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Estrogen Replacement Therapy

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What is it?

Estrogen is the female sex hormone and it plays a significant role in menstrual cycle and reproduction. Estrogen Replacement Therapy (ERT) is a medical procedure wherein the hormone is externally administered in women to elevate the estrogen levels inside the body.

Why is it advised?

ERT is specifically advised to postmenopausal women who are devoid of uterus. The therapy controls vasomotor symptoms like night sweats, hot flushes, irritability, fatigue, vaginal dryness, stress incontinence, dizziness, etc. which usually become prominent during perimenopause and menopause. One of the primary reasons behind doctors advising ERT is to prevent osteoporosis in menopausal women. This is also applicable to women of any age group who have undergone ovary removal and have become naturally prone to bone loss.

How is it Done?

ERT can be carried out in various ways:

Point to Note: Women who are with uterus are given progestin and estrogen together because if estrogen is administered alone it leads to overgrowth of the uterine lining, making one susceptible to uterine cancer.  

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1.Estrogen Pills: The dosage of the pills could be everyday or 25 days each month. Women who had undergone hysterectomy can take estrogen alone, while others take a combination estrogen and progestin pill.

2.Cyclic Method: In this method, estrogen (every day or daily for 25 days of the month) and progestin (10-14 days of the month) are taken separately.

3.Transdermal patch method:  A patch is applied to the skin of the abdomen or buttocks for 3 and a half days or 7 days, which is then discarded and a new one is applied. The patch can be left all times but cannot be exposed to direct sunlight. You can wear on while swimming or bathing but avoid while on hot tub, sauna or on tanning bed. In this technique, the estrogen, or estrogen-progestin combination is administered through the skin directly into the bloodstream.

4.Other methods: Estrogen cream, vaginal ring, intramuscular injections, subcutaneous implantation, and transdermal gels are also used mainly to heal vaginal dryness. These methods also deliver estrogen into the bloodstream without accessing the liver.

Limitations for ERT

1.Who should avoid?

 ERT is strongly not allowed for

  • Pregnant women
  • Women with phosopholipid antibodies
  • Men/women with history of heart stroke or high blood pressure
  • Women with abnormal vaginal bleeding
  • Men/women with liver problems and diseases
  • Women with ovarian, uterine and breast cancer
  • Men/women with blood clots
  • Smokers
  • Women with deep vein thrombosis

2.Side Effects: No doubt there are side effects of the pills and other methods. They include nausea, dizziness, weight gain, fluid retention, bloating, breast tenderness, cramping, indigestion, vaginal discharge, etc. However, the symptoms disappear within a few days and with change in lifestyle as suggested by doctors.

3.Risks: Risks and health hazards of undergoing ERT depend on your age and health problems. Some common risks include increase in chances of stroke, ovarian cancer, blood clots, gall stones, breast cancer, and dementia.

Advantages of ERT

The advantages definitely outweigh the risks of ERT when the appropriate candidate is chosen for the treatment.  It has been successful in many women globally and the results are:  

  • Fractures in hips, wrist, and spine decrease by 50–70%, i.e. prevention of osteoporosis.
  • The therapy reduces all the post menopausal symptoms as explained above.
  • Spinal bone density increases by ~5% within 3 years of the onset of menopause.
  • ERT decrease the risk of heart disease when initiated early in postmenopausal years.

We suggest you to consult your doctor properly and explain him/her your health conditions before he/she prescribes you the therapy. Your health condition will considerably improve with a year only if you are taking the dose properly.

Written by: Saptakee sengupta
Date last updated: January 02, 2015

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