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Hormone Replacement Therapy (HRT)


What is HRT?

Menopause can be a complicated period in a woman’s life. They suffer all sort of physical and psychological issues and they all are related with their ovaries. Woman may suffer from mood swings, hot flushes, night sweats and insomnia. Ovaries will gradually start to produce less and less oestrogen as age progresses. The lower levels of oestrogen will cause the usual menopausal symptoms. Hormone replacement therapy (HRT) is a treatment that will relieve these menopause symptoms by replacing the lack of female hormones with synthetic hormones. This hormone replacement therapy is commonly known as HRT.

HRT comes in different forms such as oral pills, skin patches and insertable vaginal rings. HRT will provide oestrogen at the same time that relieves menopausal symptoms. Please pay close attention to the fact that HRT can also thick the lining of the uterus. Women, who have not had a hysterectomy, will need progestogen as part of HRT because in an intact womb, oestrogen will stimulate the growth of the womb lining (endometrium), which may develop endometrial cancer if the growth is unopposed. Being so, keep in mind that many HRT preparations have both the oestrogen and the progestogen hormones.

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Buy HRT medications With an Online Prescription

An online doctor consultation means filling out a medical questionnaire. A registered EU doctor assesses your medical questionnaire and analize whether HRT is suitable and safe for you to buy. After approval, a prescription is issued and send to the registered EU pharmacy. You will receive your discretely shipped Hormone Replacement Therapy pills within 3 business days.

Hormone replacement therapy: The friendship between a cosmetologist and a gynecologist

How hormones and age are related, what should be considered by a cosmetologist when working with an aging patient - read the article for answers to these and other questions.

In the West, it is no longer a secret - a cosmetologist must work and think in tandem with an endocrinologist. In Russia, such a practice is only beginning to be introduced. And the success of cosmetic procedures directly depends on the diagnosis of the endocrinologist and the time prescribed combination treatment.

We repeat the features of age-related and hormonal changes occurring in the body of a woman, which should be paid attention to both the cosmetologist and the patient.

Puberty

The main hormones: somatotropic, luteinizing, follicle-stimulating. Between the ages of 10 and 14, the pituitary gland begins to produce luteinizing (LH) and follicle-stimulating hormones (FG), which together are responsible for the production of sex hormones by the ovaries - estrogen, progesterone, testosterone, which trigger the mechanism of changes in the body. LH, FG, estrogen, and progesterone play a vital role in the regulation of a woman’s menstrual cycle. Testosterone promotes muscle development and bone growth.

In addition, the pituitary gland is responsible for the production of growth hormone, or growth hormone, under the influence of which the person begins to lose infant “puffiness”, the lower jaw, cartilage and bone tissue of the nose, and the superciliary arches increase. This hormone also stimulates a growth spurt and changes the distribution of fat in the girl’s body, which is concentrated around the hips, buttocks, and abdomen.

Changes in puberty in girls

Several changes occur when a girl reaches puberty such as Breast shaping, Hips, pubic and axillary hair growth, Egg production, The beginning of menstruation, etc.

Changes at this age also affect the skin. From this time, women may experience acne and increase sebum secretion. This is due to the fact that hormone receptors are located in the sebaceous glands. During puberty, an increase in androgen hormones causes the growth of sebaceous glands, which leads to increased secretion of sebum, which is a source of nutrition for bacteria living on the skin, such as Propionibacterium acnes. The spread of these bacteria leads to an increase in inflammatory elements - pustules (acne). Estrogen, however, exhibits anti-inflammatory properties by decreasing neutrophil chemotaxis, thereby counteracting the same bacteria that cause acne. In contrast, androgens prolong inflammation, and therefore this “chain reaction” leads to a worsening of the clinical picture of acne.

Therefore, during this period, the use of oral contraceptives (OK), which reduce the amount of circulating androgen, may explain why so many young women with acne get visible improvements in the disease. OK also stimulate the production of globulin, thereby reducing free and biologically active testosterone, and inhibit testosterone production in the ovaries.

Reproductive period

The main hormones: sex hormones (estrogens and progestins, the most active are 17β-estradiol and progesterone), gonadotropin.

Sex hormones are responsible for some of the dramatic changes that occur in a woman’s body during this period. They control puberty, ovulation, pregnancy, childbirth, and lactation.

These hormones are involved at all stages of the menstrual cycle: the pituitary gland produces follicle-stimulating hormone, which is responsible for the maturation of the egg in the ovarian follicle; ovaries produce estrogen, which causes rejection of the uterine endometrium after menstruation; the pituitary, in turn, produces LH, which causes ovulation and stimulates the release of an empty follicle to produce progesterone; progesterone causes the alignment of the endometrium of the uterus to prepare it for the adoption of a fertilized egg; if fertilization does not occur, the production of estrogen and progesterone stops, the endometrium of the uterus is destroyed and menstruation occurs.

The approximate content of female hormones is normal

  • Estradiol: 25-75 pg / ml, 32 pg / ml - during menopause, 200-300 pg / ml - during menstruation
  • Progesterone: 1.5 ng / ml before ovulation, 15 ng / ml after ovulation, about 300 ng / ml during pregnancy
  • Luteinizing hormone: 20 IU / L - on the third day of the menstrual cycle
  • Follicle-stimulating hormone: less than 9 mIU / ml on the 2nd – 3rd day of menstruation, above 40 mIU / ml - in the period before menopause

Pregnancy

If the egg that leaves the ovaries receives fertilization, the hormonal background of the woman changes dramatically. The usual decrease in estrogen and progesterone levels at the end of the menstrual cycle does not occur, menstruation does not occur.

The new hormone, chorionic gonadotropin, which is produced by a developing placenta, comes to the fore, stimulating the ovaries to produce higher levels of estrogen and progesterone, which are needed to support pregnancy. It is on the measurement of the level of this hormone that pregnancy tests are built.

By the fourth month of pregnancy, the placenta is the main producer of estrogen and progesterone, which at this stage cause thickening of the walls of the uterus, increase the volume of circulating blood and relax the muscles to provide a place for the developing fetus. Progesterone and the hormone relaxin helps to relax the ligaments and muscles - all this is aimed at facilitating the passage of the fetus through the birth canal. With the approach of childbirth, new hormones - vasopressin and oxytocin - begin to be produced to ensure uterine contractions and milk production.

After giving birth, hormone levels change again, leading to changes in the body. The uterus returns to its normal state, the muscle tone of the pelvic region improves and the level of blood supply returns to normal.

Premenopause and Menopause

When the ovaries stop producing eggs (usually this happens closer to 50 years), there is a jump in the production of female sex hormones. This leads to changes in the condition of the woman (night sweats, hot flashes, mood swings) and the adjustment of the silhouette line (forms become more rounded, redistribution of fatty tissue occurs).

During this period, a woman, as a rule, begins to notice the first signs of age - wrinkles, ptosis, decreased the elasticity of the skin and its ability to retain moisture. This is due to a decrease in hormonal activity, a decrease in the overall level of estrogen. Acne may again aggravate - this is due to the fact that testosterone stimulates the sebaceous glands to produce sebum. Clinically proven changes associated with skin aging include thinning of the skin and atrophy, loss of elasticity, dryness, poor healing. Studies have shown that up to 30% of collagen (both type I, which gives elasticity and type III, which promotes skin elasticity) is lost in the first 5 years after menopause, the total collagen level decreases by an average of 2% in postmenopausal women within 15 years.

While the collagen content decreases rapidly with increasing postmenopause, some studies show that women who start taking hormone replacement therapy (HRT) with estrogen thus increase the collagen content in the skin by 6.5%. Thus, hormone replacement therapy can be used as a prophylactic for women with low levels of collagen.

In addition, there is evidence of a positive change in the collagen content in the skin of postmenopausal women receiving topical estradiol in the form of patches on the abdomen and femur. A strong correlation was noted, indicating that changes in response to estrogen therapy depend on the initial level of collagen, and there is no further increase in collagen production when its “optimal” level in the skin is reached. This study is particularly noteworthy because it shows that there is a certain therapeutic window in which estrogen-HRT can have the maximum effect in stimulating new collagen.

Estrogen-HRT can also help women with dry skin by reducing the loss of transepidermal water. In a study conducted by Pirard-Franchimont et al., It was stated that the water-holding capacity of the stratum corneum in women receiving hormone replacement therapy was comparatively higher.

The use of local hormone replacement drugs of estrogen showed an increase in the thickness of the epidermis in postmenopausal women.

Subcutaneous fat is also important when it comes to the need to maintain youthfulness, and fat distribution is another area where sex hormones play a vital role.

In postmenopausal women, a decrease in estrogen and androgen leads to the accumulation of central fat. In a study conducted by Dieudonne et al., A twice as large accumulation of adipocytes was found in the abdomen than in subcutaneous tissue.

It is widely known that menopause leads to a change in hormonal status, metabolism, and lipid profile. In a study by Mesalić et al. analyzed the effect of menopause on the concentration of lipids, lipoproteins and the effect of estradiol, progesterone, FSH, LH on the lipid profile. Scientists found that in menopause women had higher, but unreliable (p> 0.05) concentrations of total cholesterol, VLDL, LDL and triglycerides than women with regular menstruation. HDL concentration was significantly lower in women during menopause than in women with regular menstruation (p <0.05). In addition, the concentration of apolipoprotein B was significantly higher in menopausal women (p <0.05), but the concentrations of apolipoprotein and lipoprotein were lower (p> 0.05). Estrogen concentration had a significant negative correlation with VLDL and triglycerides (p <0.05) and a significant positive correlation with HDL (p <0.05) in menopausal women. The concentration of progesterone showed no correlation with the concentration of lipids and lipoproteins in menopause. Scientists have concluded that menopause leads to a change in the lipid profile by lowering HDL and increasing apolipoprotein B levels, thereby increasing the risk of developing cardiovascular disease. These changes, in turn, were caused by a decrease in estrogen concentration during menopause. that menopause leads to a change in the lipid profile due to a decrease in HDL and an increase in the level of apolipoprotein B, thereby increasing the risk of developing cardiovascular diseases. These changes, in turn, were caused by a decrease in estrogen concentration during menopause. that menopause leads to a change in the lipid profile due to a decrease in HDL and an increase in the level of apolipoprotein B, thereby increasing the risk of developing cardiovascular diseases. These changes, in turn, were caused by a decrease in estrogen concentration during menopause.

Hormone replacement therapy. Advantages and disadvantages

Some of the positive effects of hormone replacement therapy have been mentioned above. To summarize.

Hormone replacement therapy (HRT) after 50 years can significantly alleviate a woman's condition. However, disputes do not stop around HRT. The situation escalated in 2002, when the Women's Health Initiative, the National Institute of Health and the National Institute of Heart, Lung, and Blood stopped the phase of hormone replacement therapy trials due to higher than expected risks of developing breast cancer, heart attacks, strokes and the risk of lower limb thrombosis among the tested women.

It should be noted that in the West it is customary to classify HRT itself (estrogen + progestin) and the so-called ERT - estrogen replacement therapy. Hormone replacement therapy is recommended for women who have gone through natural menopause, while ERT can be given to patients who have had the onset of menopause surgically.

Despite the fact that the positive effect of hormone replacement therapy on bone density and the relief of symptoms of menopause has been known for a long time, its effect on the skin and wound healing is only beginning to be studied. It is already known that a postmenopausal woman receives a positive effect on the skin from estrogen replacement therapy, but the appointment should be carried out under the strict supervision of doctors, and the patient should undergo constant health monitoring to avoid undesirable risks.

Key risk factors

There are two key risk factors- (1) Breast cancer and cardiovascular disease, and increased risk of blood clots and cardiovascular problems associated with certain types of hormone replacement therapy. Some problems can be avoided by applying HRT dermally (patches), and not in the form of tablets.

Benefits of hormone replacement therapy

  • Relief of symptoms (vasomotor instability, sexual dysfunction, mood swings, skin atrophy) and a reduced risk of fractures.
  • Hormone replacement therapy should be prescribed for a short time and in cases of, especially severe symptoms. Especially HRT can be considered for women in the premenopausal period (early onset of menopause or 5 years after the onset).
  • Estrogen creams for women who are at risk of developing estrogen-dependent breast cancer should be excluded.
  • Topical and oral estrogens (patches or gel) are more easily absorbed.

The opinion of a gynecologist about hormone replacement therapy

The urgency of the problem that the author touches on is the commonwealth and unidirectional actions of gynecologists, endocrinologists, and dermatocosmetologists in relation to patients. Indeed, there are many changes in the body of a woman, from puberty to the transition to menopause. And the two periods in a woman’s life are very similar in clinical manifestations, but one of them is the formation of menstrual and reproductive functions, and the other, on the contrary, their extinction. It is important to understand that the correct approach and interpretation of hormonal examination data and, necessarily (!), Examination of the patient, as well as ultrasound examination of the pelvic organs, mammary and thyroid glands, provide a more objective understanding of the state of a woman in a given period of time to assess skin changes. This allows pathogenetically more accurately prescribe the correction of hormonal status, which significantly increases the success of dermatocosmetologists and the duration of the effect of the treatment they prescribed. With all this, it is important not to forget about the psychoemotional status of a woman, which can be either the cause or the most important pathogenetic factor in the revealed violations.