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Hormone Replacement Therapy

Hormone replacement therapy (HRT) or in Britain, Hormone therapy (HT) -   now often referred to as "treatment" rather than therapy - is a system of medical treatment for surgically menopausal, perimenopausal and postmenopausal women. It is based on the assumption that the treatment may prevent discomfort caused by diminished circulating estrogen and progesterone hormones.

HRT involves the use of one or more of a group of medications designed to artificially boost hormone levels. The main types of hormones involved are estrogens, progesterone or progestins, and sometimes testosterone.

Various Forms of HRT

HRT is available in various forms. It generally provides low dosages of one or more estrogens, and often also provides either progesterone or a chemical analogue, called a progestin. Testosterone may also be included. In women who have had a hysterectomy, an estrogen compound is usually given without any progesterone, a therapy referred to as "unopposed estrogen therapy". HRT may be delivered to the body via patches, tablets, creams, troches, IUDs, vaginal rings, gels or, more rarely, by injection. Dosage is often varied cyclically, with estrogens taken daily and progesterone or progestins taken for about two weeks every month or two; a method called "sequentially combined HRT" or scHRT. An alternate method, a constant dosage with both types of hormones taken daily, is called "continuous combined HRT" or ccHRT, and is a more recent innovation. Sometimes an androgen, generally testosterone, is added to treat reduced sexual desire/(libido). It may also treat reduced energy and help reduce osteoporosis after menopause.

HRT is seen as a short-term relief (often one or two years, usually less than five) from menopausal symptoms (hot flashes, irregular menstruation, fat redistribution etc.). Younger women with premature ovarian failure or surgical menopause may use hormone replacement therapy for many years, until the age that natural menopause would be expected to occur.

Synthetic Hormone Replacement

Proprietary mixtures of conjugated equine estrogens (CEE) have been a common prescribed form of HRT, as well as progestins that, while not progesterone, approximate its effects. Studies have shown that certain risks are associated with these combinations of progestins and equine estrogens. Because these have been used most commonly and for the longest time, there are many more studies of these forms of hormones than of some of the newer forms with newer delivery systems, and therefore the most is known about these kinds. Whether or not such risks exist with other forms of estrogens and progestins, and other delivery systems, remain to be seen.

Bioidentical Hormone Replacement

Bioidentical hormones are manufactured in the lab to have the same molecular structure as the hormones made by your own body. By contrast, synthetic hormones are intentionally different. Drug companies can’t patent a bioidentical structure, so they invent synthetic hormones that are patentable (Premarin, Prempro and Provera being the most widely used examples).

Though bioidentical hormones have been around for years, most practitioners are unfamiliar with them. There are several branded versions now available for use in the kind of hormone replacement therapy (“HRT”) typical of synthetic hormones. This is generally a one-size-fits-all dosage regime.

The great appeal of bioidentical hormones is that they are natural, and our bodies can metabolize them as it was designed to do, minimizing side effects. Synthetic hormones are quite strong and often produce intolerable side effects. Moreover, the compounded bioidentical hormones can be matched individually to each woman’s needs — something that’s just impossible with mass-produced products.

Are bioidentical hormones safer than synthetics? European medical studies suggest that yes, bioidentical hormones are safer than synthetic versions. This makes perfect sense. But because they have not been well-studied, especially for long-term use, use of any drug can not be ruled as completely safe.

Bioidentical Hormones and Breast Cancer

Breast cancer patients, like Suzanne Somers, use low-dose bioidentical hormones by choice. These women have researched the issues, discussed them with their doctor, and made a well-informed decision for themselves. However, very few doctors will prescribe any type of HRT — synthetic or bioidentical — for women who have had breast cancer or even a family history of breast cancer. In fact, many such women are given anti-estrogen drugs to prevent and/or treat breast cancer. Breast cancer remains the biggest risk for women choosing HRT.

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