Healing Hormones Hormone replacement therapy safely relieves menopausal symptoms for many women.
Q: What is hormone replacement therapy used for?
A: Hormone replacement therapy (HRT) is a type of treatment where the body is given hormones to prevent or treat certain medical conditions (such as treating symptoms of menopause in women and preventing osteoporosis). The hormones used in HRT are synthetic hormones, which means they are created in a laboratory (rather than by the body), but they act like natural hormones once inside the body.
At menopause, your body begins making less estrogen and progesterone hormones. This causes the body to stop having menstrual periods.
This is because estrogen and progesterone hormones control your periods and menstrual cycle. A lack of estrogen may cause symptoms such as:
• Hot flushes (or hot flashes)
• Vaginal dryness
• Dry skin
• Loss of sex drive
• Risk of bone loss (osteoporosis)
When these symptoms occur, you may choose to take hormone therapy (HT) to get back the estrogen lost during menopause.
When the hormone estrogen is given alone, it is usually referred to as estrogen therapy (ET).
When the hormone progestin is combined with estrogen, it is generally called HT or combination therapy. This was formerly known as HRT.
Your caregiver can help you make a decision on what will be best for you. The decision to use HT seems to change often as new studies are done. Many studies do not agree on the benefits of HRT.
Q: What are the benefits of HRT?
A: HT can alleviate many of the climacteric (menopausal) symptoms and protect against osteoporosis.
Hot flushes (also called hot flashes):
A hot flush is a sudden feeling of heat that spreads over the face and body. The skin may redden like a blush. It is connected with sweats and sleep disturbance. Women going through menopause may have hot flushes a few times a month or several times per day, depending on their individual bodies.
Osteoporosis (bone loss): Estrogen helps guard against bone loss. After menopause,
a woman’s bones slowly lose calcium and become weak and brittle. As a result, bones are more likely to break. The hip, wrist and spine are affected most often. HT may help slow bone loss after menopause. Performing weight-bearing exercises and taking calcium with vitamin D also may help prevent bone loss. There are also medications your caregiver can prescribe that may help prevent osteoporosis.
Vaginal dryness: Loss of estrogen causes changes in the vagina. Its lining may become thin and dry. These changes can cause pain and bleeding during sexual intercourse. Dryness also can lead to infections that cause burning and itching. Vaginal ET can help relieve pain, itching and dryness.
Urinary tract infections are more common after menopause because of lack of the estrogen. Some women also develop urinary incontinence because of low estrogen levels in the vagina and bladder. Possible other benefits of estrogen include a positive effect on mood and short-term memory in women.
Q: Are there risks? If so, what are they?
A: There are several potential risks with the use of HT, as with any medications.
Using estrogen alone without progesterone causes the lining of the uterus to grow.
This may increase your risk of cancer of the lining of the uterus (endometrial cancer). Your caregiver should give another hormone called progestin if you still have your uterus to counteract this effect.
There is a slight increased risk of breast cancer. The risk appears to be small, but it increases during the period that HT is taken.
Combination therapy makes the breast tissue slightly denser, which may make it harder to read mammograms (breast X-rays).
Combination or continuous therapy can increase the risk of spotting. HT can be taken cyclically, in which case you will have menstrual periods. Cyclical hormone therapy means HT is taken for a set amount of days, then not taken. This process is then repeated.
The estrogen in HT may increase the risk of stroke, heart attack, breast cancer and blood clots in the legs.
Transdermal estrogen (estrogen that is absorbed through the skin with a patch or a
Cream) may have more positive results with:
• Blood pressure
• Blood clots
Patients with endometrial cancer, liver disease, breast cancer, heart disease or a history
Of blood clots or stroke should not take HT.
Researchers aren’t sure, but it is possible that women who use HRT drugs other than those previously mentioned that have been studied also may be at higher risk for breast cancer, blood clots, heart attacks and strokes.
Even so, many doctors consider 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 most likely should not receive HRT.
Q: Are there different types of HRT?
A: HT can come in many different forms. The traditional way to take HT is with a pill. There are also applications that use transdermal dosing (a patch that administers the medication across the skin).
Newer formats now include vaginal pills and suppositories that are comparable to oral pill form. There also are medications produced by pharmaceutical companies, some forms of which can be created by local pharmacies or by compounding. This method allows for a greater variety of methods to receive the medication such as injections, suppositories and topical creams. Other differences in medication formats include estrogens derived from synthetic versus natural sources (plants versus animals).
Naturally occurring compounds that mimic estrogen in the body are known as phytoestrogens, and they can come from yam extracts or black cohash. These types of medications are considered supplements, and they vary in effectiveness in treating menopausal symptoms. Varying degrees of concentration make this type of HT less reliable.
Q: Who should consider discussing HRT with a doctor?
A: Any woman who is starting to experience menopausal symptoms either sporadically but still with a menstrual cycle (premenopausal) or on a fulltime daily basis without menstrual cycles.
Women who may undergo procedures that involve removing the ovaries should also discuss taking HT with their caregivers. Ideally, women who start HT as they start
Menopauses have the greatest improvement in symptoms with lower risks.
Q: How is HRT administered?
A: If you choose to take HT and still have your uterus, estrogen and progestin are usually prescribed. Your caregiver will help you decide the best way to take the medications. Possible ways to take estrogen include:
• Vaginal estrogen cream, rings and tablets it is best to take the lowest dose possible to alleviate your symptoms and use HT for the shortest period of time possible. Current guidelines recommend limiting use of hormone therapy to five years, but with proper counseling on the risks, HT can be extended beyond that.
HT can help relieve some of the problems (symptoms) that affect women at menopause. Before making a decision about HT, talk to your caregiver about what is best for you. Be well informed and comfortable with your decisions.
Q: What is a surprising fact about HRT that many women may not know?
A: The Premarin brand was originally derived by collecting and processing urine from pregnant horses in Canada, hence the name “Pre-mar-in” (mare).
The Women’s Health Initiative recently reversed concerns about the safety of HT. In
2001, the initial findings made significant news concerning the dangers of HT, but when considered in context, those risks eventually were considered less risky than previously thought.
Earlier large studies such as the Nurses’ Health Initiative and the Postmenopausal
Estrogen/Progestin Interventions (PEPI) study showed a good safety profile and benefits for relief of menopausal symptoms, osteoporosis and heart disease.
Q: Are there other options besides HRT for treating menopausal symptoms and
for lowering my risk of other diseases?
A: For some women, vaginal estrogen creams, antidepressants, soy products and certain herbal supplements may offer relief from menopausal symptoms. Specific 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 eating a healthy diet, maintaining a healthy weight, exercising regularly and, if you smoke, quitting can help protect against heart disease, osteoporosis and some types of cancer.
All Fitness _ Healing Hormone
Carlos Enrique Quezada, M.D., is board certified in obstetrics and gynecology. Quezada and his colleagues, Drs. Jose Garcia and Susan Rivera, practice at Acacia OB/GYN, located at 8715 Village Drive, Ste. 305, San Antonio, Texas 78217 and 3327 Research Plaza, Ste. 303, San Antonio, Texas, 78235. For more information or to make an appointment, call 210-226-7827