- Benefits of HRT.
The two current licensed indications for prescribing HRT are:
- Relief of menopausal symptoms
- Prevention / treatment of osteoporosis
Systemic HRT can be very effective in relieving symptoms such as hot flushes, sweats, mood swings, irritability, insomnia, palpitations, joint aches, vaginal dryness and discomfort and urinary frequency and is still the most effective treatment available. For the vaginal and bladder symptoms, vaginal estrogen alone can be used. If HRT is taken after the age of 50 for symptom relief only, then consideration should be given to stopping the HRT every 2 to 3 years to determine whether or not treatment is still required. If symptoms return, the HRT can be restarted after discussing the pros and cons. If HRT is commenced after an early or premature menopause, then it should generally be continued at least until around the age of 50. The dose of HRT for symptom control should be the lowest dose of estrogen which controls symptoms, starting with a low dose preparation and increasing the dose if necessary after 3 months.
Poor symptom control with HRT
- Allow 3 to 6 months on therapy to ensure full effect
- Inadequate estrogen dosage - increase dose or change from oral to non-oral route
- Poor absorption due to bowel disorder - change to non-oral route
- Drug interactions eg. barbiturates, phenytoin, carbamazepine - increase oral dose or change to non-oral route
- Poor patch adhesion - change delivery system
- Incorrect diagnosis - other conditions such as thyroid dysfunction and poor glucose control and lifestyle factors can cause similar symptoms to menopause
- Unrealistic expectations - HRT can help symptoms due to estrogen deficiency but is not an answer to all problems!
Systemic HRT has also been shown to be beneficial for treatment and prevention of osteoporosis for women who have, or are thought to be at risk of osteoporosis. Many studies have shown some improvements and prevention in decrease in bone density with HRT and the Women's Health Initiative study showed a significant decrease in osteoporotic fracture with HRT use. Since several other very effective treatments for osteoporosis are now available, HRT is not currently viewed as the first line treatment for osteoporosis but is useful if a woman has osteoporosis, or is thought to be at risk, and also has menopausal symptoms, and is the recommended preventive treatment for women with an early or premature menopause. If HRT is taken for osteoporosis treatment or prevention, then long term (5 to 10 years) treatment may be advised and then either bone density measurement or using other bone protective treatment should be considered. The dose of HRT for bone protection should be that containing the minimum bone protective dose of estrogen :
Estradiol tablet - 1-2mg daily
Conjugated equine estrogen tablet - 0.3-0.6mg daily
Estradiol patch - 50mcg daily
Estradiol gel - 1-5g daily
Estradiol implant - 50mg 6 monthly
Other possible benefits of HRT include reduction in risk of cancer of the colon (demonstrated by the Women's Health Initiative study [ref 7]), and reduced risk of Alzheimer type dementia, cataract formation and macular degeneration with improved dentition and skin healing. These possible benefits are not currently regarded as indications for HRT.
See also: Osteoporosis information on the Osteoporosis page.See also: Balancing the risks and benefits.