Archive for About HT (HRT)

Testosterone

Testosterone and other related hormones in the body (also known as androgens) play important physiological roles in women.

It is generally known that androgens are important for muscle and bone strength and for growth of normal body hair. But androgens may also have important positive effects on mood, wellbeing, energy and vitality in women.

The most well-known and potent of the androgens is testosterone. This hormone is produced by the ovaries and the adrenal glands, and in other parts of the body from hormones made by the adrenal glands and the ovaries, particularly from a hormone called DHEA which also circulates in the blood as DHEA-sulphate.

There is a major fall in oestrogen and progesterone over 3-4 years at menopause; however, testosterone levels start to drop in women in their younger reproductive years. This means that a woman in her forties has on average only half of the testosterone circulating in her blood stream as does a woman in her twenties, however this can vary between individual women. There is almost no change in testosterone levels at the time of natural menopause. There is only a very gradual decline in testosterone after a woman has reached her sixties. If a woman has her ovaries removed by surgery, however testosterone levels can fall afterwards by up to 50 per cent. Blood levels of the hormone DHEA-sulphate also fall during a young women’s reproductive years and continue to fall across a woman’s life span.

Testosterone and libido

Libido and sexual function are complex and relate primarily to lifestyle and relationship issues; however some studies have shown that for women at menopause who are experiencing a loss of sexual interest, various aspects of sexuality may be improved with testosterone therapy, with or without oestrogen. One small study also indicates that testosterone therapy will improve sexual interest and wellbeing in premenopausal women presenting with low libido, but further research is needed.

A study of Australian women recruited from the community, and without any complaint about their sexual function, has now shown that low sexual desire, arousal, responsiveness and other aspects of female sexuality recorded in the questionnaire are not significantly related to low testosterone levels. However women who are distressed by their low sexual function may be found to have low testosterone levels for their age.

Summary

There are further research questions to be answered on the use of testosterone therapy in women. In the meantime, any woman considering testosterone therapy should have her blood hormones checked to ensure that her testosterone level is not above a level that would increase the risks of treatment side effects and needs talk to their health practitioner to gain a clear understanding of what is, and is not, currently known about this therapy.

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Side Effects

Some women may experience nausea, fluid retention, breast enlargement and discomfort, particularly during the first few months of taking hormone therapy (HT). Usually these symptoms fade over time as the body adjusts to the new levels of hormones. If these symptoms persist then the dose, brand or the way it is administered may need to be changed. Specific preparations are less likely to cause these side effects and changing can usually overcome these problems.

Breast soreness and nausea are side effects of taking oestrogen while in some women progesterone may cause bloating, depression and mood swings – symptoms similar to those of premenstrual syndrome (PMS). Some HT does not require additional progestins and can be very useful if these effects occur. Adding testosteronemay be helpful if breast tenderness is a problem. Often a reduction in the dosage, or change of brand, overcomes this problem.

Breakthrough bleeding can sometimes become a problem. If this is an issue then you can talk to your health practitioner about ways to reduce or eliminate this.

Does HT cause weight gain?

With ageing, the base metabolic rate tends to decline and weight increases if energy intake from food and beverages exceeds energy used in daily activities and exercise.

A weight gain of around five kilograms is common over the years from 48-55.

Gaining weight specifically from hormone therapy, however, is uncommon. This may occur temporarily when starting HT, but it is usually from fluid retention and is related to the body readjusting to changing hormone levels.

Regular exercise is particularly beneficial, when combined with a well-balanced diet, not only in helping to control weight, but also in helping to reduce the risk of heart disease and osteoporosis, as well as a range of other beneficial effects.

Useful Resources

  • Bone Health – Bone is living tissue made up of specialised bone cells and, like the rest of the body, it is constantly being broken down and renewed.
  • Physical Activity – The health benefits of even moderate exercise and more.

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Benefits & Risks

Note: Hormone therapy (HT) may also be referred to as hormone replacement therapy (HRT).

What is hormone therapy?

Hormone therapy (HT) or hormone replacement therapy (HRT) is a medication with the combination of the female hormones oestrogen and progesterone, and sometimes the male hormone testosterone. It can be prescribed to relieve symptoms associated with falling levels of hormones – particularly oestrogen – during menopause, such as hot flushes, vaginal dryness, stress incontinence, insomnia and mood swings. HT can also prevent further fractures in women with osteoporosis, where other treatments are not tolerated.

Oestrogen alone is prescribed for women who have had a hysterectomy. In women who still have their uterus, oestrogen alone can overstimulate the cells lining the uterus, causing an increased risk of endometrial cancer. This risk is reduced by giving progesterone along with the oestrogen. Progesterone is known as ‘progestin’ or ‘progestogen’ and is prescribed as a tablet or patch.

Oestrogen can be prescribed as a tablet, patch, gel, implant, injection, cream or pessary (suppository). Dosages and methods of giving the medication vary according to the needs of the individual, and changes may be required before the ideal method and dose is found. Seek advice and supervision from your doctor.

What are the possible side effects of HT?

Some women experience:

  • Nausea
  • Feeling bloated
  • Breast enlargement and discomfort
  • Bleeding between periods
  • Weight gain
  • Increase in risk of blood clots
  • Small increase in risk of heart disease and stroke (in peri and post-menopausal women)

What is meant by ‘short-term’ HT and ‘long-term’ HT?

Short-term HT is usually taken for one to five years. Long-term HT is given for five years and longer. Symptoms disappear in many women within five years of menopause, and so short-term HT is all that is usually required.

What are the benefits and risks of HT?

Any decision about HT is an individual one and should be made after each woman is informed about her individual risks, benefits , needs and concerns in consultation with her prescribing practitioner.

HT – Benefits

Treatment of menopause symptoms

The most common menopause symptoms are hot flushes and vaginal dryness. Hot flushes and night sweats are symptoms of the fall in a woman’s oestrogen level at the time of menopause. No other therapy has shown to be as effective as oestrogen replacement therapy in reducing hot flushes.

Vaginal dryness is related to oestrogen loss and women with significant problems may benefit from the use of vaginal oestrogen preparations such as tablets or cream.

Many women using oestrogen therapy also obtain relief from a range of other menopause symptoms which seem to be related to low levels of oestrogen such as lowered mood, anxiety, insomnia, headaches, muscle and joint pain and decreased sex drive.

Other effects of HT

Osteoporosis

HT reduces the risk of osteoporosis. It acts by preventing bone loss. This decreases fractures of the verterbrae (spine) by up to 40 per cent and also reduces hip fractures.

Heart disease

Original studies indicated that oestrogen replacement therapy may protect post-menopausal women against coronary heart disease. Recent trials have confirmed these findings in women aged less than 60 years, but may increase heart disease risk in women starting therapy with oral hormones over 60 and especially over 70 years of age. Standard oral therapy should be avoided in women who already have established coronary heart disease.

Short-term memory and Alzheimer’s disease

Some studies suggest that oestrogen may prevent or delay the onset of Alzheimer’s disease. A recent study in women startin HT over 65 years (average age 72) showed a small increase in the risk of dementia.

Colorectal cancer

There is evidence from a major trial that HT reduces the risk of colorectal cancer.

HT – Risks

Breast cancer

Long-term HT (oestrogen with progestin) is associated with a slight increase in the risk of developing breast cancer. There has been much research into this issue with some studies indicating small risk and others indicating no risk. The report from the American Women’s Health Initiative (WHI) (July 2002) indicated that there was no increase in breast cancer risk in those women who began HT at the start of the trial, though there appeared to be an increase in those who had been on HT before the trials began.

For women who have had a hysterectomy and take oestrogen only the WHI study of 11,000 women has shown no increase (rather a trend to decrease) in breast cancer risk.

Visit your health practitioner for a Pap test every two years and regularly check your breasts. If you’re over 50, make sure you also have a mammogram every two years (a free service from BreastScreen – phone 132 050).

Thrombosis

There is an increased risk of venous thrombosis (blood clots in the veins) in women using HT, however the incidence is very low and more likely in the first year of therapy. More research is needed to identify which women are more likely to be at risk.

HT – Other Considerations

Weight gain

Women tend to gain weight, particularly around the abdomen (stomach) in their middle years whether they take HT or not. Most studies do not show a link between weight gain and HT use. In fact in several studies women who used HT had less weight gain than those who did not.

Bleeding

Some women may experience vaginal bleeding after starting HT. In most instances this can be managed simply by varying the dose or type of HT used. However all persistent unexplained vaginal bleeding must be investigated to exclude other causes such as polyps or fibroids.

Skin

There is some research to suggest that post-menopausal HT may prevent some aspects of skin ageing by increasing skin collagen. However further studies are needed to evaluate the effects of oestrogen on the skin.

Overall the main reason women choose to commence HT is for symptom relief aiming for short-term use (usually between 1-5 years).

When is HT not recommended?

Generally when a woman has:

  • A history of breast cancer
  • Endometrial cancer
  • Unexplained vaginal bleeding
  • Clotting disorder
  • A history of blood clots in the veins
  • A history of or increased risk of heart disease or stroke, including those with diabetes

However, even with one of the above, HT may be beneficial to some women if the risks and benefits are well understood. Women with liver disease, migraine headaches, epilepsy, diabetes, gall bladder disease, fibroids, endometriosis and hypertension all need special consideration before being prescribed HT.

Talking to your doctor

Prior to commencing HT, it is important that you explore your options and discuss both the benefits and the risks with your doctor. Once you have been prescribed HT, a follow-up doctor’s visit is necessary after a couple of months, and an annual review check-up is essential.

Who may benefit from testosterone therapy?

Women experiencing a loss of libido (sex drive), together with tiredness, may benefit from testosterone therapy, providing these symptoms are not related to psychosocial and/or relationship factors.

Testosterone may also be considered with HT for young women experiencing premature menopause. Testosterone is given as an implant or cream and is usually prescribed short-term. It can be given alone or together with oestrogen and progestogen, but no testosterone therapy for women is approved by the Therapeutic Goods Administration (TGA) as yet.

Where can I get more information?

Advice to Medical Practitioners regarding the use of postmenopausal hormone therapy.

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Hormone Therapy (HT)

What is Hormone Therapy?

Hormone Therapy (HT) or Hormone Replacement Therapy (HRT) is the giving of the female hormones, oestrogen and progesterone, and sometimes testosterone.

Oestrogen and progesterone are produced in the ovaries during a woman’s reproductive life. At menopause, levels of these hormones fall dramatically until, in post-menopausal years, small amounts of each are produced by the adrenal glands instead of the ovaries.

Testosterone is produced by the adrenal glands and the ovaries. Levels decline gradually over a woman’s life, but are significantly reduced in women who have had both ovaries removed.

How is HT prescribed?

Oestrogen alone is prescribed for women who have had a hysterectomy, as the benefits of oestrogen are all that is required. In women who still have their uterus, oestrogen alone can overstimulate the cells lining the uterus causing an increased risk of endometrial cancer. This risk is reduced by giving progesterone along with the oestrogen.

Progesterone is known as ‘progestin’ or ‘progestogen’ and is prescribed as a tablet or patch.

Oestrogens can be prescribed in the following ways:

1. Tablets – taken daily by mouth
2. Patches – changed either weekly or twice weekly
3. Skin gel – rubbed into the skin daily
4. Implants – inserted under the skin – each usually lasts four to six months
5. Oestrogen injections – less common form of administration
6. Oestrogen tablets, creams, pessaries, or ring for local application inside the vagina

Dosages and methods of administration vary according to the needs of the individual woman. What suits one woman may not suit another.

Changes may be required before the ideal method and dose is found for the individual woman. These are made under the close supervision of your doctor. Perseverance may be required at the early stages of HT and it may take up to six months to find the right combination for you.

What are the benefits for HT?

  • Relief of troublesome symptoms associated with falling levels of hormones, particularly oestrogen, during menopause. For most women with moderate to severe symptoms, use of HT can be effective in relieving hot flushes, vaginal dryness, stress incontinence, insomnia and mood swings.
  • HT can prevent further bone loss and fractures in women with osteoporosis where other treatments are not tolerated.

What are the possible side effects of HT?

  • Some women may experience nausea, fluid retention, breast enlargement and discomfort particularly during the first few months of taking HT. Usually these symptoms subside with time. Sometimes changing the dose, brand or the way it is administered helps.
  • Breakthrough bleeding can sometimes become a problem. Discuss with your doctor, ways to either eliminate or reduce this.
  • Often women express concern about weight gain whilst taking HT. Research does not support that HT causes weight gain or weight loss.
  • Venous thrombosis naturally occurs in one in 10,000 women per year around the typical age of menopause. HT in tablet form increases this risk to two to three in 10,000 women per year. The effect of patch therapy is as yet unknown.
  • Heart disease and stroke are uncommon in peri and early postmenopausal women, except those at high risk including diabetics, smokers, those with high blood pressure and high cholesterol. The use of oral combined HT may cause a small increase in this risk particularly in women many years after menopause and should be considered when discussing HT with your doctor.

What is meant by ‘short-term’ HT?

Short-term HT is usually taken for between one to five years. This treatment may be considered by women experiencing symptoms that are distressing. It can be commenced either before or after the last menstrual period has occurred. Symptoms disappear in many women within five years of menopause, and so short-term HT is all that is required.

What is meant by ‘long-term’ HT?

Long-term HT (oestrogen with progestin) is given for five years and longer. Because of the small increased risks of combined HT long-term, use for prevention of disease (including prevention of osteoporosis) is currently under discussion. Treatment of established osteoporosis or for significant, ongoing menopausal symptoms may be appropriate, but each individual case should be assessed for the benefits and risks to that individual woman.

Do I have a greater risk of breast cancer on HT?

Long-term HT (oestrogen with progestin) is associated with a slight increase in the risk of developing breast cancer. There has been much research into this issue with some studies indicating small risk and others indicating no risk. The report from the American Women’s Health Initiative (WHI) (July 2002) indicated that there was no increase in breast cancer risk in those women who began HT at the start of the trial, though there appeared to be an increase in those who had been on HT before the trial began.

For women who have had a hysterectomy and take oestrogen only the WHI study of 11,000 women has shown no increase in breast cancer risk (in fact it showed a trend to decrease).

Any decision about HT is an individual one and should be made after each woman is informed about her individual risks, benefits, needs and concerns in consultation with her prescribing practitioner.

How should I look after my breast health?

Women between the ages of 50-69 need to be aware of the importance of regular mammograms, annual clinical examination with a GP and breast self-examination so that they become familiar with their own breasts.

Mammography screening is the best way to detect breast cancer at its earliest stages among women in the over 50 age group. Mammographic screening is recommended every two years for women aged 50-69 without breast symptoms as this is when screening has shown to be most effective.

We know that some forms of HT can increase the density of breast tissue and therefore detecting tumours is made more difficult. Each woman has an individual breast density and there is an individual response to breast density when on HT. Not every woman’s breast density changes in the same way when on HT. Overall the effect of HT seems to reduce mammographic sensitivity by about 10 per cent.

Who should not take HT?

Generally women with:

  • A history of breast cancer
  • Endometrial cancer
  • Unexplained vaginal bleeding
  • Clotting disorder
  • History of thrombosis (blood clots in the veins)
  • A history of or increased risk of heart disease or stroke, including those with diabetes

However even with one of the above, HT may be beneficial to some women if the risks and benefits are well understood. A non-oral form of oestrogen may be preferred. Women with liver disease, migraine headaches, epilepsy, diabetes, gall bladder disease, history of blood clots, fibroids, endometriosis and hypertension need special consideration before being prescribed HT.

What should I expect of my doctor?

1. It is important to visit your health practitioner with some questions already planned. Write your questions down. This will promote clear and concise communication between you and your doctor. It is often a good idea to book a longer consultation time.

Some possible questions may include:

  • What treatment/intervention choices are available to me?
  • What are the possible benefits and risks of the different choices?
  • What might happen if I stop taking my HT immediately?
  • Where else can I gather information (websites, services, printed material)?
  • How often does my treatment need to be reviewed?
  • Do I need to have a mammogram?
  • Should I stop my HT prior to having a mammogram?
  • What will happen if I have an abnormal mammogram?

2. If HT is started:

  • A follow up visit to your doctor is necessary after the first couple of months.
  • An annual check up with your doctor is essential to review ongoing reasons for hormone therapy.
  • Pap test is necessary every two years.
  • Mammograms are recommended every two years (between 50-69 years of age).

Who is likely to benefit from testosterone replacement?

Women experiencing a loss of libido (sex drive) together with lethargy (tiredness), providing the reason appears unrelated to psychosocial and/or relationship factors may benefit from testosterone replacement. In young women who experience premature menopause, testosterone should be considered with HT.

The testosterone is administered either as an implant or a skin cream and is usually prescribed short-term. It can be given alone or together with oestrogen and progestogen.

For further information see Testosterone

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Hormones and Hormone Therapy (HT)

Hormone production

A woman produces many different natural female hormones including:

  • Oestrogen
  • Progesterone
  • Testosterone

Oestrogen and progesterone are produced in the ovaries during a woman’s reproductive life. Levels of these hormones fall dramatically at menopause until, in the post-menopausal years, small amounts of each are produced by the adrenal glands instead of the ovaries.

Testosterone is produced by the adrenal glands and the ovaries. Levels decline gradually over a woman’s life, but are significantly reduced in women who have had both ovaries removed.

Hormone Therapy (HT)

Hormone Therapy (HT) or Hormone Replacement Therapy (HRT) is the giving of the female hormones oestrogen and progesterone, and sometimes testosterone.

Oestrogen and progesterone

Oestrogen is the main hormone prescribed to relieve menopausal symptoms and for women who have had a hysterectomy, this is all that may be needed.

In women who still have their uterus, oestrogen alone can overstimulate the cells lining the uterus causing an increased risk of endometrial cancer (cancer of the uterus). This risk is neutralised by giving the hormone progesterone along with the oestrogen. It is given in a synthetic form known as ‘progestin’ or ‘progestagen’.

Testosterone

Women experiencing loss of libido, lack of energy and ongoing fatigue, even when taking oestrogen therapy, sometimes benefit from low dose testosterone replacement, however this is an area of ongoing research to further clarify clinical guidelines.

Using HT

HT is most often prescribed as tablets but there are also patches, a skin gel, implants and vaginal preparations such as creams or pessaries (pellet). What suits one does not suit all, and dosages and methods of administration vary according to each woman’s needs and response to HT. Changes may be required before a satisfactory method and dose is found for each woman, and these changes are made under the close supervision of the health practitioner. It can sometimes take up to six months to find the right combination.

Tablets

Oestrogen and progesterone are available separately or as combined tablets like the contraceptive pill packs. Dose and types vary.

Patches

Patches can be an alternative to tablets and the hormones are absorbed through the skin. Some patches contain oestrogen others are a combination of both oestrogen and progesterone. Sizes vary according to dose.

Gel

Oestrogen is also available as a gel. Progestin should be taken in tablet form or used as an IUD by women who have not had a hysterectomy. Gel comes in single dose sachets and is used daily by rubbing into the skin.

Creams and pessaries (pellet)

Creams and pessaries (pellet) are used locally by inserting the cream or pessary containing oestrogen into the vagina. They are mainly used by women who have vagina or bladder symptoms.

Implants

Implants are inserted under the skin under local anaesthetic by a doctor and are about one centimetre long.

Usual forms of progesterone and testosterone

A progestin may be prescribed as a tablet, intrauterine device (IUD) or a patch.

Testosterone is administered either as an implanted pellet or cream (see Libido) and is usually prescribed short-term.

As a general rule when using HT:

  • Start low
  • Go slow
  • Review often

As individual needs may vary it is important to talk to your health practitioner about what is right for you.

HT benefits and risks

There are benefits and risks associated with using HT and research continues in this area.

Gathering information and talking with your health practitioner can assist you in making an informed decision.

Useful resources

  • Hormone Therapy Benefits and Risks – Short-term use of hormone therapy (HT) may be useful for women experiencing more severe symptoms of menopause.
  • Hormone Therapy Side Effects – Some women may experience nausea, fluid retention, breast enlargement and discomfort, particularly during the first few months of taking HT.

About HT (HRT)

Hormone Therapy (HT) or Hormone Replacement Therapy (HRT) is the giving of the female hormones, oestrogen and progesterone, and sometimes testosterone.

Oestrogen (also known as estrogen) and progesterone are produced in the ovaries during a woman’s reproductive life. At menopause, levels of these hormones fall dramatically until, in post-menopausal years, small amounts of each are produced by the adrenal glands instead of the ovaries.

Testosterone is produced by the adrenal glands and the ovaries. Levels decline gradually over a woman’s life, but are significantly reduced in women who have had both ovaries removed.

Hormone Therapy Resources

  • Hormones – Until menopause, a woman produces three different natural female hormones.
  • Hormone Therapy – Hormone Therapy (HT) or Hormone Replacement Therapy (HRT) is the giving of the female hormones oestrogen and progesterone, and sometimes testosterone.
  • HT Benefits and Risks – Short term use of hormone therapy (HT) may be useful for women experiencing more severe symptoms of menopause.
  • Hormone Therapy Side Effects – Some women may experience nausea, fluid retention, breast enlargement and discomfort, particularly during the first few months of taking HT.
  • Androgens (testosterone) – Testosterone also appears to have important favourable effects on mood, well being, energy and ‘vitality’ in women.
  • Million Women Study – The Million Women Study (MWS) is a UK national study of women’s health, involving around one million women aged 50 and over.
  • Women’s Health Initiative USA – The Women’s Health Initiative (WHI) was established to address the most common causes of death, disability and impaired quality of life in USA postmenopausal women.

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