Understanding HRT
HRT is the most effective way to manage menopausal symptoms and to obtain long term benefits for bone, brain, and heart health. It comprises of 3 main hormones.
Estrogen:
Most of the HRT preparations have Estradiol which is a body-identical hormone. It means that it is biochemically similar to the hormones produced naturally in the body. They may be derived from plant sources like yams or soya or made synthetically in labs. Replacing this hormone gives relief from most of the menopausal symptoms along with keeping the bone and heart healthy.
This can be given in form of oral tablets, patch, gel, sprays, or implants.
Taking Estrogen in oral form is associated with slight increase in risk of thrombosis (clots in legs or lungs). They may also reduce the libido further. They are not suitable for women with certain underlying conditions like migraine, high blood pressure, diabetes, heart issues or clots in past or if they are smokers.
Transdermal Estrogen, (estrogen through the skin) does not increase risk of clots and are much safer. They can be used very safely with most women with pre-exosting medical conditions like diabetes, high blood pressure, thrombosis and migraines.
Progesterone and Progestogens:
Progestogens are essential part of HRT for women who still have their uterus. Estrogen stimulates the lining of womb (endometrium) and makes it grow excessively. This can lead to risk of unexpected bleeding, excessive growth of endometrium (hyperplasia) or even endometrial cancer. Progestogens work on the lining of the womb and keep it thin and healthy. This way, it eliminates any risk to the endometrium.
They can be natural progesterone or synthetic progestogens and can be given as oral combined HRT tablets, combined patches, Mirena coil or oral natural micronized progesterone.
Natural Body-Identical Progesterone: It is identical to the progesterone produced by our own ovaries and is derived from yams. It is available as micronized progesterone. It is the safest type of progestogen and has lower breast cancer and thrombosis risks compared to the synthetic progestogens. It also has a sedative, calming effect and can help with sleep.
Synthetic Progestogens: These are synthetic molecules which act on progesterone receptors. For e.g., the progestogens which are present in most combined oral HRT, patches and Mirena coil. They are available in many different types, giving flexibility of choice.
Testosterone:
Testosterone is often considered as a male hormone, but it is also an important female hormone, produced by the ovaries and the adrenals. Healthy young females produce 3-4 times more testosterone than estrogen. It can drop significantly in post-menopausal women and after surgical removal of ovaries (surgical menopause).
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Testosterone replacement has many beneficial effects: -
There is robust evidence that it improves libido and helps with arousal and orgasm.
Experience shows that it also helps with fatigue, muscle and bone strength and brain fog. However, there is insufficient data on these. It is available in form of gels.
