What is Hormone Replacement Therapy (HRT)?: A HealthCentral Explainer

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  • As women age, their ovaries begin to shrink and, in a period right before menopause, they start producing less and less of the hormones estrogen and progesterone, which are responsible for regulating a woman’s menstrual cycle. This stage can last several years before the menstrual cycle completely stops. This is when hormone replacement therapy may become an option to lessen the physical symptoms of menopause.

     

    What are the symptoms of menopause?

     

    Some women experience all the symptoms that come with menopause; others get lucky and have only a few. The most common symptoms brought on by drop in estrogen include hot flashes, night sweats, vaginal dryness and urinary infections. If these symptoms are severely uncomfortable, doctors may prescribe hormone replacement therapy.

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    What are the types of hormone replacement therapy?

     

    Hormone therapy may be in the form of estrogen alone, with progesterone, or with synthetic progestin. If you haven’t had a hysterectomy, you’ll receive estrogen plus progesterone or a progestin; if you have had a hysterectomy, you’ll receive only estrogen. Hormones may be taken daily or on only certain days of the month, and may be taken orally, through a skin patch, as a cream or gel, or through and IUD or vaginal ring. How the therapy is administered largely depends on the specific menopause symptom you’re trying to treat. For instance, you may be prescribed a vaginal ring or cream to ease vaginal dryness.

    [Slideshow: Natural Alternatives for Menopause Symptoms]

     

    What are the effects of hormone replacement therapy?

     

    Initially, studies found evidence that estrogen supplementation might help deal with some postmenopausal health risks, such as heart disease and osteoporosis. Many scientists thought these increased health risks were linked to the postmenopausal drop in estrogen and believed that replacing estrogen would protect against those conditions. That was until a large study was done in 1991.

     

    What did that study find?

     

    The National Heart, Lung, and Blood Institute (NHLBI) and other departments of the NIH launched the Women’s Health Initiative (WHI), which was one of the largest studies ever undertaken in the US. WHI’s three clinical trials were designed to test the effects of menopausal hormone therapy, diet modification, and calcium and vitamin D supplements on heart disease, osteoporosis-related fractures, and breast and colorectal cancer risk. The hormone trials also analyzed whether the therapies’ possible benefits outweighed potential risks from breast cancer, uterine cancer, and blood clots.  Two of the trials (the estrogen therapy and the estrogen/progestin therapy) were stopped early because of an increased risk of breast cancer and because, overall, risks from use of the hormones outnumbered the benefits.

     

    Have any new studies changed the thinking on HRT?

     

    A paper published last January in the BMJ Group’s Journal of Family Planning and Reproductive Healthcare cast doubt on the results from the Women’s Health Initiative. Researchers from Denmark

  • was conducted a study over ten years, with six additional years of follow-up, to determine if HRT was more effective, especially in  reducing cardiovascular risk, when administered early after menopause begins. The authors concluded that women treated with long-term HRT early after menopause “had significantly reduced risk of mortality, heart failure, or heart attack, without any apparent increase of cancer, DVT, or stroke.” The study also found that women who had undergone a hysterectomy and younger women taking HRT had a significantly reduced risk of breast cancer.

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    [Slideshow: Tips for Managing Hot Flashes]

     

    What’s the bottom line?

     

    While the recent study sheds a positive light on the impact of hormone replacement therapy, more research needs to be conducted. Further, each person’s unique family history and exposure to environmental and behavioral factors could substantially affect the outcome of any trial. The 2012 study, however, does offer promise for women seeking relief from the sometimes severely uncomfortable symptoms of menopause. Be sure to speak with your doctor before taking any over-the-counter hormonal supplements or prescription therapy. 

Published On: October 19, 2012