Hormone Replacement Therapy

Hormone Replacement Therapy (HRT) is a pharmacological strategy for correcting estrogen-deficient conditions in women during peri- and post-menopause.

The method is based on the pathogenetic principle of replenishing the reduced or ceased endogenous secretion of sex hormones (estrogens and progestogens) with exogenous analogs.

Etiology and pathophysiology

With age, there is a depletion of the ovarian follicular apparatus, leading to a critical drop in estradiol levels and a compensatory increase in gonadotropins (FSH). Estrogen receptors (ER-α and ER-β) are expressed in many tissues such as vascular walls, bones, the brain, and the urogenital tract. The hormone deficiency causes systemic vegetative disturbances (hot flashes) and localized atrophic changes.

In gynecology, local (vaginal) therapy with low doses of estriol is of particular importance. The preparation selectively binds to nuclear receptors in the basal layer of the vaginal, urethral, and bladder triangle epithelia. This triggers cell proliferation, restores collagen and elastin synthesis in the submucosal layer, improves vascularization, and stimulates the accumulation of intracellular glycogen.

Clinical significance

Local estrogen therapy is the only proven standard treatment for genitourinary menopausal syndrome, specifically for atrophic vaginitis. It restores the thickness and elasticity of the mucosa, normalizes pH and lactobacilli populations, alleviating symptoms such as dryness, burning, dyspareunia, and recurrent post-coital cystitis. Unlike systemic HRT, local forms are safe, as they are minimally absorbed into the systemic circulation and do not increase the risk of breast cancer or venous thromboembolisms.