Hormone Replacement Therapy

Hormone Replacement Therapy Image

The medical community once thought that hormone replacement therapy (HRT) was the answer to both reducing the symptoms of menopause and decreasing the risks of certain diseases, including heart disease, in post-menopausal women. However, some large-scale studies showed that HRT may have potentially serious side effects, including increased risk of blood clots, breast cancer, heart attack and strokes. Of note are that these studies have been criticized by many scientists about their validity.

The findings of these studies have led to some women stopping hormone replacement therapy and to an ongoing hormone replacement therapy debate that leave many women wondering what to do.

How Hormones Work

Estrogen and progesterone are the primary hormones that regulate a woman’s reproductive system and menstrual cycle. As a woman approaches menopause, levels of these hormones begin to fluctuate widely, sometimes as early as the mid-thirties. These changes potentially lead to characteristic symptoms such as hot flashes, night sweats and insomnia.

By the time a woman enters menopause — which begins one year after her last period — her body produces only about one-tenth of the estrogen previously produced, and almost no progesterone. The purpose of the hormones used in hormone replacement therapy is to replace the hormones that her body no longer makes.

HRT Therapy Benefits

HRT (now called menopausal hormone therapy) is often effective in alleviating the symptoms of menopause. Studies show HRT therapy benefits include a reduced risk of both colorectal cancer and fractures due to osteoporosis.

HRT for menopause is available in various forms, including pills, gels, creams and patches. Women who don’t have a uterus usually receive estrogen alone, while women who still have their uterus intact usually receive estrogen plus progestin (synthetic progesterone). This is because the combination has a lower risk of causing endometrial cancer (cancer of the lining of the uterus) than estrogen alone.

Weighing Your Options

Currently, the Food and Drug Administration (FDA) recommends the following:

  • Although you can use HRT for osteoporosis prevention, consider other available options first, such as dietary modifications or prescription drugs that help prevent bone loss.
  • Don’t use HRT to prevent heart disease, stroke, memory loss, or Alzheimer’s disease.
  • Use the lowest dose of HRT required to ease menopausal symptoms, and use it for the least amount of time possible, while under the care of your healthcare practitioner.

Women with heart disease aren’t advised to use HRT because it increases the risk of blood clots and the risk of heart attack in the first year of use. Other risk factors for heart disease include smoking, high cholesterol, high blood pressure, physical inactivity, obesity and diabetes, so these should be appropriately managed, if present. Weigh the HRT therapy benefits and risks to determine what’s best for you.

Resources

National Institute on Aging. (2009). Hormones and menopause. Retrieved August 25, 2010, from http://www.nia.nih.gov/HealthInformation/Publications/hormones.htm.

National Cancer Institute. (2007). Menopausal hormone replacement therapy use and cancer. Retrieved August 25, 2010, from http://www.cancer.gov/cancertopics/factsheet/Risk/menopausal-hormones.

National Institutes of Health. (2005). Facts about menopausal hormone therapy. Retrieved August 25, 2010, from http://www.nhlbi.nih.gov/health/women/pht_facts.pdf.

U.S. Food and Drug Administration. (2009). Menopause and hormones. Retrieved August 25, 2010, from http://www.fda.gov/ForConsumers/ByAudience/ForWomen/ucm118624.htm.