Hormone replacement therapy (HRT)

no.1 Menopause is the point in time when a woman’s menstrual periods stop. Menopause happens because the ovaries stop producing the hormones estrogen and progesterone. Menopause affects every woman differently. Some women have no symptoms, but some women have changes in several areas of their lives. It’s not always possible to tell if these changes are related to aging, menopause, or both. Symptoms of menopause can include insomnia, hot flashes, palpitations, thinning hair, vaginal dryness and mood changes (Longo et al, 2013).

Hormone replacement therapy (HRT) is a treatment for menopause. It replaces the hormones that the body is now producing at very low levels. HRT poses several health risks. While HRT is proven to reduce the effects of menopause it is also shown to increase a woman’s risk of certain cancers as well as strokes, heart attacks, and pulmonary embolisms. The risks and benefits should be examined closely and fully explained to the patient. Prescribing the lowest possible effective dose for the shortest duration can help decrease these potential effects. Therapy for 1 to 4 years seems to outweigh the risks, however therapy for longer than 4 years is questionable (Arcangelo & Peterson, 2013).

As a practitioner I would advise patients to try alternative treatments prior to prescribing HRT. I would instruct patients on decreasing intake of caffeine, alcohol, and refined carbohydrates to help reduce the symptoms (Arcangelo & Peterson, 2013). I would also suggest natural estrogen supplements and herbs. Estrogen gel can be used, however it poses the same risk as oral estrogen. If a patient insists on HRT, I would educate her on the risks. If I felt the patient was knowledgeable on the facts and still wanted HRT, I would prescribe it for her. I would prescribe the lowest dose for the shortest time possible to get her symptoms under control.
no.2Hormone replacement therapy (HRT) is typically seen in women who are in menopause. HRT is used to help relieve symptoms of menopausal women who still have their uterus (Hickey, Elliott & Davison, 2012). The symptoms women typically seek medical help for include insomnia, mood changes, and hot flashes (Arcangelo & Peterson, 2013). The risks of HRT include breast cancer, venous thromboembolism, coronary heart disease, stroke, and cholecystitis (Arcangelo & Peterson, 2013).

There is a higher risk for adverse reactions with the use of HRT, so that is why I would not order it on a patient who was requesting it in the office. I would recommend that the patient use herbal supplements, such as black cohosh or St John’s wort also the change in diet can help assist with some of the symptoms. These supplements should still be used in close observation as they can have an affect on a patient’s blood pressure. The supplements can help alleviate symptoms associated with menopause and increase the patient’s quality of life.

Androgen Replacement Therapy

Hormone replacement therapy in men usually involves the replacement of testosterone, or androgen replacement therapy (ART). Normal testicular function is needed for the male physical strength and behavior (Mäkinen & Huhtaniemi, 2011). Aging men can have a decreased level of testosterone this can begin around the age of 40 (Mäkinen & Huhtaniemi, 2011). The risks of low testosterone can include chronic illnesses such as hypertension, coronary artery disease, obesity, and diabetes mellitus (Mäkinen & Huhtaniemi, 2011). The adverse affects of ART may cause an increased libido, or aggression and patient should be monitored closely (Mäkinen & Huhtaniemi, 2011).

Practitioner who would be prescribing ART should be done only when the male patient is symptomatic, with low testosterone levels. Theses symptoms would include reduced muscle mass, decreased muscle strength, increased fat mass, decreased bone mineral density, decreased in morning erections, decreased libido, depression, nervousness, and insomnia (Mäkinen & Huhtaniemi, 2011). As a practitioner I would insure that the levels of the male patient’s testosterone were of a level that would cause concern, and the patient was symptomatic. I would ensure that all the proper tests were ordered.

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