What is hormone replacement therapy (HRT) and why would
I need it?
Hormone replacement therapy (HRT) provides women with,
or replaces, hormones that their ovaries stop making.
The ovaries make estrogen
and progesterone
as part of the menstrual cycle. The ovaries also make
androgens,
including testosterone.
Hormone levels usually start to change during perimenopause,
the years just before menopause. In perimenopause, many
women begin to have symptoms such as hot flashes, vaginal
dryness, irregular periods, and insomnia. The reason
for the symptoms is usually fluctuating and declining
hormone levels.
These hormonal changes are due to aging ovaries that are
losing their ability to produce eggs and hormones. Women
may have widely varying estrogen levels during their
monthly cycles as the ovaries keep trying to produce
eggs. Often there will be cycles in which no ovulation
occurs (called anovulatory cycles) and no progesterone
is produced. This can lead to irregular cycles with
heavy or abnormal bleeding as a woman approaches menopause.
At menopause,
the ovaries stop producing and releasing eggs (ovulating)
each month, and monthly periods stop completely. The
ovaries are no longer producing estradiol and progesterone
(although they continue to produce androgens). Menopause
does not mean, however, that you have no estrogen in
your body anymore. Women with more body fat usually
have more estrogen than thinner women do, because estrogen
is aromatized
in fatty tissue.
After menopause, there is much less estrogen and testosterone
in the body than before menopause, and very little progesterone.
This drop in hormone levels can have various effects,
including the familiar symptoms of menopause such as
hot flashes, night sweats, vaginal dryness, and loss
of libido.
A woman who has a surgical menopause, in which her ovaries
are removed (usually along with her uterus and fallopian
tubes), will have a much more sudden drop in all sex
hormone levels than a woman going through natural menopause.
This sudden loss of hormones can cause severe symptoms
and health problems, especially in younger women, unless
adequate hormone replacement is provided.
HRT is most often prescribed to help with the symptoms of menopause.
HRT may have a number of other benefits, such as preventing bone loss,
but it also has risks. Talk to your healthcare provider about all possible
options. Depending on your situation, you may decide to use HRT on a short-term
basis, a longer-term basis, or not at all.
