In the 1990s, it was a common practice to give a woman estrogen and progesterone in order to treat hot flashes and other symptoms of menopause. This was until a large study was released that indicated a risk for developing heart disease in women who took this kind of therapy. The practice of giving hormone replacement therapy declined quite a bit after that but it is still being used today in select cases where menopausal symptoms are severe and the woman recognizes the possible risk of taking the medication.
Hormone therapy is a good choice for certain women, depending on their risk factors. Hormone replacement therapy is also referred to as estrogen replacement therapy or menopausal hormone therapy. It is the practice of giving estrogen and progesterone for the relief of the most common symptoms of menopause and for some, to slow the progress of aging.
Healthcare providers can prescribe hormone replacement therapy (HRT) while a woman is experiencing the symptoms of menopause or after menopause has already occurred. The main purpose of hormone replacement therapy is to treat the symptoms of menopause, including thinning of the bones, vaginal dryness, hot flashes and night sweats. By giving hormone replacement therapy, the doctor is trying to replace the hormones no longer made by the woman’s ovaries.
Estrogen is important for the body. Besides being responsible for the menstrual cycle and uterine wall thickness, it has an effect on the strength of the bones, affects how the body makes use of calcium, and increases the amount of HDL (“good”) cholesterol in the body. Progesterone also plays a role in the female reproductive system. It causes the uterine lining to mature and shed at the end of the menstrual cycle.
If a woman takes estrogen alone without progesterone for the management of menopausal symptoms, the risk of endometrial cancer (cancer of the uterus) increases. Progesterone thins the lining of the uterus so that the cells don’t proliferate and cause cancerous cells to develop.
Types Of HRT
There are many ways to receive hormone replacement therapy. You need to talk to your doctor about what kind of therapy is best for you. Here are some choices:
If a woman has already had a hysterectomy, she has no chance of developing uterine cancer so that estrogen can be given alone as a form of hormone replacement therapy. Estrogen can be given in several ways, including a pill you take once daily, a patch you wear for a week at a time, a vaginal ring, a gel you put on your skin, and an estrogen-containing spray. Estrogen alone will control the symptoms of perimenopause and menopause but may increase the risk of developing breast cancer in women who have estrogen-sensitive breast cancer.
Estrogen and progesterone therapy
This is often referred to as combination therapy. It involves giving both estrogen and a synthetic progesterone, called progestin. The progestin does not do much to reduce the hot flashes alone but is designed for women who still have their uterus in order to prevent uterine cancer.
Bioidentical hormone therapy
There are compounding pharmacies that make bioidentical hormones given alone or in combination for menopausal symptoms. Bioidentical hormones are the same as the hormones in the female body and must be given as a cream or gel applied to the skin where it is rapidly absorbed.
Risks Of HRT
As mentioned, there are risks to taking hormone replacement therapy, including increased risks for heart disease, breast cancer, and stroke. In fact, certain types of HRT have a higher risk than others, and the level of risk can vary from woman to woman depending upon her health history and lifestyle.
It is important to discuss both the risks and benefits with your doctor. Typically, the best route is to take the lowest dose and re-evaluate the treatment every six months. The biggest study on this issue was the Women’s Health Initiative, which was a 15-year study that looked at more than 160,000 women who were past menopause.
According to the study, women who took both estrogen and progesterone had an increased chance of developing cardiovascular disease. In the study, the risks of taking these medications over the long term outweighed any benefits taking the medication had on menopausal symptoms.
There are some women for whom hormone replacement therapy is never appropriate. Talk to your healthcare provider if you have any of these conditions and are considering taking hormone replacement therapy:
- A history of blood clots, such as deep vein thrombosis or pulmonary emboli
- A history of uterine, endometrial, or breast cancer
- A history of cardiovascular disease
- Problems with liver disease in the past or present
- A previous heart attack
- If you are possibly pregnant
- If you have had a stroke in the past
If you have any of these conditions, the risk of taking hormone replacement therapy may outweigh the benefits of taking the therapy and there may be other medications that will be more beneficial.
Side Effects Of Hormone Replacement Therapy
There are side effects of taking hormone replacement therapy that may be significant enough that you may stop taking the medication or may not wish to start taking it. These include the following:
- Breast tenderness or swelling
- Bloating of the abdomen
- Changes in mood
- Vaginal bleeding
If you have any of these symptoms, talk to your doctor about whether or not hormone replacement therapy is right for you.
Weighing The Pros And Cons Of HRT
Read all you can about taking hormone replacement therapy and know your past and present medical history. Take this information to your doctor in order to decide if it is safe for you to take this type of therapy. For some women, especially those with severe symptoms, it may be the only way to control the symptoms. If the symptoms are mild or there are other health issues to consider, hormone replacement may not be the best choice for you.