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HORMONE REPLACEMENT THERAPY

(also called: ERT, Estrogen replacement therapy, HRT, Menopausal hormone therapy)

Menopause is the time in a woman's life when her period stops. It is a normal part of aging. In the years before and during menopause, the levels of female hormones can go up and down. This can cause symptoms such as hot flashes and vaginal dryness. Some women take hormone replacement therapy (HRT) to relieve these symptoms. HRT may also protect against osteoporosis.

However, HRT also has risks. It can increase your risk of breast cancer, heart disease and stroke. Certain types of HRT have a higher risk, and each woman's own risks can vary depending upon her health history and lifestyle. You and your health care provider need to discuss the risks and benefits for you. If you do decide to take HRT, it should be the lowest dose that helps and for the shortest time needed. Taking hormones should be re-evaluated every six months.

Menopause is a normal part of aging. It is not a disease or something that has to be treated. Women may decide to use menopausal hormone therapy because of its benefits, but there are also side effects and risks to consider. Two benefits of menopausal hormone therapy are:

• treating some of the bothersome symptoms of menopause
• preventing or treating osteoporosis

But for some women there are noticeable side effects:

• breast tenderness
• spotting or a return of monthly periods
• cramping
• bloating

By changing the type or amount of the hormones, the way they are taken, or the timing of the doses, your doctor may be able to control these side effects. Or, over time, they may go away on their own.

For some women there are also serious risks (see chart). These risks are why you need to think a lot before deciding to use menopausal hormone therapy.

Although the risks are small for any one woman, you need to take them into account. Much of the following chart on benefits and risks is based on one important clinical trial, the Women’s Health Initiative (WHI). This study looked at estrogen (conjugated equine estrogens) used alone or with a particular progestin (medroxyprogesterone acetate). Some other types of estrogen, progesterone, or progestin may have been tested in smaller clinical trials to see if they have an effect on heart disease, breast cancer, or dementia. Others have not.

Because the average age of women participating in the trial was 63, more than 10 years past the average age of menopause, some experts now question whether the WHI results apply to women around the time of menopause. The WHI study found that in every 10,000 women using estrogen plus progestin, there would be 7 more heart attacks than in every 10,000 women not using these hormones. Other research has suggested that if MHT is begun around the time of menopause, it might not increase the risk of heart disease as much as in older women in the WHI. This is a subject for further study.

Hormone Replacement Therapy: Benefits and Risks – July, 2006
Here is what scientists can say right now about the benefits and risks of MHT. Remember—which hormones you use, the way you take them, and the dose might affect these benefits and risks.

* Women who have had a hysterectomy have had their uterus removed.

Hormone Replacement Therapy: What are “natural hormones?”
Cathy’s friend Susan thinks she is not at risk for side effects from menopausal hormone therapy because she uses “natural hormones” to treat her hot flashes and night sweats. Cathy asked her doctor about them.

The natural hormones Susan uses are estrogen and progesterone made from plants such as soy or yams. Some people also call them bioidentical hormones because they are supposed to be chemically the same as the hormones naturally made by a woman’s body. So-called natural hormones are put together (compounded) by a compounding pharmacist. This pharmacist follows a formula decided on by your doctor.

Drug companies also make estrogens and progesterone from plants like soy and yams. Some of these are also chemically identical to the hormones made by your body. You get these from any pharmacy with a prescription from your doctor.

One difference between the natural hormones prepared by a compounding pharmacist and those made by a drug company is that the compounded natural hormones are not regulated and approved by the U.S. Food and Drug Administration (FDA). So, we don’t know much about how safe or effective they are or how the quality varies from batch to batch. Hormones made by drug companies are regulated and approved by the FDA.

There are also “natural” treatments for the symptoms of menopause that are available over-the-counter, without a prescription. Some of these are made from soy or yams. They are not regulated or approved by the FDA.

Cathy’s doctor told her that there is very little reliable scientific information from clinical trials about the safety of bioidentical hormones, how well they control the symptoms of menopause, and whether they are as good or better to use than FDA-approved estrogens, progesterone, and progestins. (Sources: National Heart, Lung, and Blood Institute)

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