What about Hormone Replacement Therapy (HRT)?

When we reach menopause and   menstruation ceases, our production of the two hormones – estrogen and progesterone – slows and decreases. Hormone replacement therapy (HRT) describes a treatment to replenish the loss, with either estrogen alone or estrogen plus progestin (synthetic progesterone). Natural progesterone is also available. HRT is available by prescription only, in varying dosages and schedules. It is most commonly   prescribed as a pill or skin patch.

While HRT has many advantages, the use of hormones is still relatively new. Few women have taken hormones consistently for more than a 10-year span, therefore information regarding long-term therapy is limited. Although early studies are quite promising, it will take years before experts know the long-term effects of hormone use. In the meantime, many patients and health care professionals feel strongly   about HRT's benefits and have had significant success with it. Check out our Advantages & Disadvantages on the next page, then discuss HRT with your physician to see if it is right for you.

The Need for Progesterone

If we are taking estrogen and have our uterus, we should, generally, take it in combination with progesterone. This   is because taking estrogen alone may lead to endometrial cancer. (Some women may not be able to tolerate progesterone.) Taking progesterone along with estrogen all but eliminates the risk of endometrial cancer.

Dosage & Schedules

Dosage and schedules for taking estrogen and progesterone depend on the form of HRT and your doctor's recommendation. Some schedules are intended to mimic the natural menstrual cycle and cause bleeding each month. The daily form allows a lower dosage of progesterone and should eliminate any bleeding after one year in most women. The goal of HRT is to take the minimal dosage possible to relieve symptoms and achieve long-term health benefits while minimizing side effects. For maximum benefit to our heart and bones, it is believed HRT should be taken for a decade or longer. Your doctor may have you try several different schedules, drugs and preparations before settling on what's best for you.

HRT'S Proven Advantages

• Helps decrease or eliminate hot flashes
• Lessens vaginal dryness and pain   on intercourse
• Decreases thinning of the vaginal walls
• Helps prevent osteoporosis

HRT'S Potential Advantages

• Improve skin texture, collagen content and skin thickness
• Help improve mood, sleep and short-term memory
• Reduce the risk of coronary artery disease and stroke
• Help control heart palpitations
• Help reduce urinary urgency, frequency and incontinence
• Reduce the incidence of  Alzheimer's disease

HRT'S Disadvantages

• Not recommended for women who have had breast cancer, or have a history of blood clots, liver   disease, gall stones or gallbladder disease, endometriosis, uterine cancer or asthma
• Side effects can include bloating, fluid retention, breast tenderness, abdominal cramping, anxiety,   irritability and headaches
• Skin patch can cause skin irritation
• Vaginal bleeding (periods) may return on some schedules
• Some forms of progesterone cannot be taken by women allergic to peanuts
• Progesterone may cause breast tenderness and mood changes in some women?

HRT is available as a ...

PILL This is the most common way to take HRT. Your prescription may be separate pills for estrogen and progesterone or a combined pill. If you are taking separate pills, estrogen is best taken after a meal in the morning. Progester one should be taken before bed at night.

PATCH A transdermal estrogen skin patch is applied to an area of hair-free skin such as the abdomen. The estrogen travels directly through the skin to the bloodstream for a slow, steady absorption that mimics the body's natural production of estrogen. The patch can be used by women who take estrogen alone (i.e., women who have had a hysterectomy) or along with a progesterone pill. The wearer changes the patch periodically, according to directions.

Other formulations: INJECTION is a method for administering estrogen, used mainly for women   immediately following the surgical removal of the ovaries.

ESTROGEN CREAMS are inserted directly into the vagina to improve   lubrication of dry, thinning vaginal walls, help eliminate painful intercourse and may reduce incontinence. They may be useful for women who cannot tolerate or who do not wish to take hormone replacement therapy to relieve such symptoms. The cream is absorbed into the bloodstream. The creams do not relieve other menopausal symptoms.

ESTROGEN RING is a circular ring   made of soft plastic that, inserted into the vagina, emits estrogen on a gradual basis. It helps to improve lubrication of   dry vaginal walls and eliminate painful intercourse. The ring is usually replaced about every three months by the woman or her physician. The wearer isn't aware   of the estrogen ring, and it usually   does not interfere with intercourse. Some women prefer the estrogen ring over   vaginal estrogen creams which can   be messy.

HRT and Breast Cancer What you need to know

A major concern regarding HRT is the risk of breast cancer. It is one of the main reasons why women are unwilling to take HRT. The North American Menopause Society, however, believes that there are not enough data to make a definitive statement about whether or not HRT increases the risk of breast cancer. On the other hand, there are studies indicating a risk may exist.

The Nurse's Health Study, conducted by Harvard Medical School, showed that taking HRT for more than five years could increase our risk of getting breast cancer (see the chart below). The Breast Cancer Detection Demonstration Project, a nationwide breast cancer screening   program conducted between 1973 and 1980, found in a follow-up study of 46,335 participants (postmenopausal women, average age of 58 at start of follow-up) that the estrogen-progestin regimen increases breast cancer risk beyond that associated with estrogen alone.

In some studies that show an increased risk, hormone doses were in the range of 1.25 mg per day or higher. The risk does not appear to be as high when estrogen is given in lower doses, such as 0.675 mg per day. To reach a better understanding of HRT and the risk of breast cancer, more women will need to be monitored over a longer period of time.

Until then, each of us should talk to our doctor and carefully weigh our personal risk against the benefits.