Hormone replacement therapy
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This article is about hormone replacement therapy in menopause. For other forms, see Hormone therapy.
Hormone replacement therapy (HRT), also known as menopausal hormone therapy (MHT) or postmenopausal hormone therapy (PHT, PMHT), is a form of hormone therapy used to treat symptoms associated with female menopause. These symptoms can include hot flashes, vaginal atrophy, accelerated skin aging, vaginal dryness, decreased muscle mass, sexual dysfunction, and bone loss. They are in large part related to the diminished levels of sex hormones that occur during menopause.
The main hormonal medications used in HRT for menopausal symptoms are estrogens and progestogens, among which progesterone is the major naturally-occurring female sex hormone and also a manufactured medication used in menopausal hormone therapy. Though both can have symptomatic benefits, progestogen is specifically added to estrogen regimens when the uterus is still present. Unopposed estrogen therapy promotes endometrial thickening and can increase the risk of cancer, while progestogen reduces this risk. Androgens like testosterone are sometimes used as well. HRT is available through a variety of different routes.
The results of the Women’s Health Initiative (WHI) suggest both potential risks and benefits across different organ systems. Long term follow up of the WHI participants, however, has found no difference in all-cause, cardiovascular, or cancer mortality with HRT. Later studies suggested that risk can differ depending on route of administration. “Bioidentical” hormone replacement – a development in the 21st century using manufactured compounds having “exactly the same chemical and molecular structure as hormones that are produced in the human body”, and are based mainly on steroids from plants – has inadequate clinical research to determine its efficacy and safety, as of 2017.
The current indications for use from the United States Food and Drug Administration (FDA) include short-term treatment of menopausal symptoms, such as vasomotor hot flashes or vaginal atrophy, and prevention of osteoporosis.
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