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Form of hormone therapy / From Wikipedia, the free encyclopedia
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.[1][2] 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 this time.[1][2]
The main hormonal medications used in HRT for menopausal symptoms are estrogens and progestogens.[3] 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 lead to cancer, while progestogen reduces this risk.[3][4][5] Androgens like testosterone are sometimes used as well.[6] HRT is available through a variety of different routes.[3]
The long-term effects of HRT on most organ systems vary by age and time since last physiologic exposure to hormones, and there can be large differences in individual regimens, factors which have made analyzing effect difficult.[7] There have been several large trials on hormone replacement in women, with the Women's Health Initiative (WHI) of the National Institutes of Health being the largest prospective study to date, and in particular having a significant impact since its inception. The WHI was a massive study of over 27,000 women conducted beginning in 1991 and taking place over 15 years, with multiple subsequent publications since that time analyzing its data.
The results of the WHI have been complex, and 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.[7] Later studies have suggested that risk can differ depending on route of administration.[8] Bioidentical hormone replacement is a more recent development, and while some early data suggests an improved risk profile, there have been no large prospective studies to date.[9]
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.[10]