What is Hormone Replacement Therapy (HRT)? How is HRT Performed?

Although adapting to the changes in life during menopause, one of the most unique periods for women, is quite important, it is difficult to say that adequate education has been achieved on this subject.

According to data from the World Health Organization (WHO) and the International Menopause Society (IMS), it is estimated that approximately 1.2 billion women worldwide will have entered menopause by 2025. This figure is steadily increasing due to the aging of the global population and the rise in life expectancy.

Properly managing the premenopausal, menopausal, and postmenopausal periods, defined as the cessation of menstruation in women, is essential for both a healthy and quality life. Menopause can open the door to many health problems in women, including cardiovascular diseases and osteoporosis.

What Determines the Age of Menopause?

The average age of menopause for women globally is typically around 45-55 years. This age can vary depending on genetic, environmental, and lifestyle factors. The most significant determinant is genetics. Women curious about their age of menopause can look to their mothers. Unless a unique health condition or early menopause is involved, the approximate period will likely coincide with their mother's menopause age.

Additionally, the presence of some chronic diseases and smoking can lead to earlier menopause, whereas a healthy and balanced diet and an active lifestyle can delay it. Research also suggests that women with a low BMI may experience menopause earlier, while those with a high BMI tend to experience it later, although the exact cause remains uncertain.

What Are the Symptoms of Menopause?

The transition to menopause is not a sudden event. This transition period lasts approximately two years, causing some symptoms due to changes in hormone levels.

Studies show that during the menopausal transition, around 50-75% of women experience hot flashes, night sweats, or both (vasomotor symptoms). Additionally, more than 50% experience dryness and dyspareunia, spotting or bleeding during sexual activity, burning, discomfort, and irritation, which are genitourinary symptoms (Genitourinary Syndrome of Menopause [GSM]).

About 60% of women report focus and memory issues, often referred to as "brain fog." Other symptoms include mood changes like irritability, anxiety, or depression, as well as sleep disturbances..

Of course, menopause is a natural phase that everyone will experience. However, some women may not experience any complaints even 5-10 years after entering menopause. While some women go through menopause with minimal symptoms, others may experience issues like hot flashes, intense sweating, vaginal burning, and frequent urinary tract infections even before entering menopause during the premenopausal phase. It is crucial to note that every woman's experience with menopause is unique. Each woman’s menopause story will differ from another's.. 

What is Hormone Replacement Therapy (HRT)?

Recent research indicates it is time to reconsider Hormone Replacement Therapy (HRT), which has been a subject of debate for many years.

HRT is a treatment method used to alleviate menopause symptoms and prevent health issues that may arise post-menopause. HRT typically involves a combination of estrogen and progesterone hormones..

Estrogen, also known as the "female hormone," positively impacts heart health and skin and hair health. It also protects the urinary tract and vagina from infections and has protective properties against osteoporosis. 
For individuals with vasomotor symptoms, hormone therapy is essential.

In previous years, it was noted that hormone therapy increased the incidence of cancer. However, findings indicated that HRT itself did not cause cancer but could trigger it in individuals with a predisposition. During that period, HRT was halted. However, recent studies have shown no issues with HRT. Moreover, patients are closely monitored, increasing the likelihood of detecting potential cancers at an early stage.

Who is Eligible for Hormone Replacement Therapy (HRT)?

HRT is not administered to all women. It is particularly necessary for women with complaints like hot flashes, sweating, vaginal dryness, and sleep disturbances, collectively termed vasomotor symptoms.

Additionally, it can be applied to women who enter early menopause before the age of 40 or those who have undergone surgical removal of their ovaries.

HRT is contraindicated in individuals with genetic mutations associated with cancer detected through genetic screening. However, women with a family history of cancer but no genetic mutations may be given estrogen under close monitoring.

What Tests Are Performed Before Hormone Replacement Therapy (HRT)?

Before starting HRT, women should undergo a comprehensive evaluation. During the initial consultation, menstrual regularity is assessed. This process is necessary to determine HRT's suitability and evaluate individual risk factors. Hormonal tests, mammography, and breast ultrasounds are requested for women identified as being in menopause. Bone density measurements may be conducted to assess osteoporosis risk, especially in women with a high risk.

Various blood tests, including lipid profile, liver function tests, kidney function tests, thyroid function tests, and sometimes blood glucose levels, are performed. A gynecological examination is conducted, including a Pap smear to assess uterine lining thickness and ovaries. Following an evaluation of all individual risk factors and family history, the decision is made jointly with the patient. Some patients may decide against hormone therapy, stating, "I do not want to use hormone therapy as I have no complaints." In such cases, therapy is not applied.

However, if vasomotor symptoms are present, therapy must be recommended, as studies show that women with these symptoms have a higher risk of dementia and Alzheimer’s.

How Long Does Hormone Replacement Therapy (HRT) Last?

HRT can be initiated within the first 10 years after entering menopause and continued as long as the patient desires. It is beneficial to use it for a minimum of 10 years. The patient’s menopausal age, current condition, biochemistry tests, mammography and breast ultrasound results, and bone density tests are crucial. Hence, regular follow-up during therapy is essential.

Types of Hormone Replacement Therapy (HRT)?

Oral tablets, transdermal patches, topical creams, gels, and sprays, as well as estrogen combined with progesterone or hormonal intrauterine devices, can be used. Recent publications recommend using topical creams or transdermal patches containing natural/bioidentical estrogen in combination with natural/bioidentical progesterone or hormonal spirals. For individuals who have had their uterus and ovaries removed, using estrogen alone suffices.