Hormone replacement therapy
Hormonal Replacement Therapy is a medical treatment containing estrogen, progestogen or both.
Progetogen is added to the preparation for women with an intact uterus.
Indications for HRT include:
Onset of the menopause
Premature Ovarian Failure
Mode of Action
This is almost entirely related to the function of estrogen. HRT's primary function is to reverse the effects a
decrease in blood estrogen has on the body.
While estrogens are present in both men and women, they are usually present at significantly higher levels
in women of reproductive age. They promote the development of female secondary sex characteristics,
such as breasts, and are also involved in the thickening of the endometrium and other aspects of regulating
the menstrual cycle. In males estrogen regulates certain functions of the reproductive system important to
the maturation of sperm and may be necessary for a healthy libido. Furthermore, there are several other
structural changes induced by estrogen, in addition to other functions.
o promote formation of female secondary sex characteristics
o accelerate height growth
o accelerate metabolism (burn fat)
o reduce muscle mass
o stimulate endometrial hyperplasia - progestogen may be added to
counteract this effect
o increase uterine growth
o maintenance of vessel and skin
o reduce bone resorption, increase bone formation
o morphic change (endomorphic -> mesomorphic -> ectomorphic)
* protein synthesis
o increase hepatic production of binding proteins
o increase circulating level of factors 2, 7, 9, 10, antithrombin
o increase platelet adhesiveness
o increase HDL, triglyceride, height growth
o decrease LDL, fat depositition
* Fluid balance
o sodium and water retention
o increase growth hormone
o increase cortisol, SHBG
* gastrointestinal tract
o reduce bowel motility
o increase cholesterol in bile
o increase pheomelanin, reduce eumelanin
o support hormone-sensitive breast cancers
* Lung function
o promotes lung function by supporting alveoli.
On the other hand, sexual desire rather depends on androgen levels than for estrogen levels.
The continuous combined regimen should only be used in patients who have had:
No history of endometiosis
No menstrual periods in the last 12 months
The sequential regimen should be used for everyone else requiring or requesting HRT.
Advantages and Disadvantages of Different Modes of Delivery
Mode of Delivery Advantages Disadvantages
Pills Reliable Poor Compliance
Patches Avoid first pass in liver Poor Compliance
Half-yearly visits to the doctor
Implants Good Compliance
Difficult to use for some
Pessaries Not Messy
Difficult to use for some
Rings Estrogen only
Relatively easy to use
The contraindications for HRT are absolute and include:
Breast or endometrial cancer
Undiagnosed vaginal bleeding
Abnormal liver function test
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6. British National Formulary 2007