Hormone Replacement Therapy (HRT) is a treatment that aims to relieve the effects that a woman could feel as a result of changes in hormone levels. These are most often the symptoms that are triggered by her progression through and after menopause has taken full hold.
Estrogen’s Role: From Womb to Woman
Estrogen is the primary female hormone, which promotes the characteristics of a fetus toward femininity from the earliest days in her mother’s womb. As a child matures and reaches puberty (the stage of sexual maturation), the levels of estrogen are boosted considerably thanks to the increased output of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which are produced in the pituitary gland.
In most cases, for the next 30 years, a woman will go through a monthly cycle during which the interaction of estrogen, progesterone, LH, and FSH will stimulate the release of an egg from the ovaries and pass it down the fallopian tubes to be fertilized. In the case that the egg is not fertilized and implanted in the womb, it will result in the shedding of the lining of the uterus (endometrium), leading to bleeding and the start of a new monthly cycle.
Where does menopause come from?
In both women and men, hormone levels usually undergo substantial changes in hormone levels as their body ages, starting in the mid-40s, but with a wide range of anything from the late thirties to the mid-fifties. There are significant differences between women and men in the degree and speed with which the change in levels occurs, making the impact of “the passage of time” much more significant on women than on men.
A woman entering into the phase called perimenopause or already experiencing full-blown menopause can relate to the concept that the lowering of hormone levels represents a significant change in her life because the changes are noticeable within the space of just a few years.
Variations in hormone levels are one of the main changes that lead to perimenopause. Fluctuations in estrogen levels can cause quite dramatic variations in the ovulation cycle and quite irregular menstruation. Progesterone levels, the other hormone that contributes to the monthly cycle, can be impacted even more emphatically.
Is menopause a disease?
Menopause is not a disease. It is a natural condition brought on by the changes in hormone levels accompanying aging. Most women experience some degree of change in their body’s hormone levels and feel discomfort or even pain as a result of a fall-off in estrogen. There’s no way of predicting the degree of change that a woman will experience or whether or not the symptoms that are experienced will be transient or persist for the rest of her life.
What is important is that as the life expectancy of women in first-world countries has advanced considerably over the past 50 years, so has the duration of menopause. In the 1970s, a woman would have had a life expectancy of around 74 years; currently, it’s closer to 84. The difference of 10 extra years of life produces more time living in menopause, representing an increase of nearly 50%.
Looking at menopause as if it is a disease creates the wrong approach. It is already a part of normal life for women and can only become more and more prevalent in the rest of the world as those societies catch up with the West.
Making life with menopause more livable after the changes in hormone levels
Since the underlying cause of menopause is a radical change in the levels of the hormones that are the bedrock of the feminine gender, it’s quite logical to look for ways to replace the hormones and get the balance back all through the years of menopause. And that’s why the most popular approach is menopausal hormone therapy – better known as Hormone Replacement Therapy – HRT.
Hormone Replacement Therapy is not a cure for menopause since this is a natural outcome of the aging of the body. HRT sets out to address the results of changes in hormone levels and so to relieve the physical, emotional, and psychological disturbances that come from this.
HRT is used to restore the body’s hormone levels so that the disturbances that come from reduced estrogen levels can be overcome. Estrogen and progesterone levels have decreased significantly once menopause sets in, and HRT can help return these levels to normal. Treatments have evolved over the years and generally have become more effective. There is a need to combine estrogen with progestin in all forms of HRT to offset the risk of endometrial cancer that comes from estrogen only.
Changes in hormone levels be administered via several different methods that have been developed to address the needs of women in menopause specifically. They include injections and oral medications. Other medications come as skin patches, topical creams and gels, and vaginal suppositories. Their special advantage is the delivery of controllable and lower overall dosages. This means that they don’t produce unnecessarily high levels of estrogen that will be transported through the bloodstream. It produces another important benefit since the far lower levels of estrogen do not increase the risk of breast cancer, blood clots, and heart disease, which are carried by stronger forms of HRT.
The most common forms of HRT that address changes in hormone levels are listed in the table below.
| Medication type | Feature | IsraelPharm Products |
| Oral with estrogen derivatives (estradiol) | Contain conjugated estrogens. will alleviate hot flashes and supplement the levels of estrogen to prevent osteoporosis. | Premarin, Progyluton, Estrace, Activella, Prempro, Minesse, Prometrium, Eviana, |
| Vaginal Cream | Vaginal cream is generally considered safer than oral, injected, or topical skin medications that carry a greater risk of side effects due to excess estrogen being absorbed. | Premarin Vaginal Cream, Ovestin, Vagifem |
| Skin Patch or Cream | Patches can be applied easily with fewer side effects | Estradot, Estrogel Topical Gel, |
| Internal rings | “Set and forget” for up to 3 months in the uterus | Estring, Jaydess, |
Frequently asked questions
Why is Hormone Replacement Therapy prescribed?
Hormone replacement therapy is intended to boost the depleted levels of estrogen back to normal. As a natural process of aging, there are body changes that start to reduce and eventually stop the production of estrogen, the essential feminizing hormone. HRT is not a cure for menopause but is intended to restore the levels of estrogen that the body was producing naturally until menopause. Hormone therapy is most often used to treat common menopausal symptoms, including as a preventative against osteoporosis, which increases the risk of fractures in menopausal women.
What are the Symptoms of Uncorrected Menopause?
When some form of treatment (HRT or something else) is not being administered, a wide variety of symptoms are possible. The most common include:
- Hot flashes
- Night sweats
- Dryness in the vagina and vulva, coming from vulvovaginal atrophy
- Increased occurrence of urinary tract infections (UTIs) due to a thinning of the urethra
- Painful sex due to a lack of vaginal lubrication and thinner linings of the vagina
- Decreased bone mineral density, which can eventually lead to fractures coming from osteoporosis
- Depression, sleep disturbances, mood swings, reduction in levels of attention, and fatigue.
- Lower sexual desire
- Accelerated skin aging
- Joint pain
- Irregular or absent periods (during perimenopause)
- Breast tenderness
- Headaches or more frequent migraines
What are the benefits of HRT?
HRT is prescribed in the expectation that the benefits are greater than any associated risks. Primarily, it is intended to address the following symptoms in menopausal women:
- Moderate to severe hot flashes. Estrogen therapy remains one of the most effective treatments for the relief of menopausal night sweats and hot flashes.
- The vaginal symptoms of menopause, such as vaginal dryness, itching, burning, and discomfort during sex. Estrogen cream applied directly improves these conditions quickly and easily.
- The risk of osteoporosis in women who can’t tolerate or aren’t benefiting from other treatments. Osteoporosis can lead to bone loss and fractures. Normal estrogen levels help protect against bone-thinning
HRT can be prescribed to treat women who have reduced estrogen levels due to a primary ovarian insufficiency. It can also address an elevated risk of some other health conditions in menopausal and premenopausal women, including osteoporosis, heart disease, stroke, dementia, and mood changes.
Why is addressing changes in hormone levels becoming so important in treating menopause?
With increasing life spans, women today are living one-third or more of their lives in a postmenopausal state. The quality of life can be significantly affected by the problems caused by insufficient hormones, and HRT is an effective and efficient way to treat the symptoms.
HRT is used to augment the body’s natural hormone levels and treat menopausal symptoms. Doctors typically recommend HRT for women approaching menopause, which causes estrogen and progesterone levels to decrease significantly. HRT can help return these levels to normal. Treatments have evolved over the years and generally have become more effective and the best balance between risks and benefits.
