Some of the changes in menopause can be relieved by giving replacement estrogen in place of the hormone that is no longer made by the body. The decision to take estrogen replacement therapy (ERT) or hormone replacement therapy (HRT), which is a combination of estrogen and progesterone, should be an individualized choice. A woman and her doctor should thoroughly discuss the benefits and risks before beginning therapy.
In recent years, recommendations for taking HRT have changed. While HRT has been shown to be excellent for relieving hot flashes and for preventing osteoporosis-related fractures, it may cause small increases in the risk of other problems such as heart attack, stroke, and breast cancer. Recent studies have also shown a slight increase in the risk of developing dementia. Also, though HRT may relieve hot flashes, a recent large study showed only a small benefit in the relief of insomnia without overall improvement in quality of life for women taking HRT compared to those taking a placebo. The evidence for taking ERT (estrogen alone) is less clear. A large clinical trial of estrogen alone will be closing in 2005, with additional recommendations expected to be forthcoming.
Types Of ERT
There are three (3) types of replacement therapy:
1. Estrogen alone via a pill (Premarin, Ogen, Estrace or ethinyl estradiol), a cream (Premarin or Dienestrol), a vaginal pill (Vagifem), or as a transdermal or skin patch (Estraderm or Estracomb).
2. Cyclical therapy: Estrogen taken daily via a pill or via a patch and a separate progesterone pill (such as Provera) for a certain number of days per month.
3. Continuous therapy: Estrogen plus low dose progesterone in one or two pills taken every day.
Benefits Of ERT
- reduces frequency and severity of hot flashes
- relieves vaginal dryness and discomfort
- prevents osteoporosis
- lowers risk of colon cancer
Risks Of ERT
- may produce premenstrual type symptoms such as swelling, bloating, breast tenderness, mood swings, and headaches may produce premenstrual type symptoms such as swelling, bloating, breast tenderness, mood swings and headaches
- stimulation of the growth of uterine fibroids and endometriosis
- increases risk of gallstones
- increases risk of blood clots
- gaining weight
- decreases an accurate mammogram reading
- increases the risk of breast cancer
- increases the risk of coronary artery disease
- increases the risk of stroke
Note: About 10 percent of all women receiving ERT experience minor side effects. These include swollen breasts, nausea, vaginal discharge, headaches, fluid retention, weight gain and an increase in blood pressure.
Who Should And Shouldn't Consider ERT/HRT?
Women who should consider ERT/HRT are:
- women who experience severe hot flashes that are not relieved by other measures
- women who experience menopause before age 45, naturally or due to hysterectomy
If the woman has chosen to begin replacement therapy, she must also decide how long she will want to continue this therapy. In general, women should be counseled that the only indication for estrogen replacement therapy is the relief of hot flashes, and that the lowest dose necessary to relieve symptoms should be prescribed for the shortest time necessary.
In general, women who still have a uterus should not take estrogen alone, without progesterone, because of the increased risk of endometrial cancer. Women who still have a uterus and choose to take estrogen alone should have an annual endometrial biopsy to monitor for the development of endometrial cancer. Additionally, the woman who has chosen hormone replacement therapy should have an annual pelvic examination, mammogram, and breast exam, and alert her doctor about any unusual vaginal bleeding or spotting.
Alternatives To Hormone Replacement
If the woman is thinking of foregoing replacement therapy she may want to consider the following drug and non-drug methods of alleviating some of the annoyances of menopause.
- For hot flashes: Several prescription drugs offer limited relief: synthetic progesterone (Cycrin, Megace or Provera), methyldopa (Aldomet), clonidine (Catapres), synthetic androgen (Danazol). Treatment with low doses of paroxetine (Paxil) or fluoxetine (Prozac) may also be effective. Non-drug measures include avoiding caffeine, alcohol, spicy foods and hot drinks, as well as introducing exercise and relaxation techniques into the daily life. Non-traditional forms of treatment include aromatherapy, homeopathy, acupuncture, herbal medicines (such as ginseng, evening primrose oil, red raspberry leaf tea, dong quai and black cohosh), and massage.
- For painful intercourse due to vaginal dryness: Staying sexually active, using lubricating jelly (such as Astroglide, Replens, Lubrin and K-Y Jelly) and applying a vaginal cream (such as Estrace or Premarin) once or twice a week can help minimize the discomfort. Non-traditional treatment includes the consumption of phytoestrogens, which are found in soy-based foods.
- For urinary tract infections: Drinking plenty of liquids and urinating as frequently and completely as possible.
- For osteoporosis prevention and treatment: Several prescription drugs are available to prevent and treat osteoporosis, including alendronate (Fosamax), risedronate (Actonel), raloxifene (Evista), and calcitonin. Additionally, taking 1500 mg of calcium and 400 IU of vitamin d each day as well as 45 to 60 minutes of weight-bearing exercise four times a week can also help in the prevention of this problem.
- For heart disease: To reduce the risk of heart disease doctors recommend eating a low-fat, high fiber diet, exercising regularly, stopping smoking, and maintenance of a normal body weight.
Could the irregularity in the menstrual pattern and/or the hot flashes be caused by stress or medication?
Will taking calcium help prevent osteoporosis?
If estrogen and other hormone replacement are given, what are the side effects?
Does estrogen replacement therapy increase the risk of breast cancer or uterine cancer?
Will there be mood swings or depression while going through menopause?
If so, what measures do you recommend to help relieve these symptoms?
Editorial review provided by VeriMed Healthcare Network.