Hormone replacement therapy (HRT) in perimenopause involves replacing the dropping hormone levels of perimenopause. During the menopausal transition, the body experiences a hormonal imbalance that can cause other perimenopause symptoms. Hormone replacement therapy helps manage the symptoms caused by this imbalance.
HRT is done under the guidance of a medical professional. The replacement of estrogen helps relieve hot flashes and night sweats. In addition, it helps maintain bone density, reducing the occurrence of osteopenia or osteoporosis during this time.
Mode of Therapy
Estrogen is available in oral, transdermal, and topical formulas. Vaginal applications are used to help with symptoms of vaginal dryness. Usually, women are started on either transdermal or oral preparations.
Oral estrogens should be avoided in abnormal lipid panels (high triglyceride levels), gallbladder disease, those with a higher tendency to form clots, and those who have had clots before.
Progestin is given with estrogen in order to prevent endometrial hyperplasia. This is when the endometrial lining in the uterus grows unchecked when estrogen is given alone. In women without uteruses (have undergone hysterectomy), progestin is not required.
There are many options on the market for HRT. Generally the lowest doses are started and then uptitrated as needed to help with symptoms as needed.
Oral contraceptives are preferred in perimenopausal women aged under 50, since the doses of estrogen and progestin are higher than in HRT.
With oral contraceptives, there is a higher risk for clot formation. Thus, it should be avoided in those who smoke, are obese, have hypertension, and suffer from migraines.
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-Written by Paavana Varanasi