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Principles of HRT


INDICATIONS for HORMONE REPLACEMENT THERAPY (H.R.T.)

CONTRAINDICATIONS for H.R.T.

OTHER POSSIBLE BENEFITS

Reduction in risk of colonic cancer, macular degeneration and cataract formation, with improved dentition and skin healing. If commenced in the early menopausal years, possible reduction in cardiovascular disease and alzheimer type dementia-- these still controversial.

RISKS of H.R.T.

HORMONES INVOLVED

  1. Estrogen - should be given continuously.
  2. Progestogen - given in addition to estrogen in non-hysterectomised patients to reduce the risk of endometrial hyperplasia and endometrial cancer. Duration and frequency of the progestogen determines the presence and pattern of bleeding.

ROUTE of H.R.T.

  1. Oral - Often first choice - cost-effective and acceptable.
  2. Non-oral - Transdermal--patch or gel,  - have different metabolic effects e.g. on lipid metabolism and clotting system.
  3. Non-oral therapies are thought to produce more physiological hormone levels than oral therapy, avoiding bolus first-pass effect on the liver.

INDICATIONS for NON-ORAL ROUTE

Wide range of types and routes of estrogen and progestogen allows flexibility and enables treatment to be individualised.

See Also: PDF download from The BMS - Prescribable alternatives to HRT

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