What are the basic types of hormone therapy?
Hormone therapy primarily focuses on changing your body’s estrogen production after menopause. There are two main types of estrogen therapy:
- Systemic hormonal therapy: Systemic estrogen, which comes in the form of a pill, skin patch, ring, gel, cream, or spray generally contains high doses of estrogen that are absorbed throughout the body. It can be used to treat many common symptoms of menopause.
- Low-dose vaginal products: Low-dose vaginal estrogen preparations, which come in cream, tablet, or ring form reduce the amount of estrogen your body absorbs. For this reason, low-dose vaginal preparations are generally used only to treat vaginal and urinary symptoms of menopause.
If your uterus is not removed, your doctor will usually prescribe estrogen along with progesterone or progesterone (drugs such as progesterone). This is because estrogen alone, when not balanced by progesterone, stimulates the growth of the lining of the uterus, increasing the risk of endometrial cancer. If your uterus was removed (cervical surgery), you do not need to take progestin.
Why does the body need estrogens?
Estrogen thickens the lining of the uterus and prepares the fertilized egg for implantation. Estrogen also affects the way the body uses calcium, a mineral important in building bones. Also, estrogen helps maintain a healthy level of cholesterol in the blood. Estrogen is needed to keep the vagina healthy.
As menopause approaches, the ovaries greatly reduce the production of these hormones. Decreased or fluctuating estrogen levels can lead to medical conditions such as menopausal symptoms, such as hot flashes, and osteoporosis.
Why take progesterone?
Progesterone is used in addition to estrogen in women who have a uterus. In these women, estrogen, if taken without progesterone, increases the risk of cancer of the endometrium (the lining of the uterus). During a woman’s reproductive years, cells are removed from the endometrium at the end of menstruation. When the endometrium no longer collapses, estrogen causes the cells of the uterus to grow, a condition that can lead to cancer.
Progesterone reduces the risk of endometrial (cervical) cancer by thinning the endometrium. Women taking progesterone do not have menstruation or bleeding depending on how they are taking hormone therapy. Monthly bleeding can be reduced and, in some cases, eliminated by taking progesterone and estrogen together continuously.
Women who have had cervical surgery (surgical removal of the uterus) generally do not need to take progesterone. This is an important point because estrogen alone has fewer long-term risks than HT, which uses a combination of estrogen and progesterone.
What are the risks of hormone therapy?
In the largest clinical trial to date, hormone replacement therapy with the estrogen-progestin pill (Prima Pro) increased the risk of some serious conditions, including:
- Heart disease
- Blood clots
- Breast cancer
Later studies suggest that these risks vary:
- Years: Women who start hormone therapy at the age of 60 years or older or 10 years from the onset of menopause are at increased risk for the above conditions. If hormone therapy is started before age 60 or within 10 years of menopause, the benefits outweigh the risks.
- Type of hormone therapy: The risks of hormone therapy vary depending on whether estrogen is given alone or with progestin and the dose and type of estrogen.
- Health history: Your family history and personal medical history and risk factors for cancer, heart disease, stroke, blood clots, liver disease, and osteoporosis are important factors in determining whether hormone replacement therapy is right for you.
You and your doctor should consider all of these risks when deciding whether hormone therapy is an option for you.
Who can benefit from hormone therapy?
The benefits of hormone therapy outweigh the risks if you are healthy and:
- Keep lights from high heat in moderation. Systemic estrogen therapy remains the most effective treatment for relieving the troublesome hot flashes and night sweats of menopause.
- You have other symptoms of menopause. Estrogen prolongs vaginal symptoms of menopause, reducing itching, burning, and discomfort during intercourse.
- It is necessary to avoid bone loss or fractures. Systemic estrogen helps prevent osteoporosis, also known as osteoporosis. However, doctors often prescribe bisphosphonates to treat osteoporosis. Estrogen therapy can help if you are intolerant or do not benefit from other treatments.
You are experiencing early menopause or have an estrogen deficiency. If your ovaries have been surgically removed before age 45, if you stop before age 45 (premature or early menopause), or if your ovaries lose their normal function before age 40 (primary ovarian failure), your body is less susceptible to estrogen than women who normally experience menopause. Estrogen therapy can help reduce the risk of certain health conditions, such as osteoporosis, heart disease, stroke, dementia, and mood swings.
If you take hormone therapy, how can you lower your risk?
Talk to your doctor about these strategies:
- Find the best product and delivery method for you. You can take estrogen in the form of a pill, patch, gel, vaginal cream, or a suppository or slow-release ring that is placed in the vagina. If you only experience vaginal symptoms related to menopause, a low-dose vaginal cream, tablet, or estrogen ring is often a better option than an oral pill or skin patch.
- Reduce the amount of medicine you take. Use the least effective dose for the shortest time necessary to treat your symptoms. If you are under 45, you need enough estrogen to protect against the long-term health effects of estrogen deficiency. If you have permanent menopausal symptoms that can significantly affect your quality of life, your doctor may recommend long-term treatment.
- Follow up regularly. See your doctor regularly to learn the benefits of hormone therapy that outweigh the risks and for screenings like mammograms and pelvic exams.
- Choose healthy lifestyle choices. Include physical activity and exercise in your daily routine, eat a healthy diet, maintain a healthy weight, avoid smoking, limit alcohol, manage stress, and manage chronic health conditions like high cholesterol or high blood pressure.
- If you have not had cervical surgery and are using systemic estrogen therapy, you may also need progestin. Your doctor can help you find a delivery method that offers greater benefits and convenience at lower risk and cost.
Who should not take hormone therapy (HT)?
Hormone therapy is not recommended for women in general:
- Active or past breast cancer
- Active or recurrent endometrial cancer
- Abnormal vaginal bleeding that has not been evaluated
- Active or recurring blood clots
- History of stroke
- Known or suspected pregnancy
Side effects of hormone therapy
As with almost all options, hormone therapy can have side effects.
The most common side effects are:
- Monthly bleeding (if progestin is cyclical)
- Irregular detection
- Tender breasts
Less common side effects of hormone therapy:
- Fluid retention
- Headache (including migraine)
- Skin discoloration (brown or black spots)
- Increased breast density makes it difficult to interpret mammography
- Irritation of the skin under the estrogen patch.
How can I reduce these side effects?
Adjusting the dose or form of medicine you are taking often reduces the side effects of hormone therapy. However, you should never make changes to your medication or stop taking it without consulting your doctor.