| Hormone Replacement Therapy Courtesy of Providence Health Care Systems | ||||||||
| Menopausal
symptoms can be very uncomfortable leading to loss of sleep, mood swings,
hot flashes and diminished sexual satisfaction.
For some women, menopause causes little or no symptoms; while other
women have severe symptoms that interfere with their daily lives. Although symptoms can be very uncomfortable,
they are not dangerous or life threatening.
Hormone replacement therapy (estrogen with or without progesterone)
has traditionally been prescribed to relieve these symptoms. |
||||||||
| It
was originally thought that estrogen therapy could also prevent heart disease
and protect against osteoporosis. However,
the early studies some limitations. In an effort to provide more definitive answers
on hormone replacement therapy (HRT) the National Institutes of Health funded
a very large study. Recently, results
from this study, named the Women’s Health Initiative Study, were released.
This study provides information that will help patients and their
healthcare providers make decisions about HRT.
Below are answers to several questions that have been asked by women
concerned about HRT. |
||||||||
| Do I need to stop my hormone
replacement therapy today? No. Although recent studies show a slight increase
in risk of heart disease and breast cancer – overall the risk for each individual
woman is still low. It is best to
discuss YOUR own risks and benefits with your healthcare provider before
deciding whether to continue or start HRT. |
||||||||
| What are the risks and benefits
of HRT? The Women’s Health Initiative (WHI) study included
more than 16,000 women with an intact uterus who received either PremproÒ or a placebo (a sugar pill).
PremproÒ is a combination tablet
that contains congugated estrogen (PremarinÒ 0.625 mg) plus medroxyprogesterone
2.5 mg. |
||||||||
In each year, if 10,000 women
were to take a placebo and 10,000 women were to take HRT, the following
events would occur:
The
five-year study found no difference in the number of deaths between women
taking HRT and placebo. |
||||||||
| I have had a hysterectomy. How do these studies apply to me? The recently published
studies did NOT include women who had a hysterectomy and are only taking
estrogen. The WHI study did include
a group of women who had undergone hysterectomy,
however this part of the study is still underway. The results of this part of the study are not
expected to be available until 2005.
Some researchers have theorized that it is the progesterone and not the
estrogen that increases a woman’s risk of heart disease and possibly other
problems. If this is true, than women
taking estrogen following hysterectomy may not be at increased risk. However, until the results of this part of the
WHI are published this remains controversial. |
||||||||
| I started HRT to prevent
heart disease. Should I continue
it? Surprising to physicians and researchers, in
recent placebo controlled studies, HRT did not protect against heart disease.
There is now data to suggest that if you currently have heart disease
you should not begin taking HRT. Also, it does not appear that HRT prevents heart
disease. Although there may be other
reasons to begin HRT (e.g., for bothersome menopausal symptoms), prevention
of heart disease is no longer the sole reason women should decide to take
HRT. |
||||||||
| I heard that HRT protects my bones; is this still
true? HRT
has been shown to help prevent bone loss and prevent hip fractures.
This is mainly true if you started it when your menopausal symptoms
first began. If you are concerned about osteoporosis, discuss
ALL of your options with your healthcare provider before deciding if HRT
is a good choice for you. All women
should consider regular weight-bearing exercise and calcium and vitamin
D every day to prevent osteoporosis. |
||||||||
| Does HRT really increase
my risk of breast cancer? There is
some evidence that your risk for breast cancer can increase slightly with
HRT. The WHI studies showed that
if 10,000 postmenopausal women with a uterus took estrogen plus progestin
for one year, 8 more will develop breast cancer compared to women not taking
HRT. Regardless of whether you are taking HRT or
not, all women should keep up with their regular schedule breast self-examinations
and mammograms. |
||||||||
| What about blood clots in
my veins? Taking HRT does increase your risk of developing
a blood clot in your lower leg veins that can sometimes travel to your lungs.
This increased risk does not go away with time.
Risk of blood clots is typically higher for women who smoke cigarettes
or who remain in one position for long periods of time (e.g., during airplane
flights or car trips longer than 4 hours).
|
||||||||
| Are there other types of
estrogen that I should consider taking?
What about “natural” estrogen products? The most common estrogen taken in |
||||||||
| Would a lower dose of estrogen be better for me? Since a lower dose of estrogen was not studied,
it is difficult to know exactly how taking a lower dose would affect the
risks and benefits of taking estrogen. Certainly
if you are taking estrogen to prevent menopausal symptoms, it is prudent
to take the lowest dose that keeps your symptoms under adequate control.
Whether lower doses of estrogen provide the same bone protection
is uncertain. Discuss the option
of lowering your estrogen dose with your healthcare provider. |
||||||||
|