Patient Information
Q: Is hormone replacement therapy for me?
WHAT IS HORMONE REPLACEMENT THERAPY?
Hormone replacement therapy (HRT) is a treatment used to maintain your hormone levels when you begin menopause.
WHAT IS MENOPAUSE?
Menopause is the time in a woman's life when her period stops. Production of the hormones estrogen and progesterone starts to decrease. This change occurs when a woman is age 45 to 55 years. Lower levels of these hormones can cause symptoms that may become uncomfortable.
WHAT ARE THE SYMPTOMS OF MENOPAUSE?
The main symptom is that your period will stop. Some women do not have any other symptoms. Additional symptoms are hot flashes, which make you get very warm in the face, neck, and chest. At night, you may sweat a lot and have trouble sleeping. Your period may not stop right away. The time between periods and the flow may be different each month until your period stops. Your vagina may become dry. You may also feel discomfort when having sex.
WHAT TYPES OF HRT ARE AVAILABLE?
The hormone that HRT replaces is estrogen. HRT may also include progestin. HRT is available in several forms. Your PA or doctor may prescribe HRT in the form of a pill. HRT is also available as a patch, a gel, or a cream. Some types of HRT are available as a ring that is inserted into your vagina. HRT is usually used for 5 to 7 years. This is called short-term HRT. HRT is considered long-term when you take hormones for more than 5 to 7 years.
WHAT ARE THE BENEFITS OF HRT?
HRT keeps your hormone levels high enough to relieve menopause symptoms. Hot flashes and night sweats may be uncomfortable. HRT can reduce or prevent these symptoms. HRT can also protect you from developing osteoporosis and colorectal cancers. Short-term HRT has more benefits than side effects.
WHAT ARE THE SIDE EFFECTS OF HRT?
All medications have side effects. Scientists have found that women who take long-term HRT may have a slightly higher risk of developing heart disease or having a stroke. Long-term therapy can also increase the chance of developing blood clots, breast cancer, and ovarian cancer. Side effects can be limited by using the lowest dose of estrogen that will relieve your symptoms for the shortest amount of time.
WHO SHOULD USE HRT?
If your menopause symptoms are extremely uncomfortable, your PA or doctor may prescribe HRT for you. HRT that has only estrogen is prescribed if you have had a hysterectomy. If you have not had a hysterectomy, you should use an HRT that is a combination of estrogen and progestin. This combination can protect against uterine cancer. HRT is started at the beginning of menopause. Your PA or doctor will prescribe the smallest dose of estrogen that will relieve your symptoms. The HRT dose is slowly reduced during the next 5 years.
WHO SHOULD NOT USE HRT?
If you have a history of breast cancer or ovarian cancer, you should not use HRT. If you have heart disease, you should not use HRT. If you have had blood clots or a stroke, you should not use HRT. You should not use HRT if you no longer have menopause symptoms. HRT should not be used for more than 5 to 7 years. If you are older than 65 years, you should not be using HRT.
DOES IT MATTER WHICH TYPE OF THERAPY I USE?
The risks and benefits may be the same for all forms of hormone therapy used to treat the symptoms of menopause. Your PA or doctor can help you decide if one type might be better for you than the others.
HOW LONG SHOULD I USE HORMONES FOR MENOPAUSE?
HRT should be used at the lowest dose that will relieve your symptoms and for the shortest amount of time. You may need to visit your PA or doctor every 3 to 6 months to check if you still need HRT.
DO HORMONES PREVENT AGING, HEART ATTACKS, OR ALZHEIMER'S DISEASE?
HRT has not been proven to prevent aging or wrinkles. HRT should not be used to prevent heart attacks or strokes. HRT should not be used to prevent memory loss or Alzheimer's disease.
BOTTOM LINE
HRT can be helpful in relieving menopause symptoms. You should always talk with your PA or doctor to determine the best treatment for your menopause symptoms. You can find information on HRT on the Internet. The National Institutes of Health has a lot of information about HRT (go to www.nlm.nih.gov/medlineplus/hormonereplacementtherapy.html). JAAPA