The Molecular Reasons of Estrogen (Hormone) Replacement Therapy
Estrogen is a sex hormone for both male and female. According to the study, it has been evident that estrogen replacement therapy involves some molecular reasons. The reasons include management of cardiovascular diseases, management of cancer, and management of skin aging, thrombosis treatment, sexual dysfunction, joint pain relief, and management of mood swings. The above conditions occur in women at menopause.
Estrogen is a hormone in both male and female. The ovaries, adrenal glands, and fetoplacental unit are involved in the production of estrogen in women. Testes produce estrogen in males. In females, estrogen is essential for the growth and development of female secondary sexual characteristics. The characteristics are the growth of breasts, pubic and armpit hair development, endometrium development, menstrual cycle regulation, and development of the reproductive system. During the menstruation period, estrogen acts to provide necessary conditions suitable for fertilization, implantation, and nutrition of early embryo in case fertilization occurs. Management of sexual dysfunction or changes is work of estrogen in the body of both male and female (Parker 56). Women at menopause tend to lose their interest or urge for sex. Vaginal drying and rapid mood swings explain why women at menopause lose their urge to have sexual intercourse. Estrogen replacement therapy helps fight this situation. Combined estrogen therapy treats the condition. Estrogen replacement therapy works in relief of post-menopausal joint pain. Women who experience joint pain after menopause are advised to take estrogen or receive estrogen replacement therapy. Estrogen prevents osteoporosis; therefore, it relieves joint pain during menopause.
Hormone replacement therapy (HRT) involves medical treatment that helps relieve abnormal symptoms caused by menopause. The treatment can include estrogen-only or in combination with progestin. Estrogen replacement therapy (ERT) includes a technique conducted to increase the level of estrogen in postmenopausal women to prevent risks such as uterine cancer induced by low estrogen level. Estrogen replacement therapy can also help treat conditions such as breast atrophy, vaginal atrophy, and late onset of puberty or secondary sexual characteristics. There exist some signs that indicate that the level of estrogen is low; these include dryness of vagina, sleeping problems, urinary problems, irregular periods, situations where breasts do not grow, and many other. Application of estrogen replacement therapy is due to the following molecular reasons: prevention of premenopausal signs and symptoms, prevention of osteoporosis, prevention of cancer associated with colon, and reduction in early bone loss (Parker 90).
Cardiovascular diseases have been a major cause of death among old age women during the postmenopausal period. Reasons for this influx in death involve the loss of ovarian sex hormone after menopause. Beneficial effects are observed in animals, due to the examination that is initiated before menopause. Estrogen helps prevent the activity of osteoclasts known as osteoporosis, thus leading to improvement in bone mineral density or volume. Hip fracture is a significant problem associated with movement and death among old age females. Cancer of the colon is an important problem for women during menopause. Estrogen replacement therapy is administered to prevent it. Colon cancer has a receptor for estrogen; therefore, it is referred to as estrogen–receptor–positive or ER+. Management of sexual dysfunction or changes also involves estrogen hormone replacement therapy. Women during menopause tend to lose their interest or urge for sex. Drying of vagina and change of mood are an important example to explain the above condition. Estrogen replacement therapy helps fight this ailment.
Estrogen aids in the prevention of premenopausal symptoms. It also helps prevent osteoporosis. It also assists in the reduction of early bone loss and osteoporosis in women during menopause that had their ovaries removed at their 20s and 40s. Estrogen replacement therapy is also important as it helps reverse the effects of low estrogen levels, thus resulting in advantageous effects to the body. It contributes to the control of the onset and severity of hot flashes (Jovanovic, Sharpe, and O’Neill 78-79). It aids in mood improvement and resolves the sleeping problems that occur due to hormonal change. The therapy assists in the reduction of vaginal irritation by lubrication and maintaining the lining. It helps retain the skin collagen level. It also aids in the prevention of postmenopausal osteoblast activity, gum diseases, and other tooth problems. According to study, there are different reason for the use of estrogen as a replacement therapy as discussed below.
Estrogen and Cardiovascular Diseases
Cardiovascular diseases have been the leading cause of death among old age women during the postmenopausal period. The loss of ovarian sex hormone after menopause explains in detail why there is a high influx of cardiovascular diseases in female at menopause. There is the observation of beneficial effects in animals, due to the examination that is initiated before menopause. Estrogen has both negative and positive effects on the cardiovascular system. The positive influence of estrogen consists in its impact on lipid parameters: these are the increase of high-density lipoprotein and the reduction of low-density lipoprotein. This phenomenon helps facilitate the neutralization of nitric oxide that mediates vasodilation, inhibits injuries, and advances atherosclerosis in blood vessels. On the other hand, estrogen is responsible for increases in triglycerides and inflammatory markers. The inflammatory marker can be C-reactive protein (CRP). Also, estrogen is associated with several prothrombotic effects. These prothrombotic effects include an increase in the level of circulating prothrombin and reduction in antithrombin III. This occurrence causes an upsurge in venous thromboembolic actions. Most of these estrogen-associated effects influence the liver at first. The primary cause of this effect is oral administration of hormone but not transdermal one. For example, the increase in levels of C-reactive protein (CRP) is associated with oral estrogen administration (Parker 67-69).
Mechanism of Estrogen Action in Cardiovascular Treatment
Estrogen receptors are associated with the overall effect of estrogen. These receptors are of two known types: alpha estrogen receptor and estrogen beta receptor. Both receptors are associated with or involved in cardiovascular tissues and cells. These receptors are ligand-activated transcription aspects that are harbored or found in the nucleus of the cell and act as the gene expression regulator or controller as a result of hormone binding. The name of this process is a genomic pathway. The mechanism explains the longer-term effect associated with estrogen, for example, circulating level of lipids and coagulation factors. Estrogen receptors are the result of estrogen that is of a minute help in the transduction of the rapid effects. The name of these receptors is non-genomic as gene expression changes do not determine their activity. A subpopulation of estrogen receptors located in the cell membrane is signaling or detecting domains named caveolae initiate the rapid change. A good illustration of this non-genomic pathway or process for estrogen action in the cardiovascular system is the instigation of nitric oxide synthesis in the endothelial cell. The pathway works in arterial vasodilation due to the administration of estrogen (Jovanovic, Sharpe and O’Neill 55).
Estrogen replacement therapy prevents the high increase in cardiovascular diseases during menopause. The rise in cardiovascular diseases that menopause causes due to total cholesterol is as a result of plasma lipoprotein. Low-density lipoprotein level and triglyceride level rise in women during postmenopausal period. Hormone replacement therapy helps fight these effects of lipids although cardio protective high-density lipoprotein tends to decrease them. A given age of postmenopausal and premenopausal women have this impacts. A general reduction or removal of estrogen is related to the increase of cardiovascular diseases above those that are visible in women during menopause. The effect leads to a demand for cardiovascular assistance with the help of postmenopausal estrogen replacement therapy. Many women have a tendency of reporting the onset of skin aging after menopause, which can be through skin wrinkles, skin dryness, and decreased skin firmness while some have decreased skin elasticity. Estrogen replacement therapy leads to increased epidermal hydration, skin elasticity and thickness, and reduction in skin wrinkles. Due to these changes, the content and quality of collagen level and vascularization level are enhanced. The increase in mitotic activity of epidermal keratinocytes due to the administration of estrogen are observational changes in many women. Specific antibodies for alpha and beta estrogen receptors are responsible for the changes (Parker 87).
Estrogen and Its Involvement in Osteoporosis
Estrogen helps prevent the activity of osteoclasts known as osteoporosis, thus leading to improvement in bone mineral density or volume. Hip fracture is a significant problem associated with movement and death among older females. The effect does not occur in the setting of osteoclast activity. Estrogen has two receptors in its structure and can combine with mineral elements such as calcium and result in prevention of osteoporosis. The two receptors are alpha and beta estrogen receptors. Estrogen is essential for bones as it promotes the activity of osteoblasts, cells that produce bones. When estrogen drops or fluctuates at pre or post-menopausal level, the osteoblasts are unable to produce bones; therefore, to counter this effect, artificial estrogen is administered through estrogen replacement therapy. Estrogen replacement therapy is the only approved way to treat this effect (Parker 56-67).
Mechanism Estrogen Action in Osteoporosis
Estrogen deficiency is responsible for early and late types of osteoporosis in women during the post and pre-menopausal period. This condition is as the result of a substantial increase in bone reabsorption due to increased osteoclasts number and an upsurge in their activity. Bones contain functional E-receptors. The E-receptors are involved in bone metabolism in IL-6, IL-1, pro-inflammatory cytokines, granulocyte macrophage colony-stimulating factor, and prostaglanding-E2 and macrophage colony-stimulating factor. The above factors tend to increase bone re-absorption mainly via an increase in the pool size of pre-osteoclasts in the bone marrow, thus being controlled by E-receptors. Estrogen helps improve the activity of the E-receptors, thus preventing the process of osteoporosis through eliminating re-absorption (Jovanovic, Sharpe, and O’Neill 67).
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Cancer of the colon is a significant problem for women during menopause. Estrogen replacement therapy is administered to avoid the condition. Colon cancer has a receptor for estrogen; therefore, it is referred to as estrogen–receptor–positive or ER+.The implication is that cancer cells just like normal colon cells can receive a signal from estrogen that could prevent their growth (Watkins 800). Estrogen receptors are found on the surface of colon tissue all over the body. These receptors are protein in nature and act as ‘eyes’ or ‘ears’ of the colon cells. They receive a substance from the bloodstream cell surface and tell the colon cells what to do. Estrogen is also involved in breast cancer if too much of it is used for a long time. The receptor for estrogen is found on the surface of normal breast tissue that helps detect the increase or reduction of estrogen. Estrogen in small doses contributes to preventing the growth of these breast cancer cells, thus preventing breast cancer. Estrogen in combination with progesterone plays a significant role in the prevention of postmenstrual problems. A research shows that women who take estrogen therapy and develop endometrial cancer can have higher chances of survival than those who do not take estrogen hormonal therapy at all. This phenomenon was the result of the preventive effect of hormone replacement therapy on hip fractures. The estrogen receptors are capable of detecting the growth of endometrial cancer cell and developing the necessary action to prevent it. This condition is known as endometrial hypoplasia (Watkins 896)
Sexual Dysfunction Improvement
Estrogen replacement therapy is also involved in the management of sexual dysfunction or changes. Women during menopause tend to lose their interest or urge for sex. This condition can be explained by the drying of vagina and change of mood. Estrogen replacement therapy helps fight this disease (Rasgon 67). The disease is treated and eliminated by the combined treatment with estrogen and progesterone. Estrogen replacement treatment contributes to restoring vaginal cells and tissue, improve pH, and enhance the blood flow to the vagina. The problems are all associated with an onset of menopause. Vaginal dryness is highly responsive to the estrogen replacement therapy (ERT). Urinary tract and atrophy are also exposed to a positive effect of the estrogen replacement therapy (ERT), thus improving sexual sensitivity or libido. Estrogen
replacement therapy also improves sexual desire, fantasies, frequency of coitus and orgasm, and arousal in pre and post-menopausal women (Rasgon 67-69).
Joint Pain Relief
Relief of post-menopausal joint pain has been associated with estrogen replacement therapy. Women who experience joint pain after menopause are advised to take estrogen or receive estrogen replacement therapy. Estrogen is associated with prevention of osteoporosis; therefore, it relieves joint pain during menopause (Kirk,67). It has been proved that estrogen reduces joint pains, painful intercourse, hot flashes, and insomnia. It is because these symptoms are caused by low levels of estrogen in women experiencing menopause; also, estrogen raises the level of estrogen in the body. Even though estrogen aids in curbing joint pains and other symptoms, it should be used with care and according to a prescription from qualified physicians. It is because the research has revealed that the long-term use of estrogen can increase risks of ulcerative colitis and breast cancer. Therefore, women should consult their physicians and assess risks and benefits of hormone therapy during menopause before indulging in HRT.
Estrogen Assists in Skin Improvement
Estrogen aids in maintaining and improving skin collagen level. Structural and functional changes attributed to aging in a human being are evident in the skin more than any other organ. Estrogen has a positive effect on skin physiology and improvement of collagen level (Kirk 78). Administration of estrogen helps delay skin aging by modulating the epidermal keratinocyte, melanocyte, dermal fibroblast, and skin appendages such as high follicle and sebaceous gland. Many women have a tendency of reporting the onset of skin aging after menopause that is manifested through skin wrinkles, skin dryness, and decreased skin firmness while some have decreased skin elasticity. Estrogen replacement therapy leads to increased epidermal hydration,
skin elasticity and thickness, and reduction in skin wrinkles. Due to these changes, the content and quality of collagen level and vascularization level are enhanced. The changes are observed in women as a result of the increase in mitotic activity of epidermal keratinocytes due to administration of estrogen. The specific antibodies for alpha and beta estrogen receptor are responsible for the changes (Jovanovic, Sharpe, and O’Neil 5l).
Estrogen Involvement in Mood Swings
Estrogen is responsible for the improvement of mood swings during menopause. These mood changes include anxiety, feeling of sadness and lack of motivation. Estrogen replacement therapy can help improve the mood by sending positive signals to the brain. The brain in turn initiates the correction of the problem, and the moods are improved. Post-menopausal women deal with the mood swings, Administration of the female hormone can help in correction of the condition. With the aid of the positive and negative receptors, estrogen contributes to the control of the changes and brings them to normal (Jovanovic, Sharpe and O’Neill 90-98). Estrogen acts on the hypothalamus-pituitary-adrenal axis and leads to changes in emotional behavior. It also causes emotional stimulation and alters the concentration of emotional experiences. Therefore, estrogen can change bad moods into better moods, and as such, it provides a solution to mood swings.
Estrogen in Venous Thrombosis
Blood clots that develop and accumulate within veins are called venous thrombosis. Studies conducted indicate that women aged between 50 and 60 years and those under 50 years old are at a higher risk of suffering from venous thrombosis if they partake in hormone replacement therapy. Furthermore, the risk of venous thrombosis is the highest in those who have a high blood clots risk during the first two years of receiving treatment. It should not be alarming as it relates to those with a genetic susceptibility to developing thrombosis. Usually, people with this condition will be advised not to use hormone replacement therapy. Research has it that the combination of progesterone and estrogen in tablet or oral form causes an increased risk of blood clots. Other studies indicate that the use of non-oral therapy, like implants, gels, or patches, helps reduce the likelihood of blood clots.
In conclusion, estrogen is an important hormone in women during menopause as it has more advantages than disadvantages. Estrogen assists in the prevention of premenopausal symptoms. It also helps prevent osteoporosis. It aids in the reduction of early bone loss and osteoporosis in women during menopause that had their ovaries removed at their 20s and 40s. Estrogen replacement therapy is also important as it helps reverse the effects of low estrogen levels, thus resulting in advantageous effects to the body. It contributes to the control of the onset and severity of hot flashes. It aids in mood improvement and with sleeping problems that occur due to hormonal change. It assists in the reduction of vaginal irritation by lubrication and maintenance of lining. It also helps keep the skin collagen level. Moreover, it aids in the prevention of postmenopausal osteoblasts activity, gum diseases, and other tooth problems. Many women have a tendency of reporting the onset of skin aging after menopause that tend to occur through skin wrinkles, skin dryness, decreased skin firmness while some have decreased skin elasticity. Estrogen replacement therapy leads to the increase in epidermal hydration, skin elasticity and thickness, and reduction in skin wrinkles. Due to these changes, the content and quality of collagen level and vascularization level are enhanced. The specific antibodies for alpha and the estrogen beta receptor are responsible for the changes. Hence, estrogen an important hormone for therapy replacement. It has been evident from the above discussed reasons.