Iris Publishers-World Journal of Gynecology & Womens Health| Individualized Hormone Replacement Therapy

Authored by BM Petrikovsky

Numerous studies conclude that risks and benefits of hormonal replacement therapy (HRT) are dose-dependent [1]. The pharmaceutical industry attempted to partially resolve the issue of individualization of HRT by manufacturing at least six different types of Minivelle patches (0.024mg, 0.0375mg, 0.05mg, 0.075mg, and 0.1mg). The choices offered by the pharmaceuticals are useful but fail to caliber dose based on the needs of the individual patient.

Each woman and her physician must decide whether ERT is an appropriate option for her. When making this decision, it is important to consider three factors that affect the risk-benefits of ERT: age at initiation, hormone dose, and route of administration [1]. Estrogen deficiency over a period of many years may result in significant, changes such as bone loss, vaginal and bladder atrophy, and/or other symptoms [1,2]. Therefore, the earlier after menopause ERT is initiated, the better the long-term outcome [1].

In addition, it appears that the majority of severe complications of ERT, including but not limited to strokes, uterine and breast cancers, are dose-dependent. Investigators found that an estrogen dose of 0.3 mg/day was associated with a statistically significant lower risk of cardiovascular events and stroke [1].

Lastly, the route of administration appears particularly important for the results of ERT. Transdermal estrogen use has an additional safety benefit in that it avoids the hepatic “first pass” effect, and thus, associated changes in clotting factors and other hepatic proteins.

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