Menopausal Hormone Therapy

What is menopausal hormone therapy?

Menopausal hormone therapy is a treatment for the symptoms of menopause. 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 a woman stops having menstrual periods. It usually starts gradually. The ovaries start making less hormone. Menstrual periods become less regular. After a time, periods stop completely.

Menopause happens suddenly if the ovaries are removed.

Menopause is usually part of a natural aging process. It is not a disease. For many women menopause is an easy change. 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.

Taking estrogen alone increases the risk of cancer of the uterus. If you still have your uterus, treatment usually includes both estrogen and progesterone to reduce this risk. If your uterus has been removed, you may take estrogen alone.

Hormone replacement therapy (HRT) may be taken as:

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

When is it used?

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

  • hot flashes
  • night sweats
  • vaginal dryness, sometimes causing discomfort or pain during sex
  • trouble sleeping
  • loss of sex drive (libido)
  • mood swings
  • depression
  • memory loss
  • headaches

HRT may be prescribed to treat symptoms of menopause if:

  • Other treatments are not helping your symptoms enough.
  • You and your provider decide the benefits may outweigh the risks.

Factors such as your age, race, family history, and health history will be considered. You and your healthcare provider should discuss the risks and benefits of HRT for you.

Hormone therapy may be recommended for you if you have gone through menopause early (before the age of 40). HRT is often given to younger women who have had their ovaries removed.

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 weakening of the bones that starts around age 35 and makes it easier for the bones to break. However, lifestyle changes and other prescription medicines can also help prevent osteoporosis.

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 for women who have not had their uterus removed.
  • Breast cancer: HRT may increase the risk of breast cancer. Talk to your healthcare provider about this risk. Many providers recommend that women be checked thoroughly for any tumors and have a mammogram before starting HRT. If you have a family history of breast cancer, be sure to discuss this with your provider.
  • Heart disease, stroke, and blood clots in the legs and lungs.

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

Researchers and healthcare providers are studying the benefits and risks of HRT and learning new things every day. The risks described above may be different for lower dosages of estrogen and progesterone or progesterone only.

What are the side effects of hormone therapy?

The side effects of hormone therapy may include:

  • 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 you are taking estrogen with progesterone
  • headache
  • chloasma (tan blotches on your face).

If your treatment is with estrogen only, and you have your uterus, you may get some vaginal bleeding.

If your treatment includes both estrogen and progesterone, you may have some vaginal bleeding if there are days 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.

Tell your healthcare provider about any vaginal bleeding you have.

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
  • high blood pressure you cannot control
  • blood clots in the legs, lungs, brain, or eyes
  • cancer of the breast or uterus
  • unexplained vaginal bleeding
  • liver disease

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

Also, if you smoke, you should avoid hormone therapy. Smoking while you are using this medicine increases the risk of serious side effects such as heart attack, stroke, and blood clots.

If you have any of the following diseases or conditions, you should talk to your provider about the effect of HRT on these conditions:

  • uterine fibroids (These benign tumors may grow and bleed in response to estrogen. They begin to shrink at menopause unless you are taking estrogen.)
  • endometriosis
  • fibrocystic breast disease
  • migraine headaches
  • gallbladder disease
  • high blood pressure
  • porphyria (nerve pain or sensitivity to sunlight)

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 start HRT to check for breast cancer.
  • 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 taking the hormones

If you are already taking hormones:

  • Ask your healthcare provider about any special precautions or side effects.
  • If you are taking estrogen combined with progesterone, tell your provider if you have bleeding at any time other than the days when you do not take the hormones.
  • Don’t change your dose without checking with your provider first.
  • Don’t smoke.
  • Have a mammogram as often as your provider recommends.
  • Have a complete physical exam as often as your healthcare provider recommends. Your blood should be tested regularly for cholesterol levels and liver function.

References
Adult Advisor 2011.1 Index

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