Hormone Therapy

Published: May 28, 2014

Menopause and Hormone Therapy
Menopause is a normal part of aging and it is a time in a woman’s life when her menstrual period stops.  In a woman’s body during the menopause transition, the levels of several hormones, estrogen and progesterone, fluctuate irregularly and go down which cause menopausal symptoms.

Some women have problems with symptoms that occur like hot flashes, night sweats, vaginal dryness, sleep disruptions, mood changes and thin bones.

Some women choose to relieve these bothersome symptoms by taking hormone medicines prescribed by their clinicians.  These medicines are called Hormone Therapy (HT).

Hormone Therapy (HT)

Hormone Therapy (HT) is a program of estrogen and progestin, and are taken to relieve menopausal symptoms and to lower the risk of osteoporosis.

Clinicians also recommend hormone therapy after menopause to relieve urogenital atrophy (thinning and drying of the vagina and ureter) that are exacerbated by low levels of estrogen.

A woman whose uterus has been removed can use estrogen only.  But a woman who still has a uterus must add progesterone or a progestin (synthetic progesterone) along with the estrogen. The combination lowers the chance of the thickening lining of the uterus and reduces the risk of cancer.

Like all medicines, hormone therapy has benefits and risks.  It’s important to talk to your clinician about hormones.  Every woman is different so your treatment should be individualized taking into consideration your personal and family medical history. And, if you decide to take hormone therapy, it is recommended you take the lowest possible dose to treat your menopausal symptoms for the shortest duration.

Benefits and Risks of Hormone Therapy

Benefits

Both types of HT (estrogen only and combined) are effective a relieving menopausal symptoms, i.e., hot flashes, night sweats.  It also helps prevent rapid bone loss that occurs during the early years of the onset of menopause and it has been shown to prevent hip and spine fractures.

Low doses of local estrogen help relieve vaginal dryness and irritation as long as you continue the use of it.

Estrogen improves cholesterol levels, lowering LDLs and raising HDL (the good cholesterol).  Oral estrogen taken by pill, may cause the level of triglycerides to go up.  The estrogen patch does not have this effect, but it also doesn’t improve cholesterol to the same degree as the pill form.  Estrogen should not be taken solely to reduce cholesterol levels.  There are many other things you can do to improve cholesterol levels such as exercise and making improvements in your diet.

Estrogen only therapy (not combined therapy) may reduce the risk of developing or dying from breast cancer.

Systemic hormone therapy (pill, patch, gel or spray) helps relieve hot flashes; night sweats, vaginal dryness; and prevents osteoporosis.  Some studies also suggest there are benefits for mood, memory, better sleep, improves sexual relations and helps to improve overall quality of life.

Risks

Research has found that for some women, there are serious risks in taking hormone therapy (HT).

For some women, hormone therapy may increase their chances of getting blood clots, heart attacks, strokes, breast cancer and gall bladder disease.  For a woman with a uterus, taking unopposed estrogen increases the chance of getting endometrial cancer (cancer of the uterine lining).  Adding progestin lowers this risk.

You Should Not Take Hormone Therapy If You Have:

  • Unexplained uterine bleeding
  • Had certain cancers such as breast cancer or uterine cancer
  • Had a blood clot, stroke or heart attack
  • A bleeding disorder
  • A liver disease
  • Have allergic reactions to hormone medicine

Side Effects of Hormone Therapy

Some women taking hormone therapy may have:

  • Bloating
  • Breast soreness
  • Headaches
  • Mood swings
  • Nausea
  • Water retention

Forms of Hormone Therapy

Estrogen comes in the following forms:

  • Pills or tablets taken by moth
  • Skin patches
  • Skin gel, emulsion, or spray
  • Nasal spray
  • Vaginal creams, tablets, rings

Women who have not had their uterus removed also need to take progesterone. Taking these medicines together helps reduce the risk of endometrial cancer

Progesterone or progestin comes in the following forms:

  • Pill
  • Skin patch
  • Vagina creams

How Long Should You Use Hormones For Menopause?

You should discuss this with your clinician.
Hormones should be used at the lowest dose that helps and for the shortest time, and, be checked every 3-6 months.

Other Treatments for Menopause Symptoms

Additional medications may be recommended for some women with severe symptoms. One of these medications might be testosterone, a hormone used to improve sex drive.

Non-hormonal medications are sometimes used instead of hormone therapy.  In, 2013, the FDA approved a non-hormonal treatment for moderate to severe hot flashes associated with menopause.  It also approved a medicine to treat moderate to severe dyspareunia (pain with sexual activity) due to vaginal changes that occur with menopause. In addition to those prescribed products. It’s also very important that you make healthy lifestyle modifications including healthy eating and getting regular exercise.

Pearls of Wisdom on Hormone Therapy

Hormone Therapy Is Not One Size Fits All.

We are unique as individuals and experience menopausal changes in different ways and we also deal with these changes in our own individual way.  That is why it is vitally important to find a clinician who will listen to your needs and with you discussing the benefits and risks for your physical makeup to help determine whether taking hormones are right for you.
Don’t forget to reevaluate your decision every year.

Global Consensus Statement On Menopausal Hormone Therapy

The following Consensus Statement is endorsed by The American Society for Reproductive Medicine, The Asia Pacific Menopause Federation, The Endocrine Society, The European Menopause and Andropause Society, The International Menopause Society, The International Osteoporosis Foundation and The North American Menopause Society:

http://www.menopause.org/docs/default-source/2013/ims-ht-ps-2013.pdf

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