Types of Hormone Replacement Therapy Medications and Benefits

Hormones are integral to your physiology, the efficient functioning of the many cells, tissues, and systems in your body. Even before you were born, hormones were influencing your development, determining your anatomy, and to some extent, shaping your personality. It is no wonder that when hormones fluctuate or decline sharply, the repercussions can be widespread and significant. Inadequate hormone levels impact your moods, metabolism, and even your physical structure, and the widening ripples of hormonal changes may negatively affect your relationships, your career, and your quality of life.

Hormone replacement therapy can help you find relief. More than merely putting a bandaid on symptoms, this treatment strategy corrects the cause of your discomfort by restoring optimal hormone levels. To fully realize their therapeutic potential, it is essential to understand the types of hormone replacement therapy medications and their benefits.

When Is Hormone Replacement Necessary?

Some hormonal changes are physiologically normal and expected, such as those that trigger puberty, occur during pregnancy, or lead to menopause. However, both men and women can experience hormonal shifts beyond what is considered healthy, and even natural variations can cause disruption. In these cases, hormone replacement can be the best option for regaining equilibrium.

Perimenopause & Menopause

In the years leading up to menopause, many women begin to feel the symptoms of hormonal change. As the ovaries’ production of estrogen and progesterone starts to decline, the body’s feedback mechanism attempts to increase their production, leading to ongoing fluctuation that can have both physical and emotional repercussions.

As you enter midlife—usually somewhere between 45 and 55—your ovaries stop producing estrogen and progesterone, and your menstrual cycle ends. Menopause is confirmed when periods have been absent for 12 months. As many as 75-80% of women experience symptoms during this normal hormonal transition. These may include:

  • Hot flashes, night sweats, irregular heartbeat
  • Vaginal dryness, loss of libido, pain with sex, incontinence
  • Mood swings, irritability
  • Headaches, brain fog, fatigue

The same symptoms are often reported by women during perimenopause.

In some cases, menopause isn’t the result of the normal aging process. Surgical removal of the ovaries, chemotherapy, premature ovarian insufficiency, and other medical treatments or health conditions that trigger menopause before it would occur naturally are associated with more intense symptoms and increase certain health risks, including osteoporosis.

Whether menopause occurs naturally, as the result of hormonal health conditions, or a side effect of surgery or other medical treatments, hormone replacement therapy (HRT) provides an effective treatment option for women troubled by disruptive symptoms. In fact, HRT is routinely recommended for women who experience menopause at an early age to mitigate health risks.

Low Testosterone

Unlike menopause, there is no sharp drop in hormones expected when men reach a certain age. Instead, men usually experience a gradual decline in testosterone production— about 1-2% per year after the age of 30. But many men experience a steeper than normal decline of testosterone as they age. Still others have chronically low testosterone (low T) as the result of a variety of medical conditions. Regardless of the cause, suboptimal testosterone levels can leave you vulnerable to uncomfortable symptoms, including:

  • Low sex drive
  • Loss of muscle
  • Fatigue
  • Mood changes
  • Irritability

Today, many types of hormone replacement therapy medications are available to bring testosterone levels back into the normal range. This can help to reduce symptoms, or even eliminate them altogether.

Thyroid Dysfunction

Hypothyroidism is a common condition resulting from an underactive thyroid gland or surgical removal of the thyroid. This condition can affect both men and women of any age, but it is more common in women and becomes more likely as you get older. Many of the symptoms of hypothyroidism overlap with those of other hormone deficiencies.

  • Fatigue
  • Slow heart rate
  • Sensitivity to cold
  • Weight gain
  • Depression
  • Memory impairment
  • Heavy or irregular menstrual periods

Hormone replacement therapy is the gold standard treatment for hypothyroidism.

What Types of Hormone Replacement Therapy Medications Are Available?

While hormone replacement therapy can be invaluable in the treatment of many hormone-related health conditions and symptoms, each person’s treatment journey is unique. By exploring the types of hormone replacement therapy medications available, you can discover the approach that is best for you.

Hormones That May Be Prescribed
  • Estrogen. Low or fluctuating levels of estrogen are responsible for many of the uncomfortable symptoms of menopause and perimenopause. Restoring estrogen levels is known to alleviate a variety of symptoms, but using estrogen alone may increase the risk of endometrial cancer. As such, estrogen-only therapy is recommended only for women who have undergone a hysterectomy.
  • Progesterone. Progesterone-only therapy may be prescribed to ease perimenopause and menopause symptoms, correct menstrual irregularities, or stabilize a hormone imbalance.
  • Combination estrogen/progestin. Combination therapy is the most common type of HRT for women whose uterus is intact. The inclusion of both hormones allows you to target a broad variety of hormone-related symptoms while protecting against endometrial hyperplasia—an overgrowth of the uterine lining associated with endometrial cancer.
  • Testosterone. Testosterone therapy is most commonly used to address low T in men. However, women may also be prescribed testosterone therapy in some cases, particularly to improve sexual function.
  • Thyroid hormones. Several types of thyroid hormones are used to restore levels in people with hypothyroidism. Most people with hypothyroidism will need HRT for the rest of their lives.

While these make up the overwhelming majority of HRT treatments, adrenal hormone dehydroepiandrosterone (DHEA) may also be included in comprehensive hormone replacement treatment.

Sources of Hormones

Synthetic hormones: Replacement hormones have been available for almost a hundred years. Some types are obtained from animals, like conjugated equine estrogen, which is extracted from the urine of pregnant mares. Others, like progestins (synthetic progesterone), are synthesized in a laboratory from chemical building blocks. Once inside your body, these hormones may require additional processing before they are able to activate hormone receptors.

Bioidentical hormones: Derived from yams, bioidentical hormones are designed to match your body’s own hormones. This structural similarity allows bioidenticals to activate your body’s hormone receptors in the same way your own hormones would. This precise match may help some people experience better outcomes and keep side effects to a minimum.

Hormone Delivery Methods

How hormones are administered can have a big impact on the success of treatment.

Hormone Pellets
  • Implanted under the skin
  • Systemic absorption

Hormone pellets are about the size of a grain of rice. These pellets are implanted in the fatty tissue below the skin on the hip or abdomen under local anesthetic in your doctor’s office. As the pellets slowly break down over the course of several months, they deliver a steady dose of hormones that is absorbed into the bloodstream.

Suitable for estrogen, progesterone, testosterone, and DHEA.

Pros:

  • Long-term, steady dosing (3-6 months)
  • Does not require daily dosing
  • Effective for systemic symptoms

Cons:

  • Requires minor in-office procedure 2-4 times per year
  • The implantation site must be kept dry for a brief recovery period
  • Pellets cannot be removed, so dosing estimates must be precise
Oral Tablets/Capsules/Pills
  • Oral administration
  • Systemic absorption

Tablets, capsules, or pills may be taken daily according to your doctor’s instructions. The medication is absorbed in the GI tract and passes through the liver before entering the bloodstream, where it is carried to all parts of the body.

Suitable for estrogen, progesterone, thyroid, and DHEA

Pros:

  • Familiar, easy-to-use format
  • Self-administered

Cons:

  • Requires daily dosing
  • Hormonal fluctuations may result if a dose is missed
  • Oral estrogen may increase the risk of blood clots
  • Not considered a safe method for administration of testosterone
  • GI and liver disease may affect the absorption
Injections
  • Injected into a muscle or under the skin
  • Systemic absorption

Hormones in a liquid suspension are injected into a muscle or the fat under the skin. This allows hormones to absorb slowly over time into the bloodstream.

Suitable for estrogen, progesterone, and testosterone.

Pros:

  • Longer lasting (1 week to 1 month depending on hormone)
  • Does not require daily dosing
  • Effective for systemic symptoms

Cons:

  • May cause hormone spikes after injection or unpredictable fluctuations hormones are absorbed
  • Estrogen injections may increase the risk of blood clots
  • May require a monthly trip to the doctor’s office
Topical Cream/Gel/Spray/Patch
  • Transdermal route of administration
  • Systemic absorption

The preparation or patch is applied to the skin according to prescribing directions. Hormones absorb through the skin and into the bloodstream.

Suitable for estrogen, progesterone, testosterone, and DHEA

Pros:

  • Self-administered
  • Lower risk of blood clots than oral or injectable estrogen

Cons:

  • Requires frequent dosing
  • Hormonal fluctuations may result if a dose is missed
  • Hormones may transfer to others through contact with skin
  • Patch may be visible
  • May cause skin irritation
Vaginal Tablet/Cream/Ring
  • Inserted into vagina
  • Localized absorption

The tablet, cream, or ring is inserted in the vagina with an applicator that measures dosage. The hormones absorb through the mucous membranes of the vagina and into local tissues.

Suitable for estrogen, progesterone, testosterone, and DHEA

Pros:

  • Effective for genitourinary symptoms
  • Less systemic absorption
  • Lower risk of blood clots than oral estrogen
  • Rings are longer lasting, controlled-release

Cons:

  • Must be inserted frequently
  • Hormonal fluctuations may result if a dose is missed
  • Less effective for menopause vasomotor symptoms (hot flashes, night sweats, etc.)

Finding the Best Solution for You

With all of the options available, relief for declining hormones or hormonal imbalance is well within reach. Your best guide to HRT is a hormone health specialist who can assess your hormonal health and help you to find a solution that works for you. By looking at different types of hormone replacement therapy medications and considering your personal needs, you can make smart decisions about your future.

If you want to explore your options and learn more about different types of hormone replacement therapy medications, the doctors in the EVEXIAS network can offer the guidance you need. Contact us to learn more about our innovative treatments.

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