Menopause Symptom Relief
The Ups and Downs of HRT
Up until about five years ago, doctors routinely prescribed hormone replacement therapy (also known simply as hormone therapy) to remedy menopause symptoms. However, the treatment came under intense scrutiny when researchers found that taking estrogen and progesterone could have serious side effects, including an increased risk of heart disease, breast cancer and dementia.
"The opinion has swung back and forth from every woman to no woman should take HRT," said Dr. James King, a family physician in Selmer, Tenn., and the president-elect of the American Academy of Family Physicians.
Using hormone therapy carries both risks and benefits, King said. Doctors still prescribe hormone therapy with some regularity to control menopause symptoms such as night sweats. Whether the benefits outweigh the risks or vice versa will depend, in part, on your medical history and that of your closest family members.
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Hot Flash Solution
During menopause a woman's estrogen level drops. The decrease in hormones can cause a wide range of symptoms including hot flashes, which are characterized by a feeling of heat rushing over your face or body as the blood vessels expand. Though it is not entirely known why, hormone therapy does relive hot flashes, said Dr. Nanette Santoro, professor of reproductive endocrinology at Albert Einstein College of Medicine. It is still one of the most effective treatments for both hot flashes and night sweats, she said.
Don't Dry Up
Hormone replacement therapy also helps with vaginal dryness, which also occurs during menopause. The tissues of the vagina, the lining of the uterus and the urinary tract, are sensitive to estrogen levels, Santoro said. A dip in estrogen dehydrates these tissues, and, in turn, makes them more susceptible to injury. Post-menopausal women who encounter vaginal dryness usually see their symptoms disappear within days when put on hormone therapy, Santoro added.
Build Bones
We all know that a loss of bone mass is a common problem for aging women, and about 80 percent of those with osteoporosis are the fairer sex. But what you might not know is that hormone replacement therapy can help your bones retain their density. The 2002 Women's Health Initiative (or WHI) study found that women who took the placebo had about 34% fewer hip fractures and 24% fewer fractures than women not receiving hormones, according to the NIH.
Curb Colon Cancer Risk
Estrogen-progesterone therapy may also help prevent colon cancer, though the "jury is still out on that one," King said. The WHI found that women taking the combined hormone replacement have a 37 percent decreased risk. However, women taking just estrogen appear not to have a statistical advantage over those taking the placebo.
Increase in Other Cancers
Though hormone replacement may have some benefits, researchers have found that it carries an increase risk for some cancers, including breast cancer. Generally speaking, increased estrogen levels are associated with an increased risk of breast cancer. "If women have a uterus, they have to take estrogen with progesterone," Santoro said. "Over time, that [combination] increases the risk of breast cancer." In fact, women taking combination hormone therapy have a 26 percent increased risk, according to the WHI study. Taking estrogen alone had an "uncertain effect," the researchers found.
Bolster Blood Clot Risk
Much like birth control pills which are a dose of female hormones that prevent ovaries from releasing an egg HRT increases the risk for blood clots. That's because estrogen in any form increases the possibility, said Santoro. Women who took combined hormone replacement had a significantly higher risk for clots, which are also known as venous thrombosis, usually within a deep vein of the legs, according to the NIH. These women had double the number of clots than women who took placebos. Women who took only estrogen replacement saw a 47 percent increase in clots.
A Surge in Strokes
Hormone therapy also increases the risk for stroke. In March 2004, the NIH actually shut down the estrogen-only part of the WHI study because of the increased risks. Women have a 39 to 41 percent greater chance of having a stroke while on hormone replacement, depending on whether they are taking just estrogen or estrogen plus progesterone.
Increased Heart Disease Risk
Perhaps the most shocking finding of the Women's Health Initiative is the increased risk of coronary heart disease in women taking hormone therapy. "There was a wide spread belief that hormones given after menopause in relatively low does would actually be protective of the heart," Santoro said. "The test failed." Instead, researchers found women taking estrogen and progesterone were 29 percent more likely to have a heart attack. Those on estrogen replacement had a slight statistical disadvantage, but that risk appears to diminish over time.
A Dementia Danger
Older women taking hormones have an increased risk of developing dementia, including Alzheimer's disease, than women who do not take hormone replacement therapy. A secondary analysis, called the Women's Health Initiative Memory Study found that women age 65 and older who take both estrogen and progesterone had twice the rate of dementia as women taking the placebo. The study revealed that women taking estrogen alone also have a higher likelihood of developing some sort of memory problem, but the increase was so small that it was not statistically significant.
More Menopause Management
▪ The Truth about Bioidentical Hormones
▪ Menopause Center
▪ Are You at Risk for Heart Disease?
