HRT - Is It For You?
Once thought to be the panacea for menopausal women, hormone replacement therapy (HRT) has definitely not lived up to the marketing promises. The NIH-sponsored study called the Women's Health Initiative was pulled in 2002 because it was discovered that women who were receiving combined hormone therapy using both estrogen and progesterone had an increased risk for heart attack, stroke, and breast cancer when compared to women who were not on HRT. Later studies showed that estrogen on its own was implicated in stroke risk but not heart attack or breast cancer. However, it is associated with an increased risk of developing endometrial cancer.
Using Short-Term Estrogen HT
As a result of the increased number of risks that became connected to HRT, doctors became less likely to prescribe it and most of the women who were taking HRT stopped taking it, without consulting with their doctors. Today, long-term hormone treatment to prevent menopausal symptoms is no longer recommended. However, short-term use of estrogen to relieve symptoms is used and seems to help with the symptoms as well as provide a few added benefits:
· Decreased risk for osteoporosis-related hip fractures with the use of hormone therapy has been a finding in some studies.
· Studies indicate that hormone therapy can also decrease the risk of colorectal cancer.
· There is a suggestion that estrogen may decrease the risk of heart disease if taken early in the post-menopausal years. A study is currently begin conducted but will not be completed for several years, so the data used is inconclusive at this time.
The women who experience natural menopause and use HT (hormone therapy) receive a combination of estrogen and progestin, which is man-made synthetic progesterone to avoid the incidence of uterine cancer that occurs with estrogen. However, women who go through menopause as a result of a hysterectomy can take estrogen by itself.
The Trouble with Prempro
Prempro, the combination estrogen-progestin hormone therapy has been found to increase the risk of certain serious conditions. Identified in a very large clinical study, the risk for the following health issues increased with estrogen-progestin HT:
· heart disease
· breast cancer
· blood clots
· abnormal mammograms - particularly false positives
Women who took estrogen without progestin had no increase in breast cancer or heart disease, however, the incidence of stroke, blood clots and mammography abnormalities was higher in the study. The fact that the number of abnormal mammograms increased is an indication that more frequent mammograms and additional testing is necessary for women on HT.
Even though there are health risks associated with hormone therapy, it is still considered to be the best method for treating menopausal symptoms. Depending upon an individual's symptoms, some benefits to consider for short-term use of hormone therapy that may outweigh the risks include:
· HT can help reduce severe hot flashes and other symptoms of menopause
· HT can slow the loss of bone mass in women who have already experienced some loss or who can't tolerate or aren't benefitting from other types of treatment
· HT can help balance hormones for women who are experiencing premature menopause or premature ovarian failure.
Women who experience the loss of ovarian function or early menopause before the age of 40 are at less risk for breast cancer, but have a higher risk for osteoporosis and coronary heart disease. The protective benefits of HT for younger women may outweigh the risks in those cases.
Who Should Not Use HRT or HT
Those women who have breast cancer, heart disease or a history of blood clots are not candidates for HT. If they are not bothered by menopausal symptoms, there is no need for any treatment. However, if there are symptoms, these women should talk with their doctors to determine other ways to handle the symptoms. Lifestyle changes or the use of other medications may be recommended.
Ultimately, the best way to determine if using hormone therapy is a good fit for you is to discuss your symptoms and the associated health risks from HT with your doctor. By collaborating, the best method of treatment for the individual can be developed.
Learn more about the various issues with hormone replacement in our article in this section.