Choosing the Appropriate Hormone Replacement Therapy (HRT)

Estrogens [estrone (E1), estradiol (E2), estriol (E3)], progesterone, testosterone and dehydroepiandrosterone (DHEA) are hormones produced by the ovaries. Each of them stimulates receptors in our body and thus affect us in various ways, physically and psychologically. The levels of these hormones gradually decrease  over time resulting in a series of symptoms, such as hot flashes (which are the most common symptom of menopause and menopause), weight gain, changes in psychology, reduction or loss of sexual desire. So women often feel that “they are no longer themselves / as they used to be”. These symptoms are more likely to occur before your period stops or one year after the menstrual cycle stops (menopause). Many women are interested in learning how to deal with these symptoms, as they often disrupt their quality of life. Replacing the missing hormones in the form of the drug (HRT) is effective in reducing the symptoms, however, some women choose to try herbal products or other alternative therapies.


Hormone replacement therapy (HRT) has been the subject of controversy for several years regarding the benefits and risks of its administration. Perimenopause and menopause can be a very stressful time in a woman’s life with all the physical and emotional changes that come with it. These changes can not only vary from month to month, but can last for several years. HRT has been shown to be effective in relieving many of these symptoms but it also has some risks. According to the survey Women’s Health Initiative (WHI) conducted in 2002, HRT was recommended to be administered with the onset of perimenopausal symptoms and up to menopause. Initially, HRT options were limited to a small amount of prescription drugs, however today, there are many prescription and over-the-counter medications and therefore various HRT methods are available.

In recent years noted particular interest as regards the ‘ bio -identical’ hormone replacement therapy (the bio -identical hormones are hormones compounds chemically similar to the natural hormone produced by the body). Bio- identical therapy has not been shown to be safer than traditional therapies, such as HRT, but it is certainly more effective in treating hormonal disorders. An advantage of bio- identical hormones is that they can be prescribed and the recommended dosage is determined each time based on test results (i.e. depending on the levels of hormones found in the blood or saliva sample) and depending on the symptoms. The dosage can be adjusted each time according to the changes observed in your symptoms and needs. For every woman who experiences hormonal transitions, the symptoms show gradual changes.

HRT should be individualized and used in most women to treat perimenopausal symptoms in the lowest possible dosage and for as short a time as possible. This standard of care is so defined, because of possible dangers that may arise from the therapy, such as cerebral stroke , heart attack, blood clots (in his deep vein thrombosis) and increased risk for breast cancer. Women receiving hormone replacement therapy should understand that with HRTs the intensity of symptoms will be significantly reduced and they will notice physical and psychological improvement, benefits very important for a better life, but at the same time they should be informed and understand all the possible risks.


Is HRT Safe?

In the 1960s, hormonal replacement therapy ( HRT ) was widespread, revolutionizing the management of menopause and was prescribed to women to relieve symptoms such as hot flashes, night sweats, sleep disturbances, psychological problems, vaginal problems (frequent urination and vaginal dryness) as well as for the prevention of osteoporosis. To 1990 two of the larger studies were conducted in HRT – the Women ‘ s Health Initiative ( WHI ) in the US and the Million Women Study ( MWS ) in the UK. Their published results, in 2002 and 2003, raised questions about the safety of 2 main issues: the increased risk of breast cancer and heart disease. The studies were widely publicized and UK regulators issued an urgent safety restriction. Many doctors stopped prescribing HRTs and the number of women taking it dropped by 66%, resulting in the return of menopausal symptoms. Subsequent publication of all WHI results has led to the withdrawal of some of the previous findings on breast cancer and cardiovascular disease but without changing the regulatory directive or covering the issue by the media. A large-scale controlled study conducted in Denmark states that, in 2012, healthy women who received combination HRTs for 10 years immediately after menopause had a reduced risk of heart disease, highlighting the benefits women have when taking HRTs immediately after menopause. 


HRT Today

The majority of women who use HRTs for the short-term treatment of menopausal symptoms believe that its benefits outweigh its risks. Women who want to start hormone replacement therapy (HRT) should carefully discuss the benefits and risks of treatment with their doctor in order to decide what is right for them, taking into account their age, medical history, factors risk and their personal preferences. The least effective dose of HRT should be administered with a duration of use that depends on its therapeutic purposes. HRT remains suitable for the prevention of osteoporosis and may be considered the appropriate choice for women starting treatment under the age of 60, and especially for those who experience premature menopause. Women receiving HRTs should be re-evaluated by their doctor at least once a year. For some, long-term HRT use may be necessary to relieve ongoing symptoms and improve their quality of life. The HRT is generally not recommended in women with a history of stroke or in deep venous thrombosis, severe liver disease, breast cancer and endometrial cancer. It is not usually advisable for women over 60 to start HRTs, as a WHI ( Women’s Health Initiative ) study has shown that the risks increase, but this does not mean that women who started it earlier should not continue it after 60. There is no clear answer to the effects of HRT on sexual desire but some work studies show that estrogen in HRT can help maintain or restore sexual drive. HRT will help with the symptoms of menopause such as vaginal dryness and painful sexual intercourse. If vaginal symptoms are the only problem, then the use of topical vaginal estrogen should be preferred.     


Duration of treatment

There are no reasons for mandatory limitation of the duration of HRT. The woman should decide for the continuation or not of the HRT, if she is properly informed by her treating physician and on the one hand the achievement of the specific objectives and on the other hand the assessment of the potential benefits and risks are examined. Women can choose to use HRT for as long as the symptoms of menopause are reduced through treatment. They can stop HRT every few years, but the symptoms of menopause in some women can last for many years and so should be treated with the lowest effective dose.



Small doses of HRTs can reduce symptoms effectively and maintain a woman’s quality of life.


The benefit Of HRT

  • It is the most effective treatment for sweating and atrophy of the urogenital system.
  • Muscle aches, mood swings, sleep disorders and sexual dysfunction (including decreased libido) improve during HRT.
  • Corrects the changes due to the lack of estrogen in the urogenital system and maintains the health of the genitals.
  • Prevents menopausal bone loss and reduces the incidence of all osteoporotic fractures (including vertebral and hip fractures).
  • Effectively prevents the loss of cartilage that accompanies menopause.