Menopause – Hormone Replacement Therapy
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What is hormone replacement therapy?
Hormone replacement therapy (HRT) is a type of treatment where the body is given hormones to prevent or treat certain medical conditions (such as treating symptoms of menopause in women and preventing osteoporosis).
The hormones used in HRT are synthetic hormones, which means they are created in a laboratory (rather than by the body), but they act like natural hormones once inside the body.
In the past, healthcare providers routinely prescribed HRT because they hoped it could help guard against certain diseases as well as treat the symptoms of menopause. The diseases healthcare providers hoped HRT could help prevent included osteoporosis, heart disease and cancer. Information from studies on HRT suggests that for most women, the risks of using HRT outweigh the benefits. For a few women, benefits may outweigh the risks. This is why it is important to contact your healthcare provider about HRT.
What is the Women’s Health Initiative?
The Women’s Health Initiative (WHI) was a set of studies conducted by the National Institutes of Health, a division of the U.S. Department of Health and Human Services. Through these studies, researchers gathered information about the health of women who have gone through menopause. In the HRT trial, researchers were studying the effects of HRT on the health of postmenopausal women. Researchers were trying to determine whether using HRT affects a woman’s chances of developing breast and colorectal cancers, heart disease and osteoporosis after she has gone through menopause.
Who was involved in the HRT trial?
Two groups of women were involved in the HRT trial. In one group, women who had undergone hysterectomy (surgical removal of the uterus) took either estrogen or a placebo (sugar pill). Women in the other group were also postmenopausal but they had not undergone hysterectomy. These women took either combination HRT (both estrogen and progestin) or a placebo. The specific brand of combination medicine used in this group was Prempro. There are other brands of combination-therapy HRT available, but only Prempro was used in this study.
I heard this study was stopped. What happened?
The HRT trial was scheduled to end in 2005. However, researchers decided to stop the combination-therapy part of the study in 2002 because they could see that the risks associated with combination HRT outweighed the benefits. Specifically, it was found that long-term use (5 years or more) of combination HRT increased a woman’s risk of breast cancer, blood clots, heart attacks and strokes. For each of these problems, the increased risk was about 8 more events per 10,000 women per year, compared to women who did not use HRT.
What should I do if I am taking HRT?
If you’re taking HRT, do not panic. Visit your healthcare provider before making any changes to your therapy. Your healthcare provider will consider your menopausal symptoms and your risk for developing certain diseases, and will give you advice about the pros and cons of continuing HRT. Some of your options may include stopping treatment altogether, taking a lower dose of medicine or switching to another type of treatment.
Are other kinds of drugs used in HRT safe?
Researchers aren’t sure, but it is possible that women who use HRT drugs other than the one used in the WHI study are also at higher risk for breast cancer, blood clots, heart attacks and strokes. However, even short-term use is associated with an increased risk of blood clots, stroke and coronary heart disease. HRT should only be used if your symptoms are severe and if you have been fully informed of the risks. HRT requires regular medical evaluation. Women who have a history of heart disease or blood clots are at the highest risk and should most likely not receive HRT.
Is long-term use of HRT ever a good idea?
HRT still offers protection against osteoporosis and decreases the risk of colorectal cancer. If your risk for these diseases is high and your risk for diseases like breast cancer or heart disease is low, long-term use of HRT may be an option for you. For women who have severe menopausal symptoms, benefits of HRT may also outweigh risks. You and your healthcare provider will need to talk about your personal risks and benefits before deciding whether long-term use of HRT is a good choice for you.
Are there other options besides HRT for treating menopausal symptoms and for lowering my risk of other diseases?
Yes. For some women, vaginal estrogen creams, antidepressants, soy products and certain herbal supplements offer relief from menopausal symptoms. Other medications are available to help prevent and treat osteoporosis. Your healthcare provider can help you decide which of these treatments might be most helpful for you.
Finally, remember that eating a healthy diet, maintaining a healthy weight, exercising regularly and quitting smoking if you smoke can help protect against heart disease, osteoporosis and some types of cancer.
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