How Do Estrogens/progestins-HRT Work?

Estrogens/progestins-HRT medications are used as a hormone replacement therapy (HRT) to relieve menopausal symptoms in women. Estrogens/progestins-HRT medications are synthetic combination formulations of the natural female sex hormones progesterone and estrogen and have similar effects.

Estrogens are a group of endogenous hormones responsible for the development and maintenance of the female reproductive system and secondary sexual characteristics. Progesterone is the other female sex hormone that prepares the endometrium, the inner lining of the uterus, for implantation and continuation of pregnancy.

Endogenous estrogens are of three major types, estradiol, estriol, and estrone. Estradiol is the primary type of estrogen produced by the ovaries in premenopausal women. The fall in estradiol levels in perimenopausal women leads to symptoms such as hot flushes, and vaginal dryness, and atrophy.

Estrogens/progestins-HRT is used to supplement the depleted estradiol production, which relieves menopausal symptoms and prevents bone loss due to low estrogen levels. Progestins are added to protect women with an intact uterus from the risk of endometrial hyperplasia and cancer that can result from unopposed estrogen therapy.

Estrogens/progestins-HRT works by reducing the elevated levels of reproductive hormones in postmenopausal women, which include gonadotropin-releasing hormone (GnRH) from the hypothalamus, and follicular stimulating hormone (FSH), and luteinizing hormone (LH) from the pituitary gland.

Estrogens/progestins-HRT may be administered in the following ways:

• Oral tablets or capsules are taken every day continuously, or in 28-day cycles during which withdrawal bleeding may occur
• Transdermal patches applied on clean, dry, intact, and fold-free skin on the lower abdomen or upper quadrant of the buttocks

The recommended duration for estrogens/progestins-HRT is typically 5 years or less and not beyond 60 years of age. The uses of estrogens/progestins-HRT include:

FDA-approved:

Hormone replacement therapy for the treatment of:

• Moderate to severe vasomotor symptoms (hot flushes) associated with menopause in women with an intact uterus
• Vulvar and vaginal atrophy associated with menopause in women with an intact uterus
• Hypoestrogenism (low estrogen levels) in women due to:
  • Hypogonadism (inadequate functioning of ovaries and sex hormone deficiency)
  • Primary ovarian failure
  • Removal of ovaries
• Prevention of osteoporosis in postmenopausal women with an intact uterus

Off-label uses:

• Postmenopausal hypercholesterolemia (high blood cholesterol levels)

Side effects of estrogens/progestins may include the following:

• Breast enlargement
• Breast tenderness
• Breast pain
• Breast cyst
• Galactorrhea (milky secretion from the nipples)
• Breast cancer
• Amenorrhea (absence of menstrual bleeding)
• Breakthrough bleeding
• Change in menstrual flow
• Spotting
• Leukorrhea (whitish vaginal discharge)
• Abnormal vaginal bleeding
• Pelvic pain
• Endometrial disorder
• Endometrial hyperplasia (thickening)
• Endometrial neoplasia (abnormal tissue growth)
• Endocervical polyp
• Uterine leiomyomata (fibroids)
• Uterine spasms
• Fallopian tube cyst
• Abdominal pain and discomfort
• Bloating
• Nausea
• Vomiting
• Diarrhea
• Abdominal distention
• Anorexia (loss of appetite)
• Peripheral edema
• Headache
• Back pain
• Pain in extremities
• Muscle spasms
• Accidental injury
• Flu-like symptoms
• Weakness
• Upper respiratory tract infection
• Sinusitis (inflammation of the sinuses)
• Changes in weight
• Fluid retention
• Depression
• Mood swings
• Insomnia
• Nervousness
• Dizziness
• Vertigo
• Migraine
• Somnolence (drowsiness)
• Fatigue
• Malaise
• Paresthesia (abnormal skin sensation)
• Skin discoloration
• Melasma (facial skin pigmentation disorder)
• Hot flashes
• Night sweats
• Pruritus (itching)
• Angioedema (swelling in the tissue under the skin or mucous membranes)
• Hypersensitivity
• Patch application site reactions such as rash, redness, and irritation
• Cholestatic jaundice (jaundice due to impaired bile flow)
• Cholelithiasis (gallstones)
• Cholecystitis (inflammation of the gallbladder)
• Increased transaminases (liver enzymes)
• Deep vein thrombosis/DVT (blood clot in deep veins)
• Thrombophlebitis (inflammation in the wall of a vein with an associated blood clot)
• Varicose veins
• Hypertension (high blood pressure)
• Cardiovascular disease
• Ischemic colitis (inflammation of colon from reduced blood flow)
• Growth potentiation of benign meningioma (tumor in the membranes that covers the brain)

Information contained herein is not intended to cover all possible side effects, precautions, warnings, drug interactions, allergic reactions, or adverse effects. Check with your doctor or pharmacist to make sure these drugs do not cause any harm when you take them along with travel medicines. Never stop taking your medication and never change your dose or frequency without consulting your doctor.

Generic and brand names of estrogens/progestins-HRT drugs include:

• Activella
• Angeliq
• Bijuva
• Cilest
• Climara Pro
• CombiPatch
• conjugated estrogens/medroxyprogesterone
• drospirenone/estradiol
• estradiol/levonorgestrel
• estradiol/norethindrone acetate
• estradiol/norgestimate
• estradiol/progesterone
• Lopreeza
• Mimvey
• Prefest
• Premphase
• Prempro