Hormone replacement therapy (HRT) can effectively relieve menopausal symptoms by replacing lost estrogen and progesterone, but also increases cancer risks. It is prescribed for post-menopausal women experiencing hot flashes, night sweats, and other symptoms. While HRT prevents osteoporosis and heart disease, studies have shown links to breast, ovarian, and uterine cancers. The risks and benefits must be weighed carefully and HRT should only be used at the lowest effective dose for a limited time. Lifestyle changes and alternative therapies may also help manage menopause symptoms without HRT.

1. Hormone Replacement TherapyHormone Replacement Therapy
in Post Menopausal Femalein Post Menopausal Female
Presented By :- SiddharthPresented By :- Siddharth
NarukaNaruka
:- Nidhi Shah:- Nidhi Shah

2. IntroductionIntroduction
 200 years ago, fewer than 30% of women lived long200 years ago, fewer than 30% of women lived long
enough to experience menopose.enough to experience menopose.
 100 years ago the average women’s life expectancy just100 years ago the average women’s life expectancy just
reached 50 years of age.reached 50 years of age.
 With increasing longevity after the menopause, a womanWith increasing longevity after the menopause, a woman
can now expect to spend nearly 40% of her life spancan now expect to spend nearly 40% of her life span
(about 30 year’s) after menopause.(about 30 year’s) after menopause.
 Perimenopause and menopause is a complex endocrinePerimenopause and menopause is a complex endocrine
process- Oestrogen definciency.process- Oestrogen definciency.
 For many women, Hormone Replacement TherapyFor many women, Hormone Replacement Therapy
(HRT) provides very effictive relief from distressing(HRT) provides very effictive relief from distressing
menopausal symptoms and improve their quality of life.menopausal symptoms and improve their quality of life.
 HRT used in early menopause offers an importantHRT used in early menopause offers an important
preventive role in osteoporosis and coronary heartpreventive role in osteoporosis and coronary heart
disease.disease.

3. TERMINOLOGYTERMINOLOGY
 Perimenopause/Climacteric:Perimenopause/Climacteric: follows period offollows period of
declining fertility and it preceds menopause.declining fertility and it preceds menopause.
 Menopause :Menopause : According to WHO menopause isAccording to WHO menopause is
permanent cessation of menstruation resultingpermanent cessation of menstruation resulting
from loss of ovarian follicular activity.from loss of ovarian follicular activity.
 Postmenopausal female :Postmenopausal female : these are womens atthese are womens at
stage after the menopause.generallystage after the menopause.generally
determined after 12 months of menstrualdetermined after 12 months of menstrual
cessation.cessation.
 HRT:HRT: It is the therapy used for replacement ofIt is the therapy used for replacement of
hormone to releive symptoms of thehormone to releive symptoms of the
menopausemenopause

4. Who can take HRT?Who can take HRT?
 Most Women can have HRT if they are experiencingMost Women can have HRT if they are experiencing
symptoms associated with the menopause.symptoms associated with the menopause.
 Menopausal Symptoms:Menopausal Symptoms:
 Hot flashes and vaginal drynessHot flashes and vaginal dryness
 InsomniaInsomnia
 Absence of Menstruation or irregular menstruationAbsence of Menstruation or irregular menstruation
 Dryness or loss of hairDryness or loss of hair
 OsteoporosisOsteoporosis
 Coronary Heart DiseaseCoronary Heart Disease
 The average age of women at the time of menopause isThe average age of women at the time of menopause is
51 years.51 years.
 The most common age range at which womenThe most common age range at which women
experience menopause is at 48-55 year’s.experience menopause is at 48-55 year’s.

5. Types and Intake of HRTTypes and Intake of HRT
 Different types of HRT areDifferent types of HRT are
available they are as followavailable they are as follow
1.1. Only estrogen:Only estrogen: it includesit includes
estradiol,estrone and estriolestradiol,estrone and estriol
2.2. Combined HRT:Combined HRT: it includesit includes
both estrogen andboth estrogen and
progesterone. Mainly usedprogesterone. Mainly used
for preventing endometrialfor preventing endometrial
cancercancer
 Intake of HRTIntake of HRT
1.1. Skin patchesSkin patches
2.2. TabletsTablets
33 Oestrogen gelsOestrogen gels
44 ImplantsImplants
55 Vaginal oestrogenVaginal oestrogen

6. Courses of HRTCourses of HRT
1.1. Cyclical HRT :Cyclical HRT : Recommended for womens takingRecommended for womens taking
combined HRT who have menopausal symptoms butcombined HRT who have menopausal symptoms but
still have their periods.still have their periods.
 Monthly HRT :Monthly HRT : estrogen is taken everyday, and progestroneestrogen is taken everyday, and progestrone
alongside for around last 14 days of your menstrual cyclealongside for around last 14 days of your menstrual cycle
 Three monthly HRT:Three monthly HRT: you take oestrogen every day and takeyou take oestrogen every day and take
progestogenprogestogen
2.2. Continuous combined HRTContinuous combined HRT
 It is recommended for postmenopausal womens. It involvesIt is recommended for postmenopausal womens. It involves
continuous taking of oestrogen and progestogen everyday.continuous taking of oestrogen and progestogen everyday.

7. Risks and Side-Effects of HRTRisks and Side-Effects of HRT
 It causes Cancer like Breast Cancer,It causes Cancer like Breast Cancer,
Ovarian Cancer, Womb Cancer.Ovarian Cancer, Womb Cancer.
 It causes blood clots which leads toIt causes blood clots which leads to
blocking of blood vessels.blocking of blood vessels.
 It causes heart disease and strokes.It causes heart disease and strokes.
 The main sideeffects includes breastThe main sideeffects includes breast
tenderness, nausea, headaches, vaginaltenderness, nausea, headaches, vaginal
bleeding, Mood Swings etc.bleeding, Mood Swings etc.

8. CAN HRT GIVE YOU CANCER?CAN HRT GIVE YOU CANCER?
 According to a million woman study of UK CANCER RESEARCHAccording to a million woman study of UK CANCER RESEARCH
HRT can causes cancer like Breast, Womb , and Ovarian.HRT can causes cancer like Breast, Womb , and Ovarian.
11 BREASTBREAST CANCERCANCER:: The risk of developing breast cancer isThe risk of developing breast cancer is
increased for women using any type of HRT(high for combined)increased for women using any type of HRT(high for combined)
 Once a woman stops using HRT, her risk of breast cancer will start toOnce a woman stops using HRT, her risk of breast cancer will start to
drop back down again. It takes about 4 years to go back to the samedrop back down again. It takes about 4 years to go back to the same
risk as if she hadn’t used HRT.risk as if she hadn’t used HRT.
22 WOMB CANCER:WOMB CANCER: Oestrogen only is responsible for causingOestrogen only is responsible for causing
WOMB CANCER.Thus Oestrogen and Progestrone combined areWOMB CANCER.Thus Oestrogen and Progestrone combined are
given. Progestrone counteract effect of cancer of oestrogen.given. Progestrone counteract effect of cancer of oestrogen.
33 OVARIAN CANCER:OVARIAN CANCER:Any type of HRT causes OvarianAny type of HRT causes Ovarian
Cancer. When a woman stops taking HRT the risk starts to go backCancer. When a woman stops taking HRT the risk starts to go back
down over timedown over time

9. Alternatives Of HRTAlternatives Of HRT
 Lifestyles MeasuresLifestyles Measures: -: - Take regular exercise, take balance diet,Take regular exercise, take balance diet,
stay cool at night, avoid caffeine, alcohol and spicy food.stay cool at night, avoid caffeine, alcohol and spicy food.
 Try to reduce stress level.Try to reduce stress level.
 Avoid Smoking.Avoid Smoking.
 Tibolone: -Tibolone: - It is a prescription that is similar to HRT.It is a prescription that is similar to HRT.
 It can help to relieve symptoms of menopauseIt can help to relieve symptoms of menopause..
 Antidepressants:Antidepressants: -- there are two types of antidepressants, theythere are two types of antidepressants, they
are:- SSRIs(selective serotonin reuptake inhibitor) andare:- SSRIs(selective serotonin reuptake inhibitor) and
SNRIs(selective noradrenaline reuptake inhibitor).SNRIs(selective noradrenaline reuptake inhibitor).
 Bioidentical Hormones:Bioidentical Hormones: -- They are made from plant sources andThey are made from plant sources and
are similar to human hormones.are similar to human hormones.
 Complementary Therapies:Complementary Therapies: -- It includes herbal remedies. SuchIt includes herbal remedies. Such
as evening primrose oil, black cohosh, angelica, ginseng and Stas evening primrose oil, black cohosh, angelica, ginseng and St
John’s Wort.John’s Wort.

10. CONCLUSIONCONCLUSION
 HRT is a tradeoff between the proven benefits ofHRT is a tradeoff between the proven benefits of
relieving menopausal symptoms and preventingrelieving menopausal symptoms and preventing
diseases such as osteoporosis versus the possibility ofdiseases such as osteoporosis versus the possibility of
increasing the risk of cancer. If a woman is at high risk ofincreasing the risk of cancer. If a woman is at high risk of
osteoporosis (due to age, family history, etc.) and has aosteoporosis (due to age, family history, etc.) and has a
relatively low risk of breast cancer, then HRT may be anrelatively low risk of breast cancer, then HRT may be an
easy choice. If a woman is already at high risk of breasteasy choice. If a woman is already at high risk of breast
cancer due to genetic factors, family history, etc. thencancer due to genetic factors, family history, etc. then
the decision to take HRT may be more complicated.the decision to take HRT may be more complicated.
 HRT Should be taken in a lowest effective dose forHRT Should be taken in a lowest effective dose for
limited time period.limited time period.
 However,one must take advice of an medical practionerHowever,one must take advice of an medical practioner
before starting HRT.before starting HRT.