Hormone Replacement Therapy
Hormone replacement therapy (HRT) is a type of treatment that involves taking hormones to prevent or treat certain medical conditions. Common uses for HRT include treating menopause in women and preventing osteoporosis.
The hormones used in HRT are synthetic hormones. This means they are created in a laboratory (rather than by the body). Once these hormones are inside the body, they act like natural hormones.
In the past, doctors routinely prescribed HRT. They hoped it could help guard against certain diseases and treat the symptoms of menopause. The diseases doctors hoped HRT could help prevent included osteoporosis, heart disease and cancer. Information from studies suggests HRT may not be safe for most women. This means the risks of using HRT outweigh the benefits. For a few women, benefits may outweigh the risks. This is why it is important to talk to your doctor about HRT.
Path to improved health
To study HRT, a health initiative was organized. This initiative used several studies to gather information on the effects of HRT. The goal of the initiative was to determine if HRT is safe.
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
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. 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. This is because they could see that the risks associated with combination HRT outweighed the benefits. Specifically, they 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 doctor before making any changes to your therapy. He or she will consider your menopausal symptoms and your risk for developing certain diseases. Your doctor 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 other HRT drugs aren’t safe to use, either. Women who use them could also be at higher risk for breast cancer, blood clots, heart attacks, and strokes. Even so, many doctors believe that short-term use of HRT to control menopausal symptoms is still safe for most women. 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 doctor 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 doctor can help you decide which of these treatments might be most helpful for you.
Finally, remember that following a healthy lifestyle can also help protect against heart disease, osteoporosis, and some types of cancer. A healthy lifestyle includes:
- eating a healthy diet
- maintaining a healthy weight
- exercising regularly
- quitting smoking.
Things to consider
The American Academy of Family Physicians (AAFP) recommends against the use of combined estrogen and progestin for the prevention of chronic conditions in postmenopausal women. The AAFP also recommends against the use of estrogen for the prevention of chronic conditions in postmenopausal women who have had a hysterectomy.
According to the AAFP, “This recommendation applies to postmenopausal women who are considering hormone replacement therapy for the primary prevention of chronic medical conditions. This recommendation does not apply to women younger than age 50 years who have undergone surgical menopause. This recommendation does not consider the use of hormone therapy for the management of menopausal symptoms, such as hot flashes or vaginal dryness.”
When to see a doctor
If you are having symptoms of menopause, you should see your doctor. Your doctor can evaluate your symptoms. Together, you can work out a plan to manage symptoms. This plan could involve using HRTs for a short time.
If you are currently taking HRTs, you should already be under the close care of your doctor. Be sure to keep following up with your doctor. Report any unusual symptoms to him or her.
Questions for your doctor
- Can HRT help me manage menopause symptoms?
- What will be my risks if I use HRT?
- How long can I safety use HRT?
- Is there a safer type of HRT for me?
- How do I know if I’m at risk for blood clots?
- How will you determine my does of HRT?
- What tests will I need to take before beginning HRT?