What is hormone replacement therapy and is it right for you?

Types of Hormone Therapy

Hormone therapy can help relieve the symptoms of perimenopause and menopause. Hormone therapy means taking estrogen and, if you have never had a hysterectomy and still have a uterus, progestin. Progestin is a form of progesterone. Taking progestin helps reduce the risk of cancer of the uterus that occurs when estrogen is used alone. If you do not have a uterus, estrogen is given without progestin. Estrogen plus progestin sometimes is called “combined hormone therapy” or simply “hormone therapy.” Estrogen-only therapy sometimes is called “estrogen therapy.”

Systemic Therapy

Hormone therapy can be either “systemic” or “local.” These two terms describe where and how the hormones act in the body. With systemic therapy, the hormones are released into your bloodstream and travel to the organs and tissues where they are needed. Systemic forms of estrogen include pills, skin patches, and gels and sprays that are applied to the skin. If progestin is prescribed, it can be given separately or combined with estrogen in the same pill or in a patch.

For women taking estrogen-only therapy, estrogen may be taken every day or every few days, depending on the way the estrogen is given. For women taking combined therapy, there are two types of regimens:

  1. Cyclic therapy: Estrogen is taken every day, and progestin is added for several days each month or for several days every 3 months or 4 months.
  2. Continuous therapy: Estrogen and progestin are taken every day.

Local Therapy

Women who only have vaginal dryness may be prescribed “local” estrogen therapy in the form of a vaginal ring, tablet, or cream. These forms release small doses of estrogen into the vaginal tissue. The estrogen helps restore the thickness and elasticity to the vaginal lining while relieving dryness and irritation.

Benefits, Risks, and Side Effects of Hormone Therapy

Hormone therapy has many benefits, but it also has risks. Side effects also may occur. The following sections summarize the latest information about hormone therapy.

Benefits

Hormone therapy has the following benefits:

  • Systemic estrogen therapy (with or without progestin) has been shown to be the best treatment for the relief of hot flashes and night sweats.
  • Systemic and local types of estrogen therapy relieve vaginal dryness.
  • Systemic estrogen protects against the bone loss that occurs early in menopause and helps prevent hip and spine fractures.
  • Combined estrogen and progestin therapy may reduce the risk of colon cancer.
  • Risks
  • As with any treatment, hormone therapy is not without risks. Hormone therapy may increase the risk of certain types of cancer and other conditions:
  • Estrogen therapy causes the lining of the uterus to grow and can increase the risk of uterine cancer. Adding progestin decreases the risk of uterine cancer.
  • Combined hormone therapy is linked to a small increased risk of heart attack. This risk may be related to age, existing medical conditions, and when a woman starts taking hormone therapy. Some research suggests that for women who start combined therapy within 10 years of menopause and who are younger than 60 years, combined therapy may protect against heart attacks. However, combined hormone therapy should not be used solely to protect against heart disease.
  • Combined hormone therapy and estrogen-only therapy are associated with a small increased risk of stroke and deep vein thrombosis (DVT). Forms of therapy not taken by mouth (patches, sprays, rings, and others) have less risk of causing DVT than those taken by mouth.
  • Combined hormone therapy is associated with a small increased risk of breast cancer. Currently, it is recommended that women with a history of hormone-sensitive breast cancer try nonhormonal therapies first for the treatment of menopausal symptoms.
  • There is a small increased risk of gallbladder disease associated with estrogen therapy with or without progestin. The risk is greatest with forms of therapy taken by mouth.

Side Effects

Combined hormone therapy may cause vaginal spotting. Some women may have heavier bleeding like that of a menstrual period. If you are postmenopausal, it is important to tell your health care provider if you have bleeding. Although it is often an expected side effect of hormone therapy, it also can be a sign of endometrial cancer. All bleeding after menopause should be evaluated.

Other side effects reported by women who take hormone therapy include fluid retention and breast soreness. This soreness usually lasts for a short time.

Current Recommendations

Hormone therapy can help relieve some of the symptoms that affect women at menopause. However, it is important to weigh the benefits and the risks for your individual situation. Before making a decision about hormone therapy, talk to your doctor about what may work best for you based on your symptoms and your personal and family medical history.

In general, hormone therapy use should be limited to the treatment of menopausal symptoms at the lowest effective dose for the shortest amount of time possible. Continued use should be reevaluated on a yearly basis. Some women may require longer therapy because of persistent symptoms.

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