Hormone Replacement Therapy 101 – Side Effects, Preparation

Hormone replacement therapy is intended to alleviate menopausal symptoms. Here you can find out what women should consider and which preparations are available.

What is hormone replacement therapy?

Hormone replacement therapy is intended to alleviate menopause and the associated symptoms. This is because during menopause the body produces fewer hormones, resulting in a deficiency. This can lead to sleep disorders, depressive moods, or hot flashes. These are symptoms that most women want to get rid of as quickly as possible.

Important: Hormone replacement therapy does not aim to restore the hormone concentration that existed in the body before menopause. 

Rather, it is intended to alleviate or, at best, eliminate the symptoms caused by the resulting estrogen deficiency. In the past, hormone replacement therapy was considered generally beneficial to health and preventive. Today, experts recommend it only if the complaints noticeably restrict the woman’s quality of life.

Currently, arguments in favor of hormone replacement therapy include so-called menopausal symptoms such as hot flashes, vaginal dryness, or irritability, as well as the prevention of diseases such as osteoporosis and depression.

Hormone replacement therapy: preparations

Sex hormones on prescription: In hormone replacement therapy, the woman takes either estrogens only (monotherapy) or a combination of progestin and estrogen (combination therapy). More rarely, the artificial hormone tibolone is also used, which makes it unnecessary to add progestogen. However, tibolone is only suitable from one year after the onset of menopause, as otherwise there may be increased bleeding.

Which method the doctor recommends, how high or low the dosage may be in order to be effective, and in which form the woman takes the female sex hormones in hormone replacement therapy varies from individual to individual.

  • One uncomplicated option, for example, is hormone replacement therapy using a patch. The woman changes the patch once or twice a week and can shower, exercise, and go about her daily life as normal.
  • Hormone replacement therapy using a gel is also possible, although it is somewhat more complicated than the patch. The woman applies it daily to her thigh or abdomen. The gel contains natural estrogens, in varying doses depending on the product.
  • Creams, ointments, and vaginal suppositories containing estrogen mainly act on the urethra, vagina, and bladder. Accordingly, they can be used to treat local complaints such as vaginal dryness or urinary tract infections. The woman applies them several times a week.
  • Tablets allow an individual combination of estrogens and progestins. The woman swallows them, depending on her needs and complaints, once a day and continuously or takes a break from taking them regularly, similar to the birth control pill.

In hormone therapy, the treating physician will do the medication as low as possible, that is, with the minimum dose that will effectively treat the menopausal symptoms.

In addition, there are some herbal remedies with estrogen-like effects (phytoestrogens, isoflavones) that are thought to help with menopausal symptoms. These include valerian, hops, St. John’s wort, monk’s pepper, sage, or soy. However, their effectiveness has not (yet) been adequately proven in scientific studies. Some can even be dangerous: While such medicinal plants are considered harmless in natural form (e.g. tea), they can sometimes trigger undesirable side effects in concentrated tablet or powder form.

Hormone replacement therapy: when does it take effect?

Hormone therapy should be carefully considered. However, if the doctor and patient decide in favor of it, the effect usually becomes noticeable quickly. 

Complaints such as sleep disturbances, hot flashes, and depressive moods often subside after a few days, but after two to four weeks at the latest. It takes several months for chronic conditions or degenerative diseases in which the nerve cells perish, such as arteriosclerosis or osteoporosis, to improve. 

The positive effects of estrogen on the skin and blood vessels usually take a similar amount of time.

Hormone replacement therapy: side effects

Hormones have a great influence on various processes in the body. For this reason, the doctor and the patient should always carefully consider whether treatment makes sense and discuss the benefits and risks before deciding for or against hormone replacement therapy. This should then be based on the woman’s personal wishes and needs.

A common side effect of hormone replacement therapy is weight gain, often due to water retention in the tissues.

Breast tenderness and bleeding disorders are also often undesirable side effects of hormone administration. The latter occur in 30 to 40 percent of women and range from brief intermittent to continuous bleeding. Some women lose the desire for sex or feel generally listless.

Serious illnesses can also occur in the course of hormone replacement therapy: breast cancer, for example, becomes more likely if the treatment lasts longer than five years, although the therapy does not appear to be the trigger, but merely stimulates cell growth.

The risk of thrombosis or cardiovascular disease may also increase. Women should therefore discuss with their doctor at least once a year whether and how they should continue to be treated, especially if they have a hereditary predisposition (e.g. breast cancer, thromboses), are overweight, smoke heavily or have had to lie down for a long time after an operation or similar (thromboses, embolisms).

Stopping hormone replacement therapy correctly

There is no clear and generally valid recommendation for hormone replacement therapy, nor for how long it should last. It is therefore important that the treating physician and the woman concerned regularly (at least once a year) evaluate whether the treatment is working as desired, whether there are side effects and how high the level of suffering caused by the menopausal symptoms is.

Closely monitored, hormone replacement therapy can also last longer than five years or be started after the age of 60, although the latter wants to be carefully considered due to the increased risk of serious illnesses (e.g. stroke).

Women who want to discontinue hormone replacement therapy – either because they want to test whether it is still necessary or because the side effects bother them more than the menopausal symptoms – should not do so abruptly and only in consultation with their doctor. So far, it is impossible to predict what the effect will be when hormone intake stops. It may be that the critical phase has already passed and with it the menopausal symptoms. 

Or perhaps the hormone replacement therapy has only postponed the hormone change, so that the symptoms return as soon as the woman stops taking hormones. In any case, reduce the dose slowly and wait after each stage to see how your body reacts to the adjustment.

Especially if the hormone dose was high, you may experience sweating and hot flashes if you reduce the amount too quickly. Better: “phase out” the dose over a period of two to three months.

Hormone replacement therapy in men

Men can also go through a kind of menopause. This is when testosterone production decreases. This usually becomes noticeable between the ages of 50 and 60 – with similar complaints to those experienced by women.

Research in this area is not yet very advanced, and little is known about the consequences and effects of hormone administration in men. 

Therefore, no one should prematurely undergo hormone replacement therapy with the male sex hormone. In any case, men should discuss this plan in detail with their doctor. 

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