Minimizing Side Effects of Hormone Replacement Therapy
Hormone replacement therapy (HRT) improves quality of life and can reduce the risk of future disease. But, HRT needs to be done under close medical supervision to minimize and prevent side effects of hormone replacement therapy.
Side effects of hormone replacement therapy are generally related to either excessive doses of hormones or an imbalance between two or more hormones. These side effects typically resolve once doses have been adjusted and proper balanced achieved. But some side effects do occur even with proper doses.
We will take a look at the side effects for three of the more common hormones used in replacement therapy – estrogen, progesterone, and testosterone.
Estrogens promote tissue growth and it is essential that estrogen replacement be balanced with adequate amounts of progesterone to counteract this tissue growth. This is true even for women who do not have a uterus. Too much estrogen relative to progesterone may increase the risk of breast cancer and endometrial cancer and cause other symptoms as well.
Too much estrogen relative to progesterone is called estrogen dominance and is associated with many undesirable symptoms. Estrogen dominance frequently occurs naturally without hormonal replacement as progesterone levels decline to a greater degree than estrogen dose as women approach menopause.
Symptoms of Estrogen Dominance
- Weight gain
- Breast tenderness
- Mood swings
- Heavy bleeding
- Migraine headaches
- Foggy thinking
It’s essential to make a distinction between progesterone and progestins. Progestins are synthetic non-bioidentical versions of progesterone that have been frequently prescribed as hormone replacement. But, the body does not have enzymes to metabolize progestin in the same manner as it does progesterone. Therefore toxic metabolites can accumulate in the body leading to side effects.
Side Effects of Progestins Side Effects of Progesterone
- Abnormal menstrual flow Sleepiness/drowsiess
- Breast tenderness Fluid retention
- Nausea Bloating
- Depression/mood swings Decreased libido
- Weight fluctuations Mild depression
- Development of male characteristics
- Increase LDL cholesterol
- Decrease HDL cholesterol
- Sensitivity reactions
- Decreased glucose tolerance
Testosterone side effects are usually dose related, however some testosterone gets converted into estradiol, a type of estrogen, and DHT or dihydrotestosterone. Breast or nipple tenderness and breast swelling and enlargement can occur with excessive estradiol levels, but that can be managed either by lowering the testosterone dose or by taking an aromatase inhibitor that blocks the conversion to estradiol.
While DHT is important for libido, excessive levels of DHT can lead to thinning of hair. 5-alpha reductase inhibitors can be used to block the conversion of testosterone to DHT if necessary.
It was once thought that testosterone might cause prostate cancer, but multiple studies have shown that testosterone does not cause prostate cancer. Other side effects of testosterone are listed below.
Side Effects of Testosterone
- Elevated hemoglobin and hematocrit
- Decreased sperm counts
- Testicular atrophy or shrinkage
- Fluid retention
- Rash if topical testosterone used
Overall the side effects of hormone replacement therapy are well established and can be anticipated so that their occurrences can be minimized and prevented. Should side effects still persist there are effective treatments to manage them. Thus it is rare that side effects of hormone replacement therapy would prevent its use.
See related articles.