John Sklavounos

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Estrogen and progesterone are hormones produced by the ovaries that play a significant role in a woman’s body. Reduced levels cause a wide range of physical and emotional symptoms, including hot flashes, mood swings and vaginal dryness.
Hormone replacement therapy (HRT) is a therapeutical method that aims at relieving the symptoms of menopause. It restores declining hormone levels as you approach menopause.
The aim of hormone replacement therapy is to restore hormone levels, allowing the body to function normally again.
Estrogen helps release eggs from the ovaries. It also regulates a woman’s periods and helps her conceive. Estrogen also plays a part in regulating other functions, including bone density, skin temperature and maintaining bodily fluid volume.

A drop in estrogen causes more symptoms associated with menopause, including:
– hot flashes
– night sweats
– vaginal dryness

– loss of libido (sex drive)
– incontinence stress (leakage of urine when coughing or sneezing)
– thinning of bones – which can lead to osteoporosis and fractures.

Most of these symptoms will disappear within two to five years, although vaginal dryness is likely to get worse if left untreated.

Urinary incontinence may also persist and the risk of osteoporosis will increase with age.

The main role of progesterone is to prepare the uterus for pregnancy.

It also helps to protect the inside of the uterus, known as the endometrium.

A decrease in progesterone levels does not affect your body in the same way as a drop in estrogen levels. However, taking estrogen as hormone replacement therapy when you have a uterus, that is, when you have not undergone a hysterectomy for whichever reason, increases the risk of uterine cancer.

A synthetic form of progesterone, called a progestogen, is usually used in combination with estrogen in HRT.

However, if you have undergone a hysterectomy (surgery to remove your uterus), you do not need progesterone and you can only take estrogen.

Tablets, stickers or implants are necessary if you have menopausal symptoms, such as hot flashes, and have weighed the benefits and risks of treatment.

There are many different HRT combinations, so deciding which type to use can be difficult. Your gynecologist can advise you on the most appropriate option.

The different types of hormone replacement therapy are as follows:
oral tablets
– a patch applied to the skin like a sticker
– an implant – small estrogen pellets inserted under the skin of your abdomen, in the buttock or thigh under local anesthesia
– estrogen gel – applied to the skin and absorbed

If you only experience vaginal dryness, you should probably opt for estrogen formulations that can be applied directly to your vagina. The dosage of these estrogens is so low, that they do not require the protective action of the progestogen. Topical estrogens do not carry the same risks associated with the systemic form of combined hormone replacement therapy. Vaginal estrogens can take the form of:

– pessaries that are placed directly into the vagina
– a vaginal ring
– vaginal cream

Most women can stop taking HRT once menopausal symptoms go away, which is usually two to five years after their onset. Gradually reducing your HRT dose is usually recommended rather than stopping suddenly. You may experience a relapse of menopausal symptoms after stopping hormone replacement therapy, but these will probably pass within a few months.

If symptoms persist for several months after stopping hormone replacement therapy, or if you experience severe symptoms, contact your physician, because you may need treatment again, usually at a lower dose.

After you have stopped HRT, you may need additional treatment for vaginal dryness and the prevention of osteoporosis (brittle bones).
Creams and lubricants are available to treat vaginal dryness, as they are topical estrogen preparations.

You can start HRT once you start experiencing the symptoms of menopause. However, HRT may not be appropriate for you, if you have:

– a history of breast cancer, ovarian cancer or uterine cancer,
– a history of blood clotting,
– a history of heart disease or stroke,
– high blood pressure (you will need to have your blood pressure checked before you start hormone replacement therapy)
– liver disease

Hormones used in HRT may be linked to side effects. These include:

– fluid retention
– breast tenderness or swelling
– headaches
– indigestion

Over the years, many studies have been conducted, examining the benefits and risks of hormone replacement therapy.

Its main advantage is that it is a very effective method for managing the symptoms of menopause, and can make a significant difference in the quality of a woman’s life.

HRT can also reduce the risk of osteoporosis and cancers of the colon and rectum. However, long-term use is rarely recommended, and bone density will rapidly decline after HRT is discontinued.

Combined HRT slightly increases the risk of breast cancer, uterine cancer, ovarian cancer and stroke. Systemic HRT therapy also increases your risk of deep venous thrombosis (DVT) and pulmonary embolism (obstruction in the pulmonary artery). Other drugs are available to treat osteoporoses that do not carry the same level of risk associated with HRT.

Most experts agree that if HRT is used on a short-term basis (no longer than five years), the benefits outweigh the risks.

If HRT continues for a longer period, particularly longer than 10 years, you should discuss individual risks with your doctor and review the treatment annually.