Hormone Therapy
Menopause symptoms can impact the quality of a woman’s life. The severity of symptoms and how long they are experienced can vary.
Hormone therapy (HT), also known as hormone replacement therapy (HRT), can relieve the symptoms and the discomfort of the menopause transition. But the decision to use hormone therapy is a confusing one and can be controversial.
In July 2002, the National Institutes of Health (NIH) halted part of the Women’s Health Initiative (WHI) study that looked at women who took either estrogen or progestin (combined HT) or a placebo. The WHI is a long-term study looking at ways to prevent heart disease, breast and colon cancer, and osteoporosis. The HT part of the study was halted after 5.2 years, concluding that the risks for the study group on combined HT outweighed the benefits.
Risks included small but significant increased risks of breast cancer, coronary heart disease, stroke and blood clots for women on combined HT. When deciding about using hormones, each woman and her health-care provider should review her symptoms, health concerns, and the risks and benefits of hormone therapy.
Using Hormone Therapy for symptom relief
HT remains an acceptable option for the treatment of menopausal symptoms, according to the American College of Obstetricians and Gynecologists (ACOG). Taking estrogen in one form or another can ease many menopause symptoms. Estrogen may not get rid of the symptoms entirely, but it can make them less frequent and intense. In particular, estrogen can relieve hot flashes and vaginal burning, itching and dryness. Estrogen also can relieve some mood swings associated with menopause, but it does not solve problems that are part of the aging process.
ACOG recommends that symptom relief be the primary reason for taking HT. A woman should take HT at the lowest dose for the shortest time possible, based on her symptoms, the benefits to her, and her personal health risks.
Hormone Therapy and long-term health concerns
The risk of developing heart disease and osteoporosis increases as women age. In the past, some study results indicated that hormone therapy benefited heart health. Newer studies have led ACOG to recommend that HT should not be used to prevent heart disease.
Estrogen therapy has been proven to help prevent osteoporosis; at menopause, loss of bone increases risk for the disease as a woman ages. However, there are other therapy options for slowing bone loss and reducing fracture risk. ACOG recommends that even though hormonal therapies have been shown to help build stronger bones, women should weigh the risks of hormone therapy before taking it to prevent osteoporosis.
How do I receive hormone treatments?
HT is most often prescribed in pill form. Estrogen also can be given via a skin patch. Estrogen for vaginal symptoms can be administered via cream, a special tablet, or a soft, pliable vaginal ring. Both estrogen and progestin most commonly are prescribed. Progestin protects against uterine cancer. If a woman has had a hysterectomy (surgical removal of the uterus), she could take just estrogen.
Another hormone, testosterone, also produced by the ovaries, may be added to a woman’s treatment plan. This hormone may be helpful in improving libido.
Are there side effects of hormone therapy?
HT “replaces” hormones in smaller amounts than those naturally produced during reproductive years. Side effects of estrogen include breast tenderness, fluid retention, nausea, headache and vaginal bleeding. Synthetic progestins may cause fluid retention, acne, premenstrual-like symptoms, anxiety and irritability. Natural micronized progesterone causes fewer side effects. Often, these side effects can be eliminated or reduced by changing dosage, schedule or route of delivery. Also, your body may adjust to hormones over a couple of months. Ask your health-care provider about concerns about side effects.
In addition, your health-care provider will schedule a follow-up appointment for you, usually at three months after initiation of HT, then once a year.
Will hormone therapy affect the risk for breast cancer?
There have been numerous studies on breast cancer and HT.
In July 2002, the WHI study halted a part of that study after 5.2 years when a slight increased risk of breast cancer was found in the women taking combined HT (estrogen and progestin). On average, there were 38 cases of breast cancer per 10,000 women on HT, compared to 30 breast cancer cases in women taking a placebo.
The increase in breast cancer was apparent after four years of HT use, and the risk appears to be cumulative over time. Breast-cancer risk was increasing in the placebo group, as well, because advancing age also increases risk; still, the risk for women in the HT group seemed to increase at a higher rate.
If you choose HT for relief of menopausal symptoms, the ACOG has the following recommendations:
- Take HT for the shortest possible time that works for you, in the smallest effective dose.
- Have regular consultations with your health-care provider (at least once a year) to review your reasons for taking HT and to see if you can successfully discontinue HT use.
- Get regular breast-cancer screenings, including annual health-care provider breast exams and regular mammograms. ACOG recommends a mammogram every one to two years during your 40s and annually after that.
If you have questions or would like more information about menopause, call Mercy Women’s Center at 319-398-6821.
