Hormone replacement therapy (HRT) is sometimes used on a short-term basis for the relief of unpleasant menopausal symptoms such as hot flashes, vaginal dryness, and irritability. On a long-term basis, some women have used HRT based on doctors’ assumptions that it would reduce the risk of osteoporosis and heart disease . However, results of studies on estrogen replacement therapy (ERT) and estrogen plus progestin suggest that the risks of long-term HRT may outweigh the benefits for many women.
Along with information about the risks of HRT, there are also a number of options. So if you and your doctor decide that HRT may be right for you in the short- or long-term, how do you decide which therapy would be best?
HRT can include the hormones estrogen or progesterone, or a combination of both. If you're considering HRT for the first time, or want to talk to your doctor about changing the regimen you're presently on, here's a rundown of options.
Therapies containing just estrogen are commonly referred to as estrogen replacement therapy, or ERT. Because of the increased risk of endometrial cancer (lining of the uterus), long-term ERT is usually only offered to women who have had their uteruses removed through hysterectomy .
ERT can be administered in a variety of ways. Systemic ERT delivers estrogen so that it circulates throughout the body, whereas local ERT delivers estrogen to a particular area of the body, such as the vagina to treat vaginal dryness or vaginal atrophy.
Forms of systemic ERT include:
These medications may help to reduce hot flashes and vaginal dryness and may reduce your risk of osteoporosis. Even low doses of estradiol (given as a skin patch) may help with vaginal dryness and pain during sexual activity. Evamist, which is a spray, is another type of low-dose estradiol that may reduce the number of hot flashes.
Forms of local ERT include:
Because only a small amount of estrogen circulates in the body with local ERT, these products typically only help with local symptoms, such as vaginal dryness. They are usually not helpful in controlling other symptoms of menopause , such as hot flashes, or in preventing osteoporosis.
Hormone replacement therapy (HRT) is treatment that combines ERT (estrogen only) with a form of the hormone progesterone. This may consist of natural progesterone or a synthetic progesterone, called progestin. Both forms are also called progestogens.
There are several HRT schedules and methods of delivery available, including:
Potential side effects and risks of HRT are basically the same as those listed for ERT. Long-term HRT may slightly, but significantly, increase the risk of strokes , blood clots, heart attacks, and invasive breast cancer , gallstones, gallbladder disease, and ovarian cancer. Adding progesterone, however, eliminates the increased risk of endometrial cancer caused by estrogen alone. This applies to women who have not had their uteruses removed.
If you are currently taking estrogen or combined estrogen and progesterone or were thinking about starting, talk to your doctor before making any final decisions about what to do.
RESOURCES:
American Congress of Obstetricians and Gynecologists
http://www.acog.org/
Menopausal Hormone Therapy Information
http://www.nih.gov/PHTindex.htm/
CANADIAN RESOURCES:
The Canadian Women's Health Network
http://www.cwhn.ca/indexeng.html/
The Society of Obstetricians and Gynaecologists of Canada
http://www.sogc.org/
References:
DynaMed Editors. Hormonal replacement therapy (HRT). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated June 14, 2010. Accessed June 22, 2010.
Elacqua M. Hormone replacement therapy: is it right for you? American College of Obstetricians and Gynecologists website. Available at: http://www.acog.org/acog_districts/dist_notice.cfm?recno=1bulletin=2321. Published June 4, 2007. Accessed August 4, 2008.
Estrogens (systemic), estrogens (vaginal), progesterone.USP Dictionary of USAN and International Drug Names website. Available at: http://library.dialog.com/bluesheets/html/bl0464.html.
Hormone replacement therapy. National Institute on Aging website. Available at: http://www.nia.nih.gov/. Accessed August 4, 2008.
Hormone replacement therapy. National Institutes of Health, MedlinePlus website. Available at: http://www.nlm.nih.gov/medlineplus/hormonereplacementtherapy.html. Accessed August 4, 2008.
Hormone therapy. American College of Obstetricians and Gynecologists website. Available at: http://www.acog.org/publications/patient_education/bp066.cfm. Accessed June 20, 2008.
Hormone therapy basics. North American Menopause Society website. Available at: http://www.menopause.org/healthcareprof.aspx. Accessed August 4, 2008.
North American Menopause Society. Early Menopause Guidebook. Cleveland, OH: North American Menopause Society; 2001.
9/16/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Huang A, Yaffe K, Vittinghoff E, et al. The effect of ultralow-dose transdermal estradiol on sexual function in postmenopausal women. Am J Obstet Gynecol. 2008;198:265.e1-7.
11/19/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Buster JE, Koltun WD, Pascual ML, Day WW, Peterson C. Low-dose estradiol spray to treat vasomotor symptoms: a randomized controlled trial. Obstet Gynecol. 2008;111:1343-1351.
Last reviewed June 2010 by Brian Randall, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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