Hormone replacement therapy (HRT)

GALLBLADDER DISEASE

Several studies have shown that women who use estrogen/progestin therapy are at increased risk of developing gallstones.

URINARY INCONTINENCE

HRT has not been found to improve or reduce the incidence of incontinence after menopause.

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DEPRESSION

Studies have shown that women who suffer from common vasomotor symptoms of menopause, mood swings, and sleep problems benefit from HRT in the overall quality of their life. However, there is no scientific evidence that HRT is helpful in the treatment of major depression.

ALZHEMIER'S DISEASE

Studies have not shown that HRT slows down the symptoms of Alzheimer's disease. Studies are ongoing as to whether there is any benefit to HRT with regard to other memory loss.

SIDE EFFECTS FROM HRT

As with all medicines, there are side effects associated with HRT. Some women taking HRT may experience water retention, bloating, nausea, breast soreness, mood swings, and headaches. Changing the dosage or the form of HRT may help to alleviate these side effects.

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.