Introduction:
Estrogen therapy is a hormone replacement therapy used mostly to treat menopausal symptoms, especially hot flashes, night sweats, and inflammation of the vaginal walls, which can significantly decrease the quality of life.
What Is Estrogen Therapy?
Estrogen replacement therapy is a medication that has female hormones. This medication replaces the female hormone estrogen that a body stops producing during menopause. So this therapy is often used to treat menopausal symptoms, including vaginal discomfort, night sweats, and hot flashes. Estrogen therapy also prevents bone loss and reduces fractures in postmenopausal women.
However, estrogen therapy also carries many risks; the risks depend on the dose, type of therapy, duration of the hormonal therapy, and the person's health factors. For best results, estrogen therapy should be customized to each person and reevaluated to be sure the advantages still outweigh the risks.
What Are the Indications for Estrogen Therapy?
Estrogen therapy is a useful way to fight against the uncomfortable symptoms of menopause. Around 1.5 million women between the age group of 45 and 55 face menopausal symptoms, which involve night sweats, hot flashes, and flushing. Additional symptoms include mood and sleep disturbances, irritability, fatigue, decreased libido, atrophic vaginitis (inflammation of the vagina), and dyspareunia (persistent or recurring pain in the genital area, especially during or after sex). Long-term estrogen therapy is also beneficial in a patient with a high risk of osteoporotic.
Estrogen therapy was used to prevent menopause symptoms, cardiovascular disease, and osteoporosis. Although estrogen therapy is employed to treat menopausal symptoms, the risks of systemic treatment potentially outweigh the benefits. Therefore, the non-systemic form of estrogen therapy is a definite need in women experiencing distressing symptoms. Without this therapy, a third of women experience symptoms like irritation, dryness, itching, and painful sexual intercourse, which can decrease their quality of life.
Localized estrogen treatment significantly increases the quality of life by improvements in the incidence of urinary tract infections, incontinence, and sexuality. The most important thing in estrogen therapy is the method of estrogen delivery. For instance, the use of transdermal estrogen, in contrast to oral estrogen, has been associated with a lower risk of deep vein thrombosis, osteoporosis, stroke, and cholecystitis (inflammation of the gall bladder).
What Are the Contraindications of Estrogen Therapy?
Estrogen therapy is contraindicated in the following conditions:
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History of breast or uterine cancer.
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History of pulmonary embolism or deep vein thrombosis.
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History of heart diseases like stroke or myocardial infarction.
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History of blood clotting disorders.
These contraindications are not applicable for estrogen taken transvaginally as the level of estrogen through this route is too low to cause any effect.
What Are the Types of Estrogen Hormone Therapy?
There are different types of estrogen therapy in the form of pills, patches, transdermal, and suppositories. The best type of estrogen therapy depends on health, symptoms, and personal preference.
1) Estrogen Pills - They are the most common form of estrogen therapy used. The doctor will tailor the dose depending on the severity of the symptoms, other health issues, and the age of the patient. Most estrogen pills are taken once a day, and in some people, the dosage will be adjusted based on individual needs.
Estrogen pills can resolve or reduce troublesome menopause symptoms. They can also decrease the risk of osteoporosis. Now there are many newer ways of estrogen therapy; however, oral estrogen is considered the best-studied form of estrogen therapy.
Estrogen has a slight increase in the risk of blood clots, strokes, and other problems. And if the estrogen therapy is combined with the progestin hormone, the risks of heart attack and breast cancer may also rise. People with liver damage are contraindicated to oral estrogen because it can cause damage to the liver. It can also cause side effects like painful and swollen breasts, nausea, headache, and vaginal discharges.
2) Estrogen Patches - Estrogen skin patches are another type of estrogen replacement therapy. It is also available as a combination of estrogen and progestin patches. The patch is worn on the lower belly, beneath the waistline. The patch should be changed once or twice a week, as per the doctor's instruction. These patches are convenient to wear. Patches are not harmful to people with liver problems as the patch bypasses the liver and reaches the blood directly.
Estrogen patches also have many similar side effects to the estrogen pill but in a milder form. The side effects include painful and swollen breasts, headache, nausea, and vaginal discharge. The patch will also irritate the skin. These patches should not be exposed to direct sunlight or high heat. Upon exposure to heat, they release the estrogen too quickly, producing a high dose at first and followed by very low doses.
3) Vaginal Suppository, Creams, or Rings - These are applied directly to the vaginal area. These are commonly prescribed for women with vaginal itching, burning, dryness, and pain during sex. The exact dosing schedule varies depending on the product.
Studies have shown that these treatments are more effective than any other estrogen therapy in case of treating the vaginal symptoms of menopause. The vaginal rings and suppositories are low doses and affect only the immediate area. So it has the benefit of relieving vaginal symptoms without exposing the whole body to high doses of estrogen. Therefore, reducing the more serious risks of estrogen therapy.
Their disadvantage is that low-dose of estrogen suppositories and rings are beneficial only for vaginal symptoms of menopause and will not be helpful with other symptoms like hot flashes. However, higher-dose suppositories, creams, and rings may have the same risks as other types of estrogen therapy like stroke and cancer.
4) Topical Cream, Spray, and Gels - Estrogen gels, creams, and sprays are absorbed from the skin directly into the bloodstream. They are usually used once a day, but how and where to apply the cream varies depending on the individual's symptoms, age, etc. As estrogen creams are directly absorbed from the skin and reach the bloodstream, they are safer for people with liver and cholesterol problems than using oral estrogen.
However, there are not many studies on estrogen gels, sprays, and creams, and researchers believe that tropical estrogen is safe. This type of estrogen treatment can be rubbed or washed off before it is fully absorbed. So it is essential to make sure the skin is dry before putting on clothes. It is recommended to put on tropical estrogen after bathe or showering. Also, there are chances of other people in the family touching these creams or gels. By doing so, they may also get dosed with estrogen.
Conclusion:
Estrogen therapy or combinations of certain hormones is beneficial for treating menopause symptoms. However, this treatment is not suitable for everyone, like people with heart problems, liver damage, and breast or uterine problems. So make sure that one discusses this with healthcare providers before taking this treatment to avoid any complications.
