Hormone replacement therapy (HRT) consists of medications that replenish progestin and estrogen levels in women undergoing menopause. Around the menopausal period (45-55 years), the balance between the secretion of estrogen and follicle-stimulating hormone (FSH) is sparse. The resultant of this off-balance is irregular periods, mood swings, night sweats, osteoporosis, hot flashes, and vaginal dryness. Menopause is a natural physiological process that occurs in women due to progesterone and estrogen’s slower production.

HRT is available as estrogen, progesterone, a combination of the two, and a combination of other medications and estrogen. These drugs are available as creams, gels, injections, skin patches, pills, and tablets. Pills and tablets constitute HRT available for oral route administration. Therefore, a physician’s discussion will help you assess the risk-benefit profile and choose the best HRT for your medical condition.

Oral estrogen

Doctors consider estrogen as the ‘gold standard’ treatment therapy for menopausal manifestations. Estrogen is effective in treating vasomotor symptoms. Some of the estrogen agents used for hormonal therapy include estriol, estradiol valerate, estradiol hemihydrate, micronized 17-beta-estradiol, conjugated equine estrogens (CEEs), and synthetic conjugated estrogens. These products differ in the risk-benefit profiles and routes of administration.

You can take synthetic conjugated estrogens, estradiol, estradiol acetate, esterified estrogens, estropipate, and CEEs orally to minimize menopausal symptoms. Estrogen-only drugs for HRT reduce menopausal symptoms such as night sweats and hot flushes. Furthermore, estrogen drugs will lessen the discomfort you might experience during intercourse by decreasing vaginal itchiness and dryness. Estrogen replacement therapy (ERT) is effective in alleviating irritability and insomnia.

Therefore, your doctor can recommend ERT to reduce these vasomotor symptoms. You can take orally available ERT, such as estradiol acetate, to increase bone density and minimize osteoporosis. Estrogen-only therapy is recommended for women who have undergone hysterectomy (surgical uterine removal) since there is no risk of endometrial hyperplasia or cancer development.

Oral progesterone

Progesterone induces secretory transformation of the uterine walls, controls the menstrual cycle, and maintains pregnancy. In the HRT, progesterone prevents the hyperplasia of the endometrial walls and cancer development because of unopposed ERT. However, this occurs in women with an unimpaired uterus, and thus, such women should take estrogen with progestin. Synthetic progesterone is termed as progestin and is related structurally to testosterone.

Available progestin for menopausal women includes medroxyprogesterone acetate (MPA), micronized progesterone, and dydrogesterone. However, research indicates that MPA has a lower benefit-risk profile because of the high predisposition to breast cancer development. Micronized progesterone and MPA are available as oral medications. Progestin and progesterone derivatives can increase bone density, reduce endometrial proliferation, improve the cardiovascular system (CVS), and the nervous system.

Estrogen combination with progesterone

You can find this combination as oral medications in the form of estradiol with norethindrone acetate, conjugated estrogen with MPA, ethinyl estradiol with norethindrone acetate, estradiol with drospirenone, and estradiol with norgestimate.

The combination of the two drugs follows national guidelines on HRT administration. Your doctor prescribes the duration and dose of progesterone, depending on the dosage and estrogen type you take. Furthermore, your doctor should carry out endometrial response analysis to progestin after carrying out a biopsy. If you have any underlying medical conditions, your physician will ensure that the combined benefits outweigh the side effects.

Sequential HRT encompasses the administration of estrogen daily with progesterone addition for ten days to two weeks. These progestin additions can occur monthly or after every 13 weeks. Other available approaches involve the concurrent continuous administration of progesterone and estrogen to promote amenorrhea. However, this strategy requires the administration of lower progesterone doses to reduce the risk of break cancer development and is available to women with more than two years amenorrhea.

Conversely, women in the perimenopausal period take sequential HRTs with higher doses of progesterone and low doses of estrogen. Perimenopausal women experience high production of estradiol and thus, experience irregular flows. If you are in this period and new to the HRT, you can talk to your physician to increase the levels of estrogen to stabilize the endometrium.

Estrogen combination with other drugs

Other oral combinations that are progesterone free include tibolone, raloxifene, and bazedoxifene. Raloxifene aids postmenopausal women in preventing osteoporosis. Additionally, raloxifene decreases concentrations of circulating low-density lipoprotein (LDL) and the risk of developing breast cancer. A combination of raloxifene and estrogen alleviates most of the postmenopausal symptoms.

Tibolone prevents the onset of osteoporosis experienced by postmenopausal women. A combination with estrogen eliminates hot flushes, vaginal dryness, weakening of bones, and mood fluctuations in the postmenopausal period. You can also take a combination of bazedoxifene with conjugated estrogen to minimize menopausal symptoms. Bazedoxifene acts via blocking estrogen from accessing the endometrial wall, thus preventing hyperplasia of the endometrium.

Handling menopausal symptoms can be challenging with many factors to assess to get the best outcome from the HRT. If you prefer taking hormonal therapy orally and want to solve those challenges, worry no more. We can help, call now (205) 352-9141.

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