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Hormone Replacement Therapy (HRT) Products Available for Treatment of Menopausal Symptoms

News August 8, 2020 | CanadaOnlineHealth

Many women experience menopause at the average age of 51 years, with 95 percent having their final menstrual period between the ages of 45 to 55 years.

Menopause (sometimes called “the change of life”) is a normal time in a woman’s life when her period stops. During menopause, a woman’s body makes less of the hormones, estrogen and progesterone.

Lower hormone levels may lead to symptoms like night sweats, hot flashes, mood changes, irregular periods and vaginal dryness along with thinning bones.

What Is Hormone Replacement Therapy?

Some women choose to treat their symptoms with hormone medicines, sometimes called Hormone Replacement Therapy (HRT).

HRT, also known as hormone therapy, menopausal hormone therapy (MHT), and estrogen replacement therapy (EHT) is the most effective treatment for menopause symptoms.

Risk of HRT

HRT is not for everyone. You should not take hormone therapy for menopause if you:

  • think you are pregnant
  • have problems with vaginal bleeding
  • have or have had certain cancers such as breast cancer or uterine cancer
  • have or have had a blood clot, stroke or heart attack
  • have a bleeding disorder
  • have liver disease
  • have allergic reactions to hormone medications

What Are the Basic Types of Hormone Therapy?

Hormone replacement therapy primarily focuses on replacing the estrogen that your body no longer makes after menopause. There are two main types of estrogen therapy:

  • Systemic hormone therapy.

Systemic estrogen - which comes in pill, skin patch, ring, gel, cream or spray form — typically contains a higher dose of estrogen that is absorbed throughout the body.

It can be used to treat any of the common symptoms of menopause.

  • Low-dose vaginal products.

Low-dose vaginal preparations of estrogen — which come in cream, tablet or ring form - minimize the amount of estrogen absorbed by the body.

Because of this, low-dose vaginal preparations are usually only used to treat the vaginal and urinary symptoms of menopause.

Estrogen Pills

Oral medication is the most common treatment for menopausal symptoms. Among the many forms of pills available are conjugated estrogens (Premarin), estradiol (Estrace), and conjugated estrogens/bazedoxifene (Duavee).

Pros: While there are newer ways of getting HRT, oral estrogen medicines are the best-studied type of estrogen therapy.

Cons: Oral estrogen - like any estrogen therapy - can also cause side effects. These include painful and swollen breasts, vaginal discharge, headache, and nausea. It may also increase your cholesterol.

Because oral estrogen can be hard on the liver, people with liver damage should not take it. Instead, they should choose a different way of getting estrogen.

Transdermal Topical Patches

Skin patches are another type of HRT.

Examples are Alora, Climara Patch, Estraderm, and Vivelle-Dot.

Usually, you would wear the patch on your lower stomach, beneath the waistline. You would then change the patch once or twice a week, according to the instruction.

Pros: The patch is convenient. You can stick it on and not worry about having to take a pill each day.

While estrogen pills can be dangerous for people with liver problems, patches can be used, because the estrogen bypasses the liver and goes directly into the blood. A 2007 study also showed that the patch does not pose a risk of blood clots in postmenopausal women like oral estrogen does.

Cons: While some experts believe that estrogen patches may be safer than oral estrogen in other ways, it's too early to know. So, for now, assume that estrogen patches pose similar risks - a very small increase in the risk of serious problems, like cancer and stroke.

The patch itself might irritate the skin where you apply it. Estrogen patches should not be exposed to high heat or direct sunlight. Heat can make some patches release the estrogen too quickly, giving you too high a dose at first and then too low a dose later.

Transdermal Topical Creams, Gels, and Sprays

Creams, gels and sprays offer other ways of getting estrogen into your system.

Examples include gels likeEstrogel pump and Divigell, creams like Estrasorb, and sprays like Evamist.

As with patches, this type of estrogen treatment is absorbed through the skin directly into the bloodstream. It is applied on one arm or legs.

Pros: Topical creams, gels and sprays are safer than oral estrogen for people who have liver and cholesterol problems.

Cons: They have not been well-studied. So, assume that they pose the same slight risk of serious conditions, like cancer and stroke.

Because the estrogen is absorbed right through the skin, don't let other people touch these creams or gels.

Vaginal Suppositories, Rings, and Creams

These types of estrogen treatments can be applied directly to the vaginal area. In general, these treatments are for women who are troubled specifically by vaginal dryness, itchiness, and burning or pain during intercourse.

Examples are vaginal tablets like Vagifem, creams like Estrace, Estragyn or Premarin Vaginal Cream, and insertable rings like Estring Vaginal Ring or Femring.

Pros: The advantage is that they can relieve vaginal symptoms without exposing the entire body to high doses of estrogen. Theoretically, this could reduce the more serious risks of estrogen therapy - and be a safer way for women who cannot take systemic therapy to get relief

Cons: Suppositories and rings with low doses of estrogen only help with vaginal symptoms of menopause. They won't help with other symptoms like hot flashes.

The nearly 20-year follow-up study of 53,000 nurses, published in December 2018, found that despite its “black box” warning, low-dose vaginal estrogen does not increase risk of cardiovascular disease and cancer.

This new study shows that topical applications - unlike systemic estrogen replacement - do not increase the risk of blood clots, cardiovascular disease, osteoporosis or breast and endometrial cancers.

If You Haven't Had Your Uterus Removed

Your doctor will typically prescribe estrogen along with progesterone or progestin (progesterone-like medication).

This is because estrogen alone, when not balanced by progesterone, can stimulate growth of the lining of the uterus, increasing the risk of endometrial cancer.

If you have had your uterus removed (hysterectomy), you may not need to take a progesterone.


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