HORMONE REPLACEMENT THERAPY:

The HRT is indicated in menopausal women to overcome the short-term and long-term
consequences of oestrogen deficiency.
INDICATION OF HRT:-
◦ Hormone replacement therapy (HRT) is generally advised for women who are
symptomatic and are at high risk of developing cardiovascular disorders,
osteoporosis, Alzheimer disorder or colonic cancer,
◦ for prevention of osteoporosis and
◦ To maintain the quality of life in menopausal years.

CONTRAINDICATIONS OF HRT:-
◦ It include the presence of breast or endometrial cancer,
◦ active thrombophlebitis and
◦ Undiagnosed abnormal uterine bleeding.
◦ Women with active liver disease should not be advised oral oestrogen therapy.
BENEFITS OF HORMONE REPLACEMENT THERAPY:-
◦ Improvement of vasomotor symptoms (70-80%)
◦ Improvement of urogenital atrophy
◦ Increase in bone mineral density (2-5%)
◦ Decreased risk in vertebral and hip fractures (25-50%)
◦ Reduction in colorectal cancer (20%)
◦ Possibly cardio protection.
TREATMENT REGIMEN FOR OSTEOPOROSIS:
(1) HRT
 Oestrogen: daily dose- 0.625 mg conjugated oestrogen; minimum bone sparing
dose
 Progestin’s (in women with an intact uterus)
Sequential: 5 mg medroxyprogesterone acetate (MDPA) for 2 weeks every month
Continuous combined regimen: 2.5 mg MDPA
 Oestrogen may be administered orally, subdermal implants, vaginal cream,
percutaneous gel or by transdermal patch.
(2) OTHER DRUGS
 Calcitonin 200 IU/day- inhibits bone resorption
  Fluoride 1 mg/kg- increases bone matrix
 Tibolone 1.25 mg/day
 Raloxifene- increases bone mineral density, reduce serum LDL and to raise HDL
level so risk of breast and endometrial cancer is reduced.
 Clonidine- reduce the severity and duration of hot flushes.
 Biphosphonates- Alendronate 5 mg/day for prevention; 10 mg/day
Prevents osteoclastic bone resorption.
(3)ADDITIONAL MEASURES
 Weight bearing exercises
 Adequate ultraviolet exposure
 Vitamin D >400 IU/day
 Calcium supplementation-1000 mg/day
 Stop smoking and alcohol consumption
 Avoid excessive caffeine
MONITORING PRIOR TO AND DURING HRT:-
A base level parameter of the following and their subsequent check-up (at least
annually) are mandatory.
◦ Physical examination including pelvic examination
◦ Blood pressure recording
◦ Breast examination and mammography
◦ Cervical cytology
◦ Pelvic ultrasonography (TVS) to measure endometrial thickness.
Any irregular bleeding should be investigated thoroughly.
RISKS OF HORMONE REPLACEMENT THERAPY:-
◦ Endometrial cancer
◦ Breast cancer
◦ Venous Thromboembolic disease
◦ Coronary Heart Disease
◦ Lipid metabolism
◦ Dementia, Alzheimer disease