Hormone Replacement Tx

HRT is effective at reversing the effects of aging on muscle.
Hormone replacement therapy (HRT) in menopause is medical treatment in postmenopausal, perimenopausal, and surgically menopausal women. Its goal is to mitigate discomfort caused by diminished circulating estrogens and progesterone in menopause. Combination HRT is often recommended as it decreases the amount of endometrial hyperplasia and cancer associated with unopposed estrogen therapy. The main hormones involved are estrogen like estradiol and progesterone or progestins. Some therapies include the use of androgens like testosterone or dehydroepiandrosterone (DHEA) as well
  • Specialist
  • Dr. Robert Ambrozic MD
  • Technology
  • Hormone Replacement Therapy
  • Costs
  • Upon Evaluation
  • Goals
  • Up to 95% Replenishment
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  • Early uses
  • HRT was first available in the 1940s but became more widely used in the 1960s, creating a revolution in the management of the menopause. There are more than 50 types of HRT available: HRT can be given orally (tablets), transdermally (through the skin); subcutaneously (a long-lasting implant); or vaginally. Cyclical HRT mimics the normal menstrual cycle. Oestrogen is taken every day and progestogen for 12 to 14 days. At the end of each course of progestogen there is some bleeding as the body “withdraws” from the hormone and the womb lining (endometrium) is shed. Progestogen regulates bleeding and protects the endometrium from harmful pre-cancerous changes Oestrogen-alone HRT is normally prescribed to women who have had their womb removed (hysterectomy). The benefits of all HRTs are derived from oestrogen; progestogen is only necessary to protect the womb lining.
  • Types Continued
  • In continuous combined therapy HRT (CCT) combinations of an oestrogen and progestogen are prescribed continuously to achieve period-free HRT. Usually, women start on cyclical HRT and change to CCT later Tibolone is a synthetic form of period-free HRT which may have similar benefits to CCT. It is taken continuously in tablet form Long cycle HRT uses a formulation which causes withdrawal bleeds every three months instead of every month, and is most suited to women who suffer side effects when taking a progestogen. Its safety in long-term use with regard to the lining of the womb is questionable Local oestrogen, such as vaginal tablets, creams, or rings, is used for treating local uro-genital problems, such as dry vagina, irritations, bladder problems or infections.
Next Steps?
Women wishing to start HRT should carefully discuss the benefits and risks of treatment with their doctor to see what is right for them, taking into account their age, medical history, risk factors and personal preferences. For the majority of women who use HRT for the short-term treatment of symptoms of the menopause, the benefits of treatment are considered to outweigh the risks. The lowest effective HRT dose should be taken, with duration of use depending on the clinical reasons for use. HRT remains licensed for osteoporosis prevention and can be considered the treatment of choice for women starting treatment below age 60 years, and especially for those with a premature menopause.
Hormone Roles

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FDA Indications

The current indications for use from the U.S. Food and Drug Administration include short-term treatment of menopausal symptoms, such as vasomotor hot flashes or urogenital atrophy, and prevention of osteoporosis. In 2012 and 2017, the United States Preventive Task Force concluded that the harmful effects of combined estrogen and progestin are likely to exceed the chronic disease prevention benefits in most women. A consensus expert opinion published by The Endocrine Society stated that when taken during perimenopause, or the initial years of menopause, hormonal therapy carries significantly fewer risks than previously published, and reduces all cause mortality in most patient scenarios. The American Association of Clinical Endocrinology also released a position statement in 2009 that approved of HRT in appropriate clinical scenarios.

HRT for Cardiovascular Effects

HRT for Endometrial effects

HRT for Musculoskeletal effects

HRT for Neurologic effects