Hormone replacement therapy

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Uterus

Some women have irregular bleeding when they start taking HRT, but changing the dosage often eliminates this side effect.

SUMMARY OF RISKS/BENEFITS

The WHI study shows relatively small absolute increases in the risk of heart disease, breast cancer, blood clots, and stroke to an individual woman. However, when the entire population of postmenopausal women and the number of years a woman may be on HRT are considered -- the number of strokes, heart attacks, breast cancer cases, and blood clots appears to outweigh the protective effect of HRT on bones.

Some women may still wish to consider HRT for short-term treatment of menopausal symptoms. The key is to weigh the risks associated with taking HRT against a particular woman's risk of heart disease or osteoporosis without taking HRT. Every woman is different. Therefore, your entire medical history should be evaluated individually when considering HRT.

FORMS OF HRT

HRT is available in various forms, including pills, patches, and vaginal creams. Your health care provider will start you on a regimen that is best suited for you. It may be necessary to try more than one regimen before finding the one that works best for you.

• Cyclic hormone therapy is often recommended. With this therapy, estrogen is taken in pill form for 25 days, with progestin added somewhere between days 10 - 14. The estrogen and progestin are taken together for the remainder of the 25 days. Then, no pills are taken for 3 - 5 days. There will be monthly bleeding with cyclic therapy.
• Continuous, combined therapy is where estrogen and progestin are taken together every day. When this therapy is started, or when switching from cyclic to continuous therapy, women may experience irregular bleeding. Most women stop bleeding within one year after starting this therapy.
• HRT is also available as a patch which is applied to the abdomen or the thigh. This patch allows the estrogen to be absorbed through the skin into the bloodstream. Some women prefer this method because they do not have to take pills.
• Vaginal cream containing estrogen may be given to women for vaginal dryness. The cream is usually given along with one of the other forms of HRT because the cream may not relieve many of the other symptoms and does not appear to protect against bone disease.

Additional medications may be recommended for some women with severe symptoms from menopause, or women who are at very high risk for osteoporosis or heart disease. One of these supplemental drugs might be androgen, a male hormone given with estrogen to relieve severe hot flashes.

HEALTHY LIFESTYLE

In addition to taking HRT, there are other things that can help women adjust to the changes in life during menopause. Eating healthy foods and getting regular exercise will also help to decrease bone loss and maintain healthy heart muscle.

CALLING YOUR HEALTH CARE PROVIDER

It is important to have regular checkups with your health care provider when taking HRT. If you have continual vaginal bleeding during HRT, or for any other unusual symptoms, call your health care provider.

Review Date: 02/09/2006
Reviewed By: Frederic F. Little, MD, Department of Allergy and Pulmonary/Critical Care Medicine, Boston University School of Medicine, Boston, MA. Review provided by VeriMed Healthcare Network.