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Side Effects of HRT

Side Effects of HRT

Hormone Replacement Therapy has some side effects. These side effects are negligible in comparison to the benefits it gives. Hence women should be encouraged to use ERT.

Does HRT have side effects similar to those of birth control pills



The use of HRT has been complicated for menopausal women as well as for prescribing doctors by the contraindications contained in the pharmaceutical data sheets. The similarity between the data sheets for oral contraception's and HRT preparations suggest that the contraindications for the former have been uncritically accepted for the latter.  This has led to the wide spread misconception that oral contraceptive and HRT preparations are similar with regard to contraindications as well as risk for side effects. Since estrogens play such an essential role in the health and well being of women, women should be en

couraged to use ERT so that they continue to enjoy the same quality of life they experienced before menopause.


Are there any drawbacks to HRT

Some patients complain that oral drugs sometimes aggravate menopausal problems.  This could be due to metabolism in the liver and the intestine, resulting in wide fluctuations in plasma hormone levels, changes in hepatic protein synthesis and perturbations of the haemostatic system.

Administering HRT with Transdermal Drug Delivery Systems

HRT is an effective method of easing the menopausal symptoms. Administration of HRT can be oral, parenteral, rectal, vaginal, topical and transdermal. Transdermal Drug Delivery is done through application of patches containing drug to skin. Know more about this method of application.

How is HRT administered

There are various ways of administering HRT. Some of them include: oral, parenteral, rectal, vaginal, topical and transdermal (through the skin).  These treatments can also be classified as oral, percutaneous and transdermal.


What are transdermal drug delivery systems

Transdermal (through the skin) drug delivery system is one way of administering HRT.  Other methods of administering HRT include oral, parenteral, rectal, vaginal and topical.

Transdermal applicators are the patches containing the drug.  They are flat, smooth, discrete and can be used for long term medication. Transdermal delivery systems are not just an alternative route of administration but they improve the therapeutic value of a drug and provide many other advantages including increasing compliance.

Transdermal therapy could be of two types: (a) Reservoir type: Those that control the rate of drug delivery to skin; and (b) Matrix type: Those that allow the skin to control rate of drug absorption.


Why is skin the site for transdermal drug delivery

Skin is one of the most readily accessible organs of the human body. It has a thickness of only a few mm.  Skin is a multi-layered organ composed of many histological layers.  Its three main layers are: the epidermis, the dermis and the hypodermis.

The epidermis is further divided into 5 anatomical layers. The outermost layer is the stratum corneum which is exposed to external environment. The transdermal permeation of neutral molecules at steady state can be considered as a process of passive diffusion through the stratum corneum in the interfollicular region.


General considerations for the use of Transdermal Drug Delivery systems 

The site selected for application should be clean dry and hairless e.g. estradiol patches are applied to buttocks or abdomen, nitroglycerine patches are applied to chest. Scopolamine behind ear. Because of possible occurrence of skin irritation, sites of application for patches are rotated weekly. 
Transdermal patch should not be applied to skin that is already irritated or act so as to ensure maximum absorption. 
Patches should be removed from its protective package being careful not to tear or damage patch. Protective backing should be removed to expose the adhesive layer and it should be applied firmly with the palm of the hand until it is secured in place. 
Patches may be left on when bathing or swimming. If the patch gets dislodged one must re-apply it or it may be replaced.


Benefits and Drawbacks of Transdermal Drug Delivery Systems

Transdermal Drug Delivery systems are the easiest way of ERT. There are some discomforts associated with this but its advantages outweigh the discomforts. Know about this in detail.

Possible discomforts of Transdermal Drug Delivery systems

Transdermal drug delivery systems could be unsuitable for drugs that irritate or sensitize skin. 
The natural limits of drug entry imposed by the skin's permeability indicates that relatively potent drugs are suitable only for transdermal delivery. 
Under various environmental conditions, adhesions of the system to different skin types sometimes result in technical difficulties. 

Advantages of Transdermal Drug Delivery systems

Avoids gastrointestinal tract difficulties during absorption caused by enzymes, drug interactions with food, etc. 
Suitable in instances like vomiting/diarrhoea where oral route is not desirable. 
Avoids first pass i.e. the initial passage of a drug substance through the systemic and portal circulation.
Provides the capacity for multi day therapy with a single application thereby improving patient compliance. Extends the activity of drugs having short half - life through the reservoir of drug present in the delivery system and its controlled release characteristics. 
Therapy can be quickly terminated by removal of the patch from the skin. 
Provides ease of rapid identification of medication in emergencies - non-responsive patients, unconscious or comatose patients. 
Less chances of over or under dosing as the result of prolonged preprogrammed delivery of drug at the required therapeutic rate. 

What is ETS

ETS is a new transdermal hormone replacement therapy that is supposed to be convenient, safe, low dosage estrogen therapy.  It is a once-a-week dosage with a matrix patch, and offers various benefits over the existing treatments:

Physiological low dose hormone
Avoids hepatic first pass
Convenient once a week treatment
Prevents and manages post-menopausal symptoms - early symptoms like depression, anxiety, vaginal dryness, osteoporosis and cardiovascular diseases.

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Breast cancer risk factors you cannot change

Gender

Simply being a woman is the main risk factor for developing breast cancer. Men can develop breast cancer, but this disease is about 100 times more common among women than men. This is probably because men have less of the female hormones estrogen and progesterone, which can promote breast cancer cell growth.

Aging

Your risk of developing breast cancer increases as you get older. About 1 out of 8 invasive breast cancers are found in women younger than 45, while about 2 of 3 invasive breast cancers are found in women age 55 or older.

Genetic risk factors

About 5% to 10% of breast cancer cases are thought to be hereditary, resulting directly from gene defects (calledmutations) inherited from a parent.

BRCA1 and BRCA2: The most common cause of hereditary breast cancer is an inherited mutation in the BRCA1 andBRCA2 genes. In normal cells, these genes help prevent cancer by making proteins that help keep the cells from growing abnormally. If you have inherited a mutated copy of either gene from a parent, you have a high risk of developing breast cancer during your lifetime.

The risk may be as high as 80% for members of some families with BRCA mutations. These cancers tend to occur in younger women and more often affect both breasts than cancers in women who are not born with one of these gene mutations. Women with these inherited mutations also have an increased risk for developing other cancers, particularly ovarian cancer.

In the United States, BRCA mutations are more common in Jewish women of Ashkenazi (Eastern Europe) origin than in other racial and ethnic groups, but they can occur in any racial or ethnic group.

Changes in other genes: Other gene mutations can also lead to inherited breast cancers. These gene mutations are much rarer and often do not increase the risk of breast cancer as much as the BRCA genes. They are not frequent causes of inherited breast cancer.

• ATM: The ATM gene normally helps repair damaged DNA. Inheriting 2 abnormal copies of this gene causes the disease ataxia-telangiectasia. Inheriting one abnormal copy of this gene has been linked to a high rate of breast cancer in some families.
• TP53: The TP53 gene gives instructions for making a protein called p53 that helps stop the growth of abnormal cells. Inherited mutations of this gene cause the Li-Fraumeni syndrome. People with this syndrome have an increased risk of breast cancer, as well as several other cancers such as leukemia, brain tumors, and sarcomas (cancers of bones or connective tissue). This is a rare cause of breast cancer.
• CHEK2: The Li-Fraumeni syndrome can also be caused by inherited mutations in the CHEK2 gene. Even when it does not cause this syndrome, it can increase breast cancer risk about twofold when it is mutated.
• PTEN: The PTEN gene normally helps regulate cell growth. Inherited mutations in this gene cause Cowden syndrome, a rare disorder in which people are at increased risk for both benign and malignant breast tumors, as well as growths in the digestive tract, thyroid, uterus, and ovaries. Defects in this gene can also cause a different syndrome called Bannayan-Riley-Ruvalcaba syndrome that is not thought to be linked to breast cancer risk.
• CDH1: Inherited mutations in this gene cause hereditary diffuse gastric cancer, a syndrome in which people develop a rare type of stomach cancer at an early age. Women with mutations in this gene also have an increased risk of invasive lobular breast cancer.
• STK11: Defects in this gene can lead to Peutz-Jeghers syndrome. People affected with this disorder develop pigmented spots on their lips and in their mouths, polyps in the urinary and gastrointestinal tracts, and have an increased risk of many types of cancer, including breast cancer.

Genetic testing: Genetic testing can be done to look for mutations in the BRCA1 and BRCA2 genes (or less commonly in other genes such as PTEN or TP53). Although testing can be helpful in some situations, the pros and cons need to be considered carefully.

If you are considering genetic testing, it is strongly recommended that first you talk to a genetic counselor, nurse, or doctor qualified to explain and interpret the results of these tests. It is very important to understand what genetic testing can and can't tell you, and to carefully weigh the benefits and risks of genetic testing before these tests are done. Testing is expensive and might not be covered by some health insurance plans.

Family history of breast cancer

Breast cancer risk is higher among women whose close blood relatives have this disease.

Having a first-degree relative (mother, sister, or daughter) with breast cancer almost doubles a woman's risk. Having 2 first-degree relatives increases her risk about 3-fold.

Although the exact risk is not known, women with a family history of breast cancer in a father or brother also have an increased risk of breast cancer.

Overall, less than 15% of women with breast cancer have a family member with this disease. This means that most (85%) women who get breast cancer do not have a family history of this disease.

Personal history of breast cancer

A woman with cancer in one breast has a 3- to 4-fold increased risk of developing a new cancer in the other breast or in another part of the same breast. This is different from a recurrence (return) of the first cancer.

Race and ethnicity

Overall, white women are slightly more likely to develop breast cancer than are African-American women, but African-American women are more likely to die of this cancer. In women under 45 years of age, however, breast cancer is more common in African-American women. Asian, Hispanic, and Native American women have a lower risk of developing and dying from breast cancer.

Dense breast tissue

Women with denser breast tissue (as seen on a mammogram) have more glandular tissue and less fatty tissue, and have a higher risk of breast cancer. Unfortunately, dense breast tissue can also make it harder for doctors to spot problems on mammograms.

Certain benign breast conditions

Women diagnosed with certain benign breast conditions may have an increased risk of breast cancer. Some of these conditions are more closely linked to breast cancer risk than others. Doctors often divide benign breast conditions into 3 general groups, depending on how they affect this risk.

Non-proliferative lesions: These conditions are not associated with overgrowth of breast tissue. They do not seem to affect breast cancer risk, or if they do, it is to a very small extent. They include:

• Fibrosis and/or simple cysts (sometimes called fibrocystic changes or disease)
• Mild hyperplasia
• Adenosis (non-sclerosing)
• Phyllodes tumor (benign)
• A single papilloma
• Fat necrosis
• Mastitis (infection of the breast)
• Duct ectasia
• Periductal fibrosis
• Squamous and apocrine metaplasia
• Epithelial-related calcifications
• Other benign tumors (lipoma, hamartoma, hemangioma, neurofibroma, adenomyoepthelioma)

Proliferative lesions without atypia: These conditions show excessive growth of cells in the ducts or lobules of the breast tissue. They seem to raise a woman's risk of breast cancer slightly (1 ½ to 2 times normal). They include:

• Usual ductal hyperplasia (without atypia)
• Fibroadenoma
• Sclerosing adenosis
• Several papillomas (called papillomatosis)
• Radial scar

Proliferative lesions with atypia: In these conditions, there is excessive growth of cells in the ducts or lobules of the breast tissue, with some of cells no longer appearing normal. They have a stronger effect on breast cancer risk, raising it 3½ to 5 times higher than normal. These types of lesions include:

• Atypical ductal hyperplasia (ADH)
• Atypical lobular hyperplasia (ALH)

Women with a family history of breast cancer and either hyperplasia or atypical hyperplasia have an even higher risk of developing a breast cancer.

Lobular carcinoma in situ

In lobular carcinoma in situ (LCIS) cells that look like cancer cells are growing in the lobules of the milk-producing glands of the breast, but they do not grow through the wall of the lobules. LCIS (also called lobular neoplasia) is sometimes grouped with ductal carcinoma in situ (DCIS) as a non-invasive breast cancer, but it differs from DCIS in that it doesn’t seem to become invasive cancer if it isn’t treated.

Women with lobular carcinoma in situ (LCIS) have a 7- to 11-fold increased risk of developing cancer in either breast.

Menstrual periods

Women who have had more menstrual cycles because they started menstruating early (before age 12) and/or went through menopause later (after age 55) have a slightly higher risk of breast cancer. The increase in risk may be due to a longer lifetime exposure to the hormones estrogen and progesterone.

Previous chest radiation

Women who as children or young adults were treated with radiation therapy to the chest area for another cancer (such as Hodgkin disease or non-Hodgkin lymphoma) have a significantly increased risk for breast cancer. This varies with the patient's age when they got the radiation. If chemotherapy was also given, it might have stopped ovarian hormone production for some time, lowering the risk. The risk of developing breast cancer from chest radiation is highest if the radiation was given during adolescence, when the breasts were still developing. Radiation treatment after age 40 does not seem to increase breast cancer risk.

Diethylstilbestrol (DES) exposure

From the 1940s through the early 1970s some pregnant women were given an estrogen-like drug called DES because it was thought to lower their chances of losing the baby (miscarriage). These women have a slightly increased risk of developing breast cancer. Women whose mothers took DES during pregnancy may also have a slightly higher risk of breast cancer

What is Cervical Cancer?

We are most interested in helping to keep women from getting cervical cancer. 

Cervical cancer is a terrible disease that kills 280,000 women every year worldwide, mostly in less developed countries in Africa, Asia and Latin America. The saddest part is that it is completely preventable! We are working to prevent it. 

Who is likely to get Cervical Cancer?

Women over the age of 35, women who had sex before they were 15, and women with HIV have the highest risk. Women who have had many sex partners or whose partner has had many sexual contacts are also at higher risk.

What is a Cervix?

The cervix is the mouth of the uterus (womb) that sits at the back of the vagina. It's where a sperm gets in to make a baby, and how the baby comes out later.

Cervical cancer is caused by an invisible virus that is spread by having sex, just like HIV. It's called HPV (human papillomavirus), and more than half of women have it by age 35. Most men and women don't know they have it, unless they get the kind that causes warts: little bumps you may see or feel on the woman's or man's genitals. Warts are not cancer.

How is cervical cancer prevented?

The HPV virus gets into the skin of the vagina and cervix and lives there. Many infections are cleared up by your own immune system; but the bad kinds can stay, and slowly cause changes in the cervix that may become cancer, over a 5 to 10 year time period. These abnormal cells are called dysplasia. If it is found and treated early, it can be completely removed. We can look at your cervix with a simple test, called VIA (washing it with vinegar), and see the dysplasia. Then we can freeze them, or remove them. VIA is even better than a Pap test in finding the dysplasia. It is not painful, just a little uncomfortable.

If we see precancerous cells, we will take a biopsy to be sure. This is a small pinch of skin, which we send to a laboratory for examination under a microscope. We will also check inside the cervix to be sure we don't miss anything.

If we think it is not too severe, and we can see all of it, we can freeze and kill the dysplasia. This is called cryotherapy. It causes a little menstrual-type cramps for a few minutes; we can give you medicine (Ibuprofen) to help the cramps. The frozen dead skin will gradually fall off, while new healthy skin grows underneath. You will have a watery discharge for about 2 or 3 weeks. You should not put anything in the vagina or have sex till the discharge stops, so it heals well.

If the dysplasia is severe, or we can't see it all, we need to remove those areas of the cervix. We will make it all numb so you don't feel any pain; then we use a thin wire with electricity to remove the bad parts. This is called LEEP. We will send the tissue to a lab to be sure there was no cancer, only dysplasia. We will use a tiny electric ball to stop the bleeding; then we paint the cervix with a mustard-like medicine to help it heal.

Afterwards, you will have a discharge of blood, like a period, and a dark grainy stuff like coffee grounds for 2 to 3 weeks. It is best not to do any heavy lifting or exercise for a week, so the bleeding doesn't get worse. It is very important that you don't put anything in the vagina during the healing time, about 1 month, so it can heal up well. Otherwise you could have more bleeding, or re-infect the healthy new skin that is growing. Be sure to explain this to your partner. Using a condom for 2 months after treatment also helps to prevent recurrence. 9 out of 10 women have no more dysplasia after treatment; but you should be re-examined in 6 months to be sure, as a few women need another treatment.

Having treatment for dysplasia will not keep you from getting pregnant or having a baby. However, you should not have LEEP or cryotherapy while you are pregnant. Tell the doctor or counselor if you think you might be pregnant.

If you have HIV or AIDS, the HPV virus will develop towards cancer much more rapidly. Even if you have been treated in the past, the pre-cancerous cells can recur. It is very important that you have frequent, regular examinations for dysplasia (every 6 months).

Share this information about preventing cervical cancer with your friends and family. You, too, could help to save someone's life!

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