Hormone Replacement Therapy (HRT) is a medical approach that involves supplementing the body with reduced sex hormones to alleviate symptoms caused by hormonal imbalance. It primarily targets menopausal women experiencing estrogen decline, such as hot flashes, insomnia, and osteoporosis; men with testosterone deficiency due to aging or illness; and certain congenital hormone deficiencies. This therapy requires evaluation by a qualified physician to develop a personalized plan based on the patient's age, medical history, and severity of symptoms.
Hormone replacement therapy can be divided into estrogen replacement therapy (ERT) and combination therapy (ERT + progestogen). Estrogen, absorbed through transdermal patches or oral formulations, acts directly on the hypothalamus to regulate body temperature and mood swings; progestogen is used in women with a uterus to prevent the increased risk of endometrial cancer associated with long-term estrogen use alone. For men, testosterone is supplemented via subcutaneous injections or gels to promote muscle synthesis and restore libido.
Primarily used for menopausal syndrome (such as severe hot flashes, vaginal dryness), osteoporosis, estrogen deficiency after hysterectomy, and primary hypogonadism in men. Hormone deficiency caused by certain congenital adrenal hyperplasia or pituitary tumors can also be improved with this therapy to enhance secondary sexual characteristics and reproductive function.
Estrogen formulations include oral tablets (e.g., 1.25mg Conjugated Equine Estrogens), transdermal patches (releasing 25-50mcg daily), and creams. Progestogen is typically administered via oral progesterone capsules (10mg-200mg daily) or vaginal rings. Male testosterone gels are used at a daily dose of 25-50mg, evenly applied to dry skin. Physicians will adjust the dosage every 3-6 months based on symptom severity and organ metabolism status.
This therapy can effectively relieve menopausal symptoms in 70-80% of patients, reduce the rate of bone loss by up to 30%, and decrease fracture risk. Long-term use can also improve cardiovascular health indicators, such as lowering LDL cholesterol and increasing HDL cholesterol. In men, it can enhance muscle mass, improve erectile function, and overall quality of life.
Long-term use may increase the risk of endometrial cancer (5-10 times higher without progestogen), thrombosis (2-3 times higher in older patients), and breast cancer (1.3 times increased after 5 years of continuous use). Common short-term side effects include breast tenderness, edema, and headaches; men may experience acne or gynecomastia. Strict adherence to prescribed cycles is essential; do not adjust dosages independently.
Contraindications include a known history of thrombosis, untreated endometrial cancer, severe liver disease, and recent myocardial infarction. During treatment, regular ultrasound and endometrial thickness assessments should be performed every 6 months, along with monitoring liver and kidney functions. Pregnant or breastfeeding women must not use this therapy. Patients should inform their healthcare provider of all medications they are taking to avoid interactions.
Concurrent use with anticoagulants (e.g., warfarin) may increase bleeding risk and require dosage adjustments. When used with anticonvulsants (e.g., phenytoin), hormone metabolism may be accelerated, reducing effectiveness. When using selective estrogen receptor modulators (SERMs), evaluate potential antagonistic effects with estrogen. Patients should proactively inform their healthcare providers about all prescriptions, traditional medicines, and supplements.
Large studies show that after 1 year of HRT, 85% of women experience symptom improvement, and bone mineral density increases by 2-4%. WHO guidelines recommend short-term use for women under 60 with severe symptoms and no contraindications. Testosterone therapy in men with low testosterone levels can restore serum testosterone to normal ranges and improve sexual function indices.
Non-hormonal alternatives include selective estrogen receptor modulators (e.g., Raloxifene), SSRIs for mood symptoms, and bisphosphonates for osteoporosis prevention. Lifestyle modifications such as calcium and vitamin D intake and regular weight-bearing exercise can serve as foundational treatments. Traditional Chinese medicine approaches like acupuncture and herbal supplements (e.g., black cohosh) are available in some countries as adjunct therapies but require quality control considerations.
HRT can be administered via transdermal patches, oral pills, or topical gels. Patches should avoid contact with irritating chemicals and be replaced weekly to prevent skin irritation; oral pills should be taken with meals to reduce gastrointestinal discomfort; gels need to be fully absorbed before contact with water or friction. The choice of method should be based on individual lifestyle and medical advice.
What tests or preparations are needed before starting therapy?Before initiating therapy, ultrasound of the uterus, blood tests, and personal medical history assessments are necessary. Additional evaluation of risks related to cardiovascular disease or breast cancer may be required. The doctor will tailor the plan based on age, symptom severity, and whether the uterus is retained (necessitating progestogen). An informed consent form explaining potential risks should be signed.
How should I respond if I experience side effects like hot flashes or edema during treatment?Short-term hot flashes can be managed with cold compresses or layered clothing; if frequent, the physician may adjust the dose or add medications like GABA agonists. Edema can be managed by reducing salt intake and increasing exercise; severe cases should be evaluated for possible excess estrogen. All side effects should be documented and communicated with the healthcare provider promptly.
Are there specific dietary or exercise considerations during hormone therapy?During treatment, increasing calcium and vitamin D intake is recommended to maintain bone density, while avoiding high-fat diets that may contribute to weight gain. Moderate aerobic exercise can improve circulation and alleviate symptoms, but excessive vigorous activity may accelerate hormone metabolism. Caffeine and alcohol may trigger hot flashes and should be consumed in moderation.
Will symptoms worsen immediately after stopping or adjusting the dosage of therapy?After dosage adjustments or discontinuation, some symptoms like hot flashes may reappear within 1-2 weeks, but not everyone will experience immediate worsening. The doctor will gradually adjust to prevent rebound phenomena. If symptoms worsen significantly, a follow-up is necessary to evaluate whether to switch medications or add supportive drugs.
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