The most commonly prescribed hormone replacement therapy (HRT) is estrogen plus progestogen combination therapy. This type of HRT contains forms of the female hormones estrogen and progestogen. It is primarily prescribed for women going through menopause to help manage troublesome symptoms like hot flashes, night sweats, vaginal dryness, and sleep disturbances.
The specific medications prescribed can vary, but common forms include:
- Estrogen:
- Conjugated equine estrogens (Premarin)
- Estradiol
- Oral preparations (tablets, patches, gels, sprays)
- Vaginal preparations (creams, rings, tablets)
- Progestogens:
- Progesterone
- Micronized progesterone (Prometrium)
- Progestins
- Medroxyprogesterone (Provera)
- Norethindrone (Aygestin)
Combination estrogen-progestogen therapy is generally the preferred option for women with an intact uterus to reduce the risk of endometrial hyperplasia and cancer that can occur with estrogen alone. The progestogen component helps mitigate this risk.
There are a few different regimens and formulations that may be used:
- Continuous combined HRT: Both estrogen and progestogen taken daily
- Cyclic/Sequential HRT: Estrogen taken daily, progestogen taken for ~14 days of each month
- Continuous estrogen with intermittent progestogen
The route of administration may also vary:
- Oral tablets/capsules
- Transdermal patches
- Gels, sprays, creams
- Vaginal rings, creams, tablets
Key factors that help determine which specific medications and regimens are prescribed include:
- Age and time since menopause
- Younger, recently menopausal women may benefit more from standard cyclic regimens
- Older women further from menopause may do better on continuous combined
- Presence/absence of uterus
- Those with no uterus can take estrogen alone
- Those with a uterus need combo therapy with progestogen
- Individual symptom profile
- Vasomotor symptoms (hot flashes) often respond well to oral/transdermal
- Genitourinary syndrome of menopause may benefit more from localized vaginal estrogen
- Personal preferences
- Some may prefer oral tablets while others favor patches, gels or creams
- Risk factors
- Age, time since menopause, family history of cancers, cardiovascular and thrombotic risks help determine regimen
The goals of HRT are to:
- Alleviate bothersome menopausal symptoms like hot flashes, night sweats
- Prevent or slow osteoporosis-related bone loss
- Improve vaginal atrophy and dryness
- Slow skin changes and collagen/elastic tissue breakdown
- Help stabilize mood, energy, cognitive performance
- Improve sleep hygiene and quality
- Improve urogenital and sexual health
The duration of HRT is individualized but often recommended for the shortest time needed to manage symptoms, generally a few years or until around age 60. Some women may be advised to continue longer based on symptoms, risk factors and shared decision making with their provider.
There are some risks to consider with
hormone therapy, primarily strokes, blood clots, gallstones, and certain cancers if used for more than 3-5 years. However, for most women under 60 who use HRT for less than 5 years, the benefits outweigh the risks. Careful screening and monitoring by healthcare providers can help mitigate these risks.
In summary, the most common HRT prescribed is a combination of estrogen and progestogen, available in various formulations, routes of administration and cyclic regimens. The specific choice depends most importantly on the presence/absence of a uterus, timing since menopause, individual risk factors, bothersome symptoms, and personal preferences. When individually optimized under medical supervision, HRT offers a safe and effective option for managing symptoms and improving quality of life for many women transitioning through menopause.
