If you need hormone replacement therapy (HRT), the options can be confusing.
From a medical perspective, here is a description of this condition from the Mayo Clinic:
Hormone replacement therapy — medications containing female hormones to replace the ones the body no longer makes after menopause — used to be a standard treatment for women with hot flashes and other menopause symptoms. Hormone therapy (as it’s now called) was also thought to have the long-term benefits of preventing heart disease and osteoporosis.
Attitudes about hormone therapy changed abruptly in 2002, when a large clinical trial found that the treatment actually posed more health risks than benefits for postmenopausal women. As the number of health hazards attributed to hormone therapy grew, doctors became less likely to prescribe it. And most women on hormone therapy discontinued its use, often without talking to their doctors.
What are the benefits of hormone therapy?
Women who choose standard hormone therapy during natural (nonsurgical) menopause typically take estrogen and progestin, a man-made version of progesterone. It can also ease vaginal symptoms of menopause, such as dryness, itching, burning and discomfort with intercourse.
Long-term hormone therapy for the prevention of postmenopausal conditions is no longer routinely recommended. But women who take estrogen for short-term relief of menopausal symptoms may gain some protection against the following conditions:
- Osteoporosis.Studies show that hormone therapy can prevent the bone loss that occurs after menopause, which decreases the risk of osteoporosis-related hip fractures.
- Colorectal cancer.Studies show that hormone therapy can decrease the risk of colorectal cancer.
- Heart disease.Some data suggest that estrogen can decrease risk of heart disease when taken early in your postmenopausal years. A randomized, controlled clinical trial — the Kronos Early Estrogen Prevention Study (KEEPS) — exploring estrogen use and heart disease in younger postmenopausal women is under way, but it won’t be completed for several years.
For women who undergo menopause naturally, estrogen is typically prescribed along with progestin, a man-made version of progesterone. This is because estrogen without progestin can increase the risk of uterine cancer. Women who undergo menopause as the result of a hysterectomy can take estrogen alone.
What are the risks of hormone therapy?
In the largest clinical trial to date, the combination estrogen-progestin (Prempro) increased the risk of certain serious conditions.
According to the study, over one year, 10,000 women taking estrogen plus progestin might experience:
- Seven more cases of heart disease than women taking a placebo
- Eight more cases of breast cancer than women taking a placebo
- Eight more cases of stroke than women taking a placebo
- Eighteen more cases of blood clots than women taking a placebo
- An increase in abnormal mammograms, particularly false positives
The study found no increased risk of breast cancer or heart disease among women taking estrogen without progestin. Over one year, however, 10,000 women taking estrogen alone might experience:
- Twelve more cases of stroke than women taking a placebo
- Six more cases of blood clots in the legs than women taking a placebo
- An increase in mammography abnormalities
The effect of hormone therapy on mammograms is important, because it suggests that women on hormone therapy may need more frequent mammograms and additional testing.
Who should consider hormone therapy?
Despite the health risks, estrogen is still the gold standard for treating menopausal symptoms. The absolute risk to an individual woman taking hormone therapy is quite low — possibly low enough to be acceptable to you, depending on your symptoms.
The benefits of short-term hormone therapy may outweigh the risks if you:
- Experience moderate to severe hot flashes or other menopausal symptoms
- Have lost bone mass and either aren’t able to tolerate other treatments or aren’t benefitting from other treatments
- Stopped having periods before age 40 (premature menopause) or lost normal function of your ovaries before age 40 (premature ovarian failure)
Women who experience premature menopause or premature ovarian failure have a different set of health risks compared with women who reach menopause near the average age of about 50, including:
- A lower risk of breast cancer
- A higher risk of osteoporosis
- A higher risk of coronary heart disease (CHD)
In addition, hormone therapy appears to reduce the risk of osteoporosis and CHD when started soon after menopause in young women. For women who reach menopause prematurely, the protective benefits of hormone therapy may outweigh the risks.
Talk with your doctor about your personal risks.
From a woman’s perspective, the description is a bit different.
Like any medications, HRT has its own set of pros and cons. Hot flashed and night sweats are a huge concern. If for no other reason, women want HRT to “cool off”.
Other reasons for wanting medications:
- Crying at the drop of a hat
- Osteoporosis concerns
- Hair thinning or loss
- Overall mental stability
Women also have concerns for the medication:
- Increased risk of heart disease
- Increased risk of breast cancer
- Prempro- based on that it is derived from a pregnant mare’s urine
There are options that are OTC:
- Generic menopausal support at local drugstores
- Black cohosh
- Soy based supplement
Food for thought
If you are looking at HRT, do your homework and search out as many options as you can before your decide on the medication that is right for you. You are the only one who can choose which benefits and risks are most important. Your doctor can also provide you with many options that may add additional vitamins, minerals or natural herbs. Adding more soy to your daily diet may also provide relief. Try having a glass of soy milk, snacking on dry roasted soybeans, or adding a heaping helping of garbanzo beans to your salad.
Please visit WebMD for more information on supplements that can with menopause symptoms.
What is premature ovarian failure?
Thank you for reading Women’s Health. The writer of this article is not a certified medical practitioner. For further information, please see your doctor. If you enjoyed this article, click the subscribe button at the top of the page so that you will receive email notification of further publications.