Menopausal Hormone Therapy

What is menopausal hormone therapy?

Menopausal hormone therapy is a treatment that can relieve the symptoms many women have during menopause. Regular doses of hormones are taken to replace some of the natural hormones that decrease at menopause. The 2 main female hormones are estrogen and progesterone.

Menopause is the time when menstruation stops for 12 consecutive months. It is usually a gradual process, but it can occur suddenly in some cases. The ovaries begin to produce fewer hormones. The reduced amount of hormone causes menstrual periods to become irregular. Eventually they stop completely. Menopause can also suddenly occur when the ovaries are surgically removed.

Menopause is part of a natural aging process and not a disease. For many women menopause is an easy change. but some women have problems caused by the decrease in hormones, particularly by the decrease in estrogen. These problems may be helped by treatment that replaces some of the lost hormone.

If your uterus has been removed, you may take estrogen alone. If you still have your uterus, taking estrogen alone increases your risk of cancer of the uterus. Your provider will recommend taking progesterone with estrogen to reduce this risk.

Hormone replacement therapy (HRT) may be taken as:

• tablets to be swallowed
• patches or lotion to be put on the skin
• a vaginal ring
• a cream to be put into the vagina
• pellets placed under the skin
• injections

When is it used?

You may never have symptoms of menopause, or they may occur for a few weeks, for a few months, or sometimes over several years. Your symptoms may come and go, or they may occur regularly. Your healthcare provider might recommend hormone therapy to relieve the following symptoms, especially if they are very severe:

• hot flashes
• night sweats
• vaginal dryness, which can cause discomfort, pain or bleeding during sexual intercourse.
• depression
• loss of sex drive (libido)
• memory loss
• headaches
• insomnia

Researchers and healthcare providers are studying the benefits and risks of HRT, and learning new things every day. You and your healthcare provider should discuss the risks and benefits of HRT for you. Factors such as your age, race, family history, and health history must be considered. Treatment with the female hormones estrogen and progestin can help relieve some of the symptoms of menopause. It can also help prevent bone loss (osteoporosis). HRT may be prescribed to treat symptoms of menopause if other treatments have been tried and failed, and if you and your provider decide the benefits may outweigh the risks. Depending on your age, treatment with estrogen and progestin may increase the risk for heart disease. It may also increase your risk for stroke, breast cancer, blood clots, some gallbladder problems, and possibly dementia.

Sometimes hormones may be recommended for women who go through menopause early (before the age of 40). Removal of the ovaries causes a sudden decrease in hormones and early menopause. HRT is often given to younger women who have had their ovaries removed to treat the symptoms of menopause and try to prevent osteoporosis.

What are the benefits of hormone therapy?

• Relief of menopausal symptoms, including hot flashes and vaginal dryness
• Prevention and treatment of osteoporosis

  Osteoporosis is a disease that thins and weakens bones. This makes it easier for the bones to break. Bone loss begins around age 35. You start losing bone more quickly at menopause. Hormone therapy can slow down bone loss if it is begun soon after menopause. However, your provider may prescribe other medicines to help prevent osteoporosis. Weight-bearing exercise, such as walking, and making sure that you have enough calcium and vitamin D in your diet also help to keep your bones healthy. Your healthcare provider may recommend calcium supplements with vitamin D.

What are the risks of hormone therapy?

The risks of hormone therapy include:

• Uterine cancer: Estrogen taken without progesterone increases the risk of cancer of the uterus. To lessen this risk, healthcare providers prescribe estrogen combined with progesterone if you have not had your uterus removed.
• Breast cancer: Hormone replacement therapy may increase the risk of breast cancer. Talk to your provider about this risk. Many providers recommend that women be checked thoroughly for any tumors and have a mammogram before beginning HRT. If you have a family history of breast cancer, it is especially important to discuss this with your provider.
• Cardiovascular disease, strokes, and blood clots in the legs and lungs.
• Enlargement of or bleeding from a fibroid tumor in your uterus, if you have one.

Hormone therapy may also increase your risk for some gallbladder problems and dementia.

The risks of all forms of HRT are continuing to be studied. The risks described above may be different for hormone therapy that involves lower doses of estrogen and progesterone or progesterone only. You and your healthcare provider should discuss the risks and benefits of hormone therapy for you.

What are the side effects of hormone therapy?

The side effects of hormone therapy may include:

• Uterine bleeding or vaginal discharge if your uterus has not been removed.
• Bloating, fluid retention, and weight gain.
• Breast tenderness and enlargement.
• Nausea.
• Symptoms like those of premenstrual tension (PMS), such as headaches and mood swings. when progesterone is part of the treatment.
• Abnormal blood clotting.
• Acne if taking estrogen with progesterone.
• Headache.
• Chloasma (tan blotches on face).

If your therapy includes both estrogen and progesterone, you may have some vaginal bleeding if there are days in the cycle when you are not taking hormones. Not a menstrual period, the bleeding typically lasts 2 or 3 days. Usually you will not have any cramps with the bleeding. If you take both estrogen and progesterone in low doses every day, the hormones will not cause bleeding except perhaps some spotting of blood for the first 2 to 3 months.

Who should not take hormone therapy?

Hormone therapy is not recommended for women who have any of these conditions, diseases, or medical history:

• heart attack or stroke
• uncontrolled high blood pressure
• blood clots in the legs, lungs, or eyes
• cancer of the breast or uterus
• unexplained vaginal bleeding
• liver disease
• porphyria (nerve pain or sensitivity to sunlight)

You should not take hormones if you are or think you may be pregnant.

Also, if you smoke, you should avoid hormone therapy. Smoking may increase your risk of heart attack or stroke while you are taking hormones.

If you have any of the following diseases or conditions, you should discuss with your provider the effect of hormone therapy on these conditions:

• uterine fibroids (These benign tumors may grow in response to estrogen. They begin to shrink at menopause unless you are taking estrogen.)
• endometriosis
• fibrocystic breast disease
• migraine headaches
• gallbladder disease

What can I do to take care of myself?

If you are thinking about taking hormones:

• Talk to your healthcare provider about the risks and benefits.
• Get a mammogram before you begin HRT to check for breast cancer. Then get a mammogram every 1 to 2 years, according to your provider's recommendation.

Ask your healthcare provider about:

• The different types and dosages of hormone therapy.
• Any side effects or special precautions you should know about while you are taking hormones.
• When you should start and stop the taking hormones.

If you are already taking hormones:

• Ask your provider about any special precautions or side effects.
• If you are taking estrogen combined with progesterone, tell your provider if bleeding occurs at any time other than the days when you do not take the hormones.
• Be sure to have a yearly pelvic exam with a Pap test.
• Do not change your hormone dose without checking with your provider.
• Eat a healthy diet and exercise regularly according to your provider's recommendations.
• Do not smoke.
• Have a mammogram every year. Examine your breasts monthly.
• Have a complete physical exam every year. Your blood should be tested regularly for cholesterol levels and liver function.