Misinterpretation of data by WHI led to widespread concern
among both women and physicians.
• Resulted in significant decline in the utilization of MHT.
• According to recent studies, benefits outweigh the risks by
HRT.
• Also HRT affects individuals in unique ways.
20. References
Hodis, H. N., & Mack, W. J. (2022). Menopausal hormone replacement therapy and reduction of all-
cause mortality and cardiovascular disease: it is about time and timing. The Cancer Journal, 28(3), 208-
223.
Cagnacci, A., & Venier, M. (2019). The controversial history of hormone replacement
therapy. Medicina, 55(9), 602.
Vigneswaran, K., & Hamoda, H. (2022). Hormone replacement therapy–Current recommendations. Best
practice & research Clinical obstetrics & gynaecology, 81, 8-21.
Pinkerton, J. V. (2020). Hormone therapy for postmenopausal women. New England Journal of
Medicine, 382(5), 446-455.
Chakrabarti, R., & Chakrabarti, R. (2023). Prescribing hormone replacement therapy: key considerations
for primary care physicians. British Journal of General Practice, 73(732), 330-332.
Caretto, M., & Simoncini, T. (2020). Hormone Replacement Therapy (HRT). Female Reproductive
Dysfunction, 1-18.
Dam, T. V., Dalgaard, L. B., Ringgaard, S., Johansen, F. T., Bisgaard Bengtsen, M., Mose, M., ... &
Hansen, M. (2021). Transdermal estrogen therapy improves gains in skeletal muscle mass after 12 weeks
of resistance training in early postmenopausal women. Frontiers in physiology, 11, 596130.
21. Gosset, A., Pouillès, J. M., & Trémollieres, F. (2021). Menopausal hormone therapy for the
management of osteoporosis. Best Practice & Research Clinical Endocrinology &
Metabolism, 35(6), 101551.
Deli, T., Orosz, M., & Jakab, A. (2020). Hormone replacement therapy in cancer survivors–review of
the literature. Pathology & Oncology Research, 26, 63-78.
Vinogradova, Y., Coupland, C., & Hippisley-Cox, J. (2020). Use of hormone replacement therapy
and risk of breast cancer: nested case-control studies using the QResearch and CPRD
databases. Bmj, 371.
Liang, Y., Jiao, H., Qu, L., & Liu, H. (2022). Association between hormone replacement therapy and
development of endometrial cancer: results from a prospective US cohort study. Frontiers in
Medicine, 8, 802959.
Skeith, L., Le Gal, G., & Rodger, M. A. (2021). Oral contraceptives and hormone replacement
therapy: How strong a risk factor for venous thromboembolism?. Thrombosis Research, 202, 134-
138.
Johansson, T., Fowler, P., Ek, W. E., Skalkidou, A., Karlsson, T., & Johansson, Å. (2022). Oral
contraceptives, hormone replacement therapy, and stroke risk. Stroke, 53(10), 3107-3115.
