Menopausal Hormone Replacement Therapy (Term Paper Sample)

Menopausal Hormone Replacement
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ABSTRACT
Hormonal Replacement Therapy (HRT) has continued to capture the interests of many scholars across the globe. Since its development and introduction in the market, HRT has helped women in overcoming some of the menopause-related physiological problems. The following is a comprehensive article on a review of the published literature on the intricacies of HRT. The literature covers the meaning of menopause and the onset, the resultant menopausal symptoms, history if the HRT use and its action mechanism. The literature also covers the HRT types, planning and initiation of HRT, monitoring of HRT, contraindications of HRT, and the benefits, as well as risks of the HRT. Importantly, it is clear from the published literature that many scholars have focused on examining the benefits or risks that menopausal women may have on the use of HRT. However, a lot is seemingly required to discover more about the relation between various diseases and HRT among the menopausal women. The article thus poses a challenge for any person interested in doing germane studies to try filling the gaps in the available literature.
INTRODUCTION
According to Villiers et al. (2013), the last 10 years have seen much confusion about the utilization of HRT. New evidence has occasionally challenged earlier accepted guidelines on HRT, particularly on the aspects of disease prevention and safety. The consequence of the controversies was the restriction of use of the therapy by many menopausal women. However, various menopausal societies have remained committed to producing and publishing comprehensive revised guidelines (Hingle,2005).
Importantly, many clinicians have sought to understand the main benefits that women may get from using the HRT in order to juxtapose them against any proven risks and side effects (Villiers et al. 2013). Nevertheless, before delving deeper into the HRT and the studies done on them, it is necessary to depict a brief overview of what menopause is while at the same time understanding its associated symptoms.
Precisely, menopause normally involves the cessation of a woman’s menstruation and signifies the potential end of her reproductive capacity (Moulton, Hohenhaus & Anvar, 2007). The event tentatively occurs when the woman is around 50 years of age although some occur prematurely before the woman is even 45 years of age (Bruno, 2007). Furthermore, premature menopause may occur following the removal of a woman’s ovaries if she undergoes hysterectomy.
Notably, the ovaries begin ceasing their normal function at about 10 years prior to menopause. During that time, different physiological changes take place, including ovulation failure and a reduction in the production of luteinizing hormone and Follicle stimulating hormone (Bruno, 2007). The aforementioned ovarian changes ultimately lead to amenorrhea and hence the diagnosis of menopause in a woman.
Symptoms of Menopause
Most of the menopausal symptoms result from estrogen deficiency secondary to the failure of the ovaries. Sometimes, it may be a little bit difficult for the physician to distinguish the symptoms from the ones caused by normal aging or from domestic and social pressures that middle-aged women face (Bruno, 2007). Precisely, the physical symptoms experienced include night sweating, hot flashes, and migraine or tension headaches (HHS, 2005). Consequently, the aforementioned temporary symptoms trigger insomnia and irritability among the menopausal women.
Furthermore, a woman may suffer from osteoporosis due to prolonged or severe bone loss secondary to estrogen deficiency. Research indicates that around 35% of the women who have natural menopause suffer from osteoporosis (Bruno, 2007). From another perspective, menopausal women may experience various psychological symptoms, including anxiety, diminished energy, and tension (HHS, 2005). Other psychological symptoms may include difficulty in concentrating, stress and depression. Interestingly, several menopausal women report heightened libido because they are aware that they cannot conceive any longer. Nevertheless, emotional problems associated with menopause may lower the women’s sexual activity.
In the subsequent discussion, there is a comprehensive analysis of HRT use among the women who are approaching menopause, those who have reached menopause and those who are in their postmenopausal ages. Through the discussion, it will be possible to understand the history of HRT, the way the therapy works, the types of HRT in the market, the prescription, the monitoring and the benefits, as well as side effects associated with HRT. The literature covered is extremely important in indicating the main research developments made on the HRT. In particular, the information will help in unraveling the controversies associated with HRT use with respect to the published benefits and possible risks. In so doing, women will be able to understand more about HRT as an important intervention in relieving menopause symptoms.
DISCUSSION
History of the HRT Use
The reduction in menopausal women’s estrogen levels has interested scholars, patients and doctors for very many years (Hingle,2005). After its development in 1920s, synthetic estrogen started aiding in relieving various menopausal symptoms by mid-1930. By mid-1960, a book by name Feminine Forever advertized synthetic estrogen for the maintenance of femininity and youth (Brett & Chong, 2001). The book was such a hit by late 1960’s press and largely increased HRT demand.
Nevertheless, HRT use started decreasing in 1970s when some scholars pinpointed its association with increased predisposition to endometrial cancer. Since 1980s, HRT use started going up again following the publication of research findings on the HRT’s protective effects against osteoporosis, as well as heart disease (Brett & Chong, 2001). Fortunately, the ameliorated treatment schedules, as well as effective delivery systems for the HRT have increased its use in many American States.
In order to reduce the users’ risk of developing endometrial cancer, scholars have emphasized on the need to prescribe lower estrogen doses while at the same time combining carefully with progesterone if the user has an intact uterus. In addition, the production of various HRT formulations, as well as dosing schedules allows doctors to better customize HRT to every patient (Brett & Chong, 2001).
Prevalence of HRT Use
There are different studies examining HRT use in the world and in specific countries. Of great importance to note in the studies are the varying trends of HRT use. For instance, HRT in the U.S. has decreased over time perhaps owing to fears of the associated side effects. To highlight the trend, research indicates that from 2001 to 2002, total HRT prescription in the country reduced by 17% from 112.2-93.1 million reported prescriptions (Stagnitti & Lefkowitz, 2011). Moreover, from 2001 to 2003, total HRT prescription reduced by 45% from 112.2-61.3 million reported prescriptions.
From another perspective, from 2001 to 2008, total HRT prescription reduced by 72% from 112.2-38.8 million reported prescriptions (Stagnitti & Lefkowitz, 2011). In fact, in echoing the same trend, Canadian Institute for Health Information [CIHI] (2008) indicates that both combination and estrogen-only HRT use declined at around 14.7% yearly from 2001-2002, as well as from 2006-2007. Undoubtedly, the presented information is a clear indication of the fluctuating change in prevalence of the HRT use.
HRT Action Mechanism
Before delving into the way HRT works in menopausal women, it is necessary to understand the way the sex steroids function. In a woman’s reproductive age, progesterone and estrogen as the main female sex steroids normally result from ovarian steroidogenesis process, with minimal amounts secreted by peripheral compartments (adipose tissue and adrenals). The processes continue until the woman reaches menopause when she experiences a reduction in the ovarian synthesis (Voican et al. 2012). Consequently, serum levels of the sex steroids start relying on the peripherally produced steroids.
In the normal reproductive age, ovarian sex steroid secretion follows the monthly cycle controlled by pituitary gonadotropins. The aforementioned central control depends on synchronized secretions of a person’s hypothalamic Gonadotropin-releasing hormone (GnRH), as well as of the pituitary gonadotropins (Voican et al. 2012). When sex steroids decrease in menopause, the negative feedback expected at the pituitary glands and hypothalamus stops hence leading to over-secretion of the gonadotropins, particularly the Follicle Stimulating Hormone (FSH).
Therefore, HRT pharmacological basis entails the compensation of the decreased estradiol production in the ovaries (Voican et al. 2012). The compensation works to limit any adverse events that may occur due to the deficiency of sex steroids.


Figure adopted from Voican et al. (2012).
HRT Types
HRT can be systemic in nature or sometimes local. The two terms normally describe how and where the hormones function in the human body. With the systemic therapy, hormonal release occurs in the bloodstream after which the hormones travel to various body tissues and organs. The systemic types of estrogen comprise pills, gels, sprays, and skin patches applied to a woman’s skin (American College of Obstetricians and Gynecologists [ACOG], 2015).When the physicians prescribe progestin, they give it separately or in combination with estrogen as a single patch or pill.
A woman who is taking the estrogen-only therapy should take it daily or after few days, contingent on the method of administration (Goodman et al. 2011). However, if a woman is taking the...