Hormone replacement therapy

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Uterus

OSTEOPOROSIS

A woman's body produces less estrogen during and after menopause, which may affect her bone strength. The WHI study showed that women taking HRT had 34% fewer hip fractures and 24% fewer fractures than women not receiving hormones.

However, the short-term use of HRT to relieve symptoms at the time of menopause does little to prevent fractures in women when they reach 75-80 years of age. Women who take estrogen to maintain bone density must continue taking estrogen because the beneficial effects on bones disappear when it is discontinued.

Women who are considering taking HRT to prevent osteoporosis should discuss with their physician their individual risk of coronary heart disease, stroke, blood clots, and breast cancer.

Instead, supplemental calcium and increasing vitamin D intake may be recommended for some women to help prevent and treat loss of bone mass. Other lifestyle changes, such as adding an exercise regimen to your routine and not smoking, may help in the prevention and treatment of osteoporosis as well.

In addition, there are some medications available specifically for prevention and treatment of osteoporosis. These include risedronate, calcitonin, etidronate, and alendronate.

BREAST CANCER

The WHI estrogen/progestin trial was stopped primarily because of a 26% increased risk of breast cancer found in women taking hormone therapy. For every 10,000 women taking estrogen/progestin, 38 will develop invasive breast cancer; of 10,000 women not taking HRT, 30 will develop the disease.

The second component of the WHI study, which looked at estrogen alone in women who no longer have a uterus, did not find any increased risk of breast cancer.

UTERINE CANCER/ENDOMETRIAL CANCER

Taking estrogen alone causes the lining of the uterus to grow. The risk for endometrial cancer is six to eight times higher in women who take estrogen, compared with those who do not.

Progestin works to decrease the lining of the uterus. For women who still have their uterus, most doctors prescribe progestin (a synthetic progesterone) to counteract the effect of the estrogen.