Q: Should I use hormone replacement therapy? And if I am already on hormone replacement therapy, what should I do?
A: Hormone replacement therapy is generally prescribed to relieve menopausal symptoms such as: hot flashes, sleep disturbance, vaginal dryness, mood swings, and urinary symptoms, and to reduce the risk of osteoporosis and related fractures. There is some evidence that it may prevent Alzheimer’s disease and colon cancer as well.
Hormone replacement therapy is estrogen or a combination of estrogen and progestin. If you still have your uterus, doctors generally prescribe estrogen and progesterone. If you no longer have your uterus, only estrogen is prescribed.
Here are some of the advantages and disadvantages of hormone replacement therapy (HRT) and estrogen replacement therapy (ERT).
Pros
- HRT and ERT reduce the risk of osteoporosis.
- HRT and ERT relieve hot flashes and night sweats.
- HRT and ERT may improve mood and psychological well being.
Cons
- ERT, especially without the use of a progestin, increases the risk of cancer of the uterus (endometrial cancer).
- HRT can have unpleasant side effects, such as bloating or irritability.
- HRT and ERT may increase the risk of breast cancer; long-term use may pose the greatest risk.
- In women at risk of blood clots, HRT and ERT may be dangerous.
- HRT and ERT may increase the risk of cardiovascular complications such as heart attacks and stroke.
The decision to use hormone replacement therapy after menopause should be made by the woman and her doctor after weighing the possible risks and benefits. The first step is to decide how much you are bothered by menopausal symptoms. You will also need to think about your medical history, your risk of heart disease, osteoporosis, and breast cancer, and your family history of these illnesses.
Any decision about HRT or ERT that you make now is not final. You can start or end the treatment anytime. Your decision about hormone therapy should be reviewed each year with your doctor at your annual checkup. After menopause, it is important to continue yearly breast and pelvic exams, Pap tests, and mammograms, as well as a general physical exam.
Recent data concerning HRT and ERT show that there is a small but definite increase in the risk of cardiovascular disease and breast cancer with long term use. When added to the increased risk of endometrial cancer and blood clots, which we’ve known about for a long time, these data give us pause.
Clearly, a woman and her physician must make this decision on an individual basis. Perhaps her risk of osteoporosis outweighs the other risks. Perhaps a short course of hormone therapy can treat her menopausal symptoms without long term side effects. Each woman is different and therefore the decision to use hormone therapy must be individualized.
