Hormone Replacement Therapy
Hormone therapy or HT is prescribed to help women cope with the symptoms of menopause and bone loss.
While HT has been used for decades, it’s fallen in and out of favor with physicians because of medical studies suggesting it may help or hurt health.
Today, things are swinging back in favor of HT, but only for limited use.
In fact, HT was once called hormone replacement therapy, but that name changed because of goals to provide only enough hormones to relieve a woman’s symptoms and not replace the number of hormones she had before menopause.
Eventually, a woman’s reproductive system stops working—typically between the ages of 45 and 55.
The ovaries stop releasing eggs and dramatically reduce the production of the hormones estrogen and progesterone.
The result: a woman no longer menstruates each month and is no longer fertile.
This shut down of the reproductive system doesn’t happen overnight. According to the National Institute on Aging, it’s a gradual change lasting anywhere from a few years to 14.
The time duration leading up to menopause is known as perimenopause. Menopause occurs when a woman has not menstruated for 12 consecutive months.
One exception to this time frame: Women who undergo surgical removal of the ovaries—for example, due to cancer—are immediately thrown into menopause, even if they are young women.
CHANGES AND SYMPTOMS
Estrogen and progesterone are chemical messengers that help regulate many-body systems.
When hormones plummet, a woman experiences numerous physical, emotional, and even psychological changes.
Classic symptoms that occur before, during, and after menopause include hot flashes, night sweats, mood swings, heart palpitations, fatigue, and vaginal dryness.
But there are myriad ways that a lack of hormones affects the body.
- Depleted progesterone can lead to irregular (heavy or long) periods in perimenopause.
- A lack of estrogen increases a woman’s risk for heart attack, stroke, and other heart problems.
- Hormone changes in the brain and central system are associated with memory loss, trouble concentrating, irritability, mood swings, anxiety, and depression.
- Without estrogen, many women develop chronic urinary tract infections. (Estrogen offers a protective effect in the vagina, keeping bad bacteria levels down and warding off urinary tract infections.)
- Estrogen depletion promotes urinary incontinence, as it makes the lining of the urethra drier and less flexible. (The urethra is the tube allowing urine to leave the body.)
- According to the National Osteoporosis Foundation, when estrogen levels drop, women lose bone density—as much as 20% in the first five to seven years after menopause. (Estrogen plays a key role in protecting bone mass and strength. The hormone regulates the activity of bone-forming and bone-resorbing cells.)
- The losing of estrogen causes the skin to become thinner, lose elasticity, and get dry, saggy, and wrinkly. The skin may also be less able to heal quickly after menopause.
COPING WITH CHANGES
Doctors may prescribe HT to help women cope with the symptoms that develop before, during, and after menopause. The two basic types of HT are:
- Estrogen-progestogen therapy or EPT consists of estrogen and progestogen (progestogens include natural progesterone and synthetic progestins). Estrogen causes the lining of the uterus (womb) to thicken. That can increase the risk of developing cancer of the endometrium (the lining of the uterus). To prevent this, progestogens are given. They help prevent abnormal buildup.
- Estrogen therapy or ET consists of estrogen alone. It’s used in women who do not have a uterus.
The products come in many forms, such as pills, skin patches, creams, and gels. Some HT products are synthetic, made in a lab.
Others are called “bioidentical” or “natural,” derived from plants. The FDA approves both types of hormones.
However, the FDA does not approve hormones that are custom-made in a compounding pharmacy.
Some people claim that custom-compounded bioidentical hormones are safer or more effective than government-approved therapies.
However, the North American Menopause Society states that there is no evidence to support those claims.
From the 1960s until the turn of the century, doctors prescribed HT as a way to help women find relief from menopause symptoms and also as a way to protect an older woman’s heart.
But results of a large study called the Women’s Health Initiative, published in 2002, suggested that HT could hurt women by increasing the risks for stroke, heart attack, blood clots in the lungs and legs, dementia, and breast cancer.
That caused many doctors to stop prescribing HT.
Since then, studies have suggested that HT is associated with a protective effect against heart disease and stroke in women younger than 60.
But there are still risks associated with HT. It is accepted that HT increases the risks for heart attack and stroke in women who are 60 or older.
The non-profit group Breastcancer.org warns that:
- EPT increases breast cancer risk by 8 cases per year for every 10,000 women taking EPT based on follow-up Women’s Health Initiative studies.
- Using estrogen-only HRT increases breast cancer risk if used for more than 10 years.
The North American Menopause Society, the American Society for Reproductive Medicine, and the Endocrine Society maintain that:
- Healthy women can use EPT to treat symptoms of menopause, such as hot flashes and vaginal dryness, for a period of five years or less.
- The risk for breast cancer increases when EPT is used continuously for five or more years. The use of et al. one for an average of seven years did not appear to boost breast cancer in the Women’s Health Initiative.
- The Food and Drug Administration has also approved HT to help prevent bone loss and fractures in some postmenopausal women.
WHAT YOU SHOULD DO
The North American Menopause Society recommends tailoring HT to the individual.
In other words, you and your doctor will have to consider your treatment goals, age, and health risks when talking about whether HT is right for you.
And if you do use HT, it is recommended that you take the lowest effective dose for the shortest time.
“Hormonal Therapy for Treating Breast Cancer.” Breastcancer.org. September 26, 2018. https://www.breastcancer.org/treatment/hormonal (accessed January 29, 2019).
“Hormone Therapy: Resource Overview.” American College of Obstetricians and Gynecologists (ACOG). https://www.acog.org/Womens-Health/Hormone-Therapy (accessed January 29, 2019).
“Hormone Therapy FAQs.” The North American Menopause Society, NAMS. http://www.menopause.org/for-women/expert-answers-to-frequently-asked-questions-about-menopause/hormone-therapy-menopause-faqs (accessed January 29, 2019).
“Menopausal Hormone Therapy Information.” National Institutes of Health (NIH). April 25, 2016. https://www.nih.gov/health-information/menopausal-hormone-therapy-information (accessed January 29, 2019).
American College of Obstetricians and Gynecologists, 409 12th Street SW, Washington, DC 20024-2188, Washington, DC, 20024-2188, (800) 673-8444, (202) 638-5577, https://www.acog.org .