Hormone replacement therapy (HRT)

Over time, hormone levels decline - a normal process, not a disease. The female hormonal balance is reorganized, and the body limits its production of estrogen and progesterone in phases. This is often accompanied by various disorders, the intensity of which may vary from one woman to another.

In the case of pronounced menopausal disorders, current treatment guidelines, including the guideline program of the Swiss, Austrian and German gynaecological and obstetric societies, recommend that gynaecologists offer their patients hormone replacement therapy (HRT). ¹

It's important to know that the aim of HRT is not to restore hormone levels prior to the onset of menopause. ² In fact, HRT is only intended to restore hormone levels when

• the menopausal symptoms and health risks associated with estrogen deficiency are alleviated by estrogen preparations.
• in women who have not had their uterus removed (hysterectomy), a progesterone- or gestagen-based preparation is also used. There are two main reasons for this: to balance an irregular menstrual cycle, and to protect the uterus from overgrowth. Indeed, thickening of the uterus means hyperplasia of the endometrium, which corresponds to the preliminary stage of cancer of the uterine lining.

Depending on the severity of the symptoms and the state of health, the choice of hormones will always be adapted to the woman's individual phase of life.

In addition to a physical examination, the patient's medical and family history must be established with the treating gynecologist prior to therapy. This is important in order to rule out any previous illnesses or risks.

Before starting HRT, it is also important to discuss the schedule of use and the ideal form of preparation for the patient. In addition, to ensure optimal tolerance, the treating gynecologist should limit hormone intake to the minimum dose necessary. ²

How hormones enter the body depends on the form of application. The two most common forms of use are:

• Tablets or capsules
  

Oral administration is undoubtedly the best-known form. In this way, hormones reach their destination via the gastrointestinal tract and the liver. In the liver, however, some of the hormones are directly metabolized and degraded.

• Transdermal
  

In this case, hormones are administered through the skin. The active ingredient applied to the skin passes through the skin layers into the bloodstream. In this way, the hormones are delivered directly into the bloodstream. This also prevents a large proportion of the hormones from already being broken down in the liver.

It's also important to bear in mind that only a small proportion of the hormones applied to the skin penetrate the body, so the amount of hormones absorbed by the body during transdermal application is considerably lower than when taken orally. Depending on the preparation, this may correspond to around 5% of the total amount.

This means that when hormones are administered via the skin, the risk of side effects is proportionately lower. ^3-5