Hormone replacement therapy: should you take it?

Hormone Replacement Therapy: Should You Take It?

Menopause is the stage in a woman's life when menstruation stops and she can no longer bear children. During menopause, the body makes less of the female hormones, estrogen and progesterone after menopause, the lower hormone levels free a woman from concerns about monthly menstrual periods and getting pregnant. But they can also cause troublesome symptoms, such as hot flashes (a sudden flush or warmth, often followed by sweating) and sleep problems. Sometimes women have other physical problems, such as vaginal dryness. While many women have little or no trouble with menopause, others have moderate to severe discomfort. Estrogen loss also raises a woman's risk for other serious health problems. They include heart disease and stroke, leading causes of death for women over the age of 50. Estrogen loss also can lead to bone loss.

Some bone loss is normal as people age. However, a more serious condition called osteoporosis weakens bones and lets them break easily. It affects 24 million people in this country. Women have a higher risk than men.

Doctors sometimes prescribe hormones to replace those lost during menopause. This treatment, called hormone replacement therapy (HRT), can ease symptoms of menopause and protect against risks of heart disease, stroke, and osteoporosis. Although millions of women take HRT, this may not be the right choice for everyone.

What Can You Do?

Doctors usually prescribe HRT combining estrogen and another female hormone, progestin. They usually prescribe estrogen without progestin for women who have had their uterus removed (hysterectomy). Estrogen can be used in pill or tablet form, vaginal creams, or shots. There are also patches that attach to the skin and release estrogen through the skin. The form of estrogen your doctor chooses may depend on your symptoms. For instance, creams are used for vaginal dryness, while pills or patches are used to ease different menopause symptoms, such as hot flashes, or to prevent bone loss. Progestin usually is taken in pill form.

Doctors may prescribe different schedules for taking HRT. Some women take estrogen for a set number of days, add progestin for a set number of days, and then stop taking one or both for a specific period of time. They repeat the same pattern every month. This pattern often causes regular monthly bleeding like a menstrual period. Some women take HRT every day of the month without any break. This pattern usually stops regular monthly bleeding. Talk with your doctors about the system that is best for you.

Who Should Take HRT?

Many experts believe that the benefits of HRT may be greater than the risks. But scientists do not yet fully know the risks of long-term HRT. Before you decide about HRT, discuss the possible benefits, risks, and side effects with your doctor.

Your doctor may warn against HRT if you have high blood pressure, diabetes, liver disease, blood clots, seizures, migraine headaches, gall-bladder disease, or a history of cancer. Also, daughters of mothers who took DES (diethylstilbestrol) during pregnancy may have changes to their reproductive system that make HRT dangerous.

Side Effects and Risks of HRT

Some women may have side effects from HRT, such as unwanted vaginal bleeding, headaches, nausea, vaginal discharge, fluid retention, swollen breasts, or weight gain. Other health concerns for women taking HRT include:

Cancer of the uterus (endometrial cancer). Research shows that women who have their uterus and use estrogen alone are at risk for endometrial cancer. But today, most doctors prescribe the combination of estrogen and progestin. Progestin protects against endometrial cancer. If a woman who still has a uterus takes estrogen alone, her doctor should take sample tissue from her uterus (endometrial biopsy) to check for cancer every year. Women without a uterus have no risk of endometrial cancer.

Breast cancer. Today, many scientists are studying the possible link between HRT and breast cancer. Some studies have shown that HRT increases the risk of breast cancer.

Heart disease. Estrogen alone or combined with progestin reduces the risk of heart disease. Scientists recently have shown that estrogen lowers risks of heart disease and stroke in women over the age of 50, when they are most at risk for heart disease and stroke.

Abnormal vaginal bleeding. Women taking HRT are more likely than other women to have abnormal vaginal bleeding. When this happens, the doctor may perform a "D and C" (dilation and curettage) to find the cause of bleeding. In more serious cases, the doctor may suggest removing the uterus.

Scientists are still studying the risks of taking estrogen alone or in combination with progestin over a long period of time. Women who have their uterus, are at low risk for stroke, heart disease, or serious bone disease, and have no major menopause symptoms may choose to avoid HRT.

Medical Checkups

If you are taking hormones, you should have regular medical checkups. The American College of Obstetricians and Gynecologists recommends that all women taking HRT get a medical checkup every year. At that time, the doctor or nurse should read your blood pressure, give you pelvic and breast exams, and take an x-ray picture of your breasts (mammogram) to check for breast cancer.

If You Don't Take HRT

If you decide against HRT, there are other ways to deal with the symptoms of menopause. There are drugs that can reduce hot flashes, and you can apply water soluble surgical jelly (not petroleum jelly) to the vagina to reduce dryness. Simply lowering the room temperature may help you sleep better and ease uncomfortable hot flashes.

To strengthen your bones, good health habits can help, even if you don't start until later in life. Experts suggest that all adult women have 1,000 mg of calcium each day; after menopause, women not using HRT should have 1,500 mg each day. Low-fat milk and dairy foods such as cheese and yogurt are good sources for calcium. If you find it hard to get that amount from your diet, you can take calcium supplements.

Your body also needs vitamin D to absorb calcium. Most people get enough vitamin D just by being out in the sun for at least a short time every day. Supplements or milk fortified with vitamin D are also good sources for this vitamin.

Weight-bearing exercises, which make your muscles work against gravity, help strengthen bones and prevent osteoporosis. Walking, jogging, and playing tennis are all good weight-bearing exercises.

You may also want to ask your doctor about a new drug to treat osteoporosis in women past menopause. The new treatment is safe and effective in increasing bone mass.

RELATED ARTICLE: Risk Factors For Osteoporosis

Women who are at high risk of getting osteoporosis may want to think about taking HRT to prevent it. Risk factors include:

* Having early menopause (natural or due to surgery)

* Being White or Asian

* Being physically inactive

* Taking corticosteriod medicines (prescribed for arthritis or other inflammatory diseases)

* Having a slight build

* Getting too little calcium from diet

* Smoking cigarettes

* Drinking more than a moderate amount of alcohol

* Having thyroid or kidney disease

Resources

You can get more information on this topic by contacting the organizations listed below.

The American College of Obstetricians and Gynecologists (ACOG) offers the following pamphlets, Hormone Replacement Therapy, Preventing Osteoporosis, and The Menopause Years. To obtain copies, send a self-addressed envelope to:

ACOG

409 12th Street, S.W.

Washington, DC 20024-2188

The American Association of Retired Persons (AARP) Women's Initiative has a fact sheet, Hormone Replacement Therapy: Facts to Help You Decide. To obtain a copy, write:

AARP

601 E Street, N.W.

Washington, DC 20049

1-800-424-3410

The National Osteoporosis Foundation (NOF) has information for health professionals and the public. Contact:

NOF

1150 17th Street, N.W., Suite 500

Washington, DC 20036-4603

1-800-223-9994

The National Resource Center on Osteoporosis and Related Bone Diseases is a national clearinghouse with information on the risks, prevention, and treatment of osteoporosis. For more information, call: 1-800-624-BONE

The North American Menopause Society (NAMS) answers written requests for information. Write:

NAMS

11100 Euclid Avenue

7th Avenue

McDonald Hospital

Cleveland, Ohio 44105

The National Women's Health Network distributes educational materials on a variety of women's health topics. Contact:

National Women's Health Network

514 10th Street, N.W.

Washington, DC 20004

202-347-1140

The Older Women's League (OWL) educates the public about problems and issues of concern to middle age and older women. Contact:

OWL

666 11th Street, N.W.

Suite 700 Washington, DC 20001

202-783-6686

The National Cancer Institute (NCI), part of NIH, funds cancer research and offers information for health professionals and the public. For more information about cancer risks and other related issues, call: 1-800-4-CANCER

The National Heart, Lung, and Blood Institute, part of NIH, carries out research and provides educational information on heart disease, stroke, and other related topics. For more information call: 301-251-1222

National Institute on Aging Information Center has information on menopause, osteoporosis, and a variety of other topics related to health and aging. Contact:

P.O. Box 8057

Gaithersburg, MD 20898-8057

800-222-2225

800-222-4225 (TTY)