When a woman's body no longer makes estrogen, hormone therapy may be an option. But, hormone therapy (HT), in which estrogen and progestin (a synthetic progesterone) are used in combination, has been controversial over the years.
To learn more about women's health, and specifically hormone therapy, the National Institutes of Health (NIH) did a study called the Women's Health Initiative (WHI) beginning in 1991. The study involved more than 161,000 generally healthy postmenopausal women.
The study was designed to test the effects of postmenopausal hormone therapy, diet modification, and calcium and vitamin D supplements on heart disease, fractures, and breast and colorectal cancer in women.
The study had 2 arms:
The estrogen-plus-progestin study of women with a uterus
The estrogen-alone study of women without a uterus
Women with a uterus were given progestin in combination with estrogen, which is known to prevent endometrial cancer. All women were randomly assigned to either the hormone medicine being studied or to placebo (inactive substance). Compared with placebo, the estrogen plus progestin treatment resulted in:
Small increase in risk of heart attack (in women younger than 60 when combined hormone therapy is started in perimenopause, it may reduce risk of heart attack)
Small increase in risk of stroke
Small increase in risk of blood clots
Small increase in risk of breast cancer
Reduced risk of colorectal cancer
No protection against mild cognitive impairment and increased risk of dementia (study included only women 65 and older)
Compared with the placebo, treatment with estrogen alone resulted in:
No difference in risk for heart attack
Increased risk of stroke
Increased risk of blood clots
Reduced risk of breast cancer
No difference in risk for colorectal cancer
Reduced risk of fracture
The WHI recommends that women follow the FDA advice on hormone (estrogen-alone or estrogen-plus-progestin) therapy. It says that hormone therapy should not be taken to prevent heart disease.
These products are approved therapies for relief from moderate to severe hot flashes and symptoms of vaginal dryness. Although hormone therapy may be effective in preventing fractures, it should only be considered for women at high risk of osteoporosis who cannot take other medicines. The FDA recommends that hormone therapy be used at the lowest doses for the shortest time needed to achieve treatment goals. Postmenopausal women who use or are considering using hormone therapy should discuss the possible benefits and risks to them with their healthcare providers.
The National Heart, Lung, and Blood Institute offers the following suggestions for women who are deciding whether or not to use hormone therapy:
The most important thing a woman can do in deciding to continue hormone therapy is discuss the current research with her healthcare provider.
Women need to be aware that taking a combined progesterone and estrogen regimen or estrogen alone is no longer recommended to prevent heart disease. A woman should discuss other ways of protecting the heart with her healthcare provider.
Women should discuss with their healthcare providers the value of taking combined progesterone and estrogen therapy or estrogen to prevent osteoporosis. There may be other treatments based on a woman's health profile.
Always consult your healthcare provider for more information.
What is hormone therapy?
As a woman approaches menopause, the production of estrogen and progesterone fluctuates and then decreases significantly. Symptoms such as hot flashes often result from the changing hormone levels. After a woman's last menstrual period, when her ovaries make much less estrogen and progesterone, some symptoms of menopause might disappear, but others may continue.
To help relieve these symptoms, some women use hormones. This is called menopausal hormone therapy (MHT). This approach used to be called hormone replacement therapy or HRT. MHT describes several different hormone combinations available in a variety of forms and doses.
How is hormone therapy administered?
Hormone therapy can be given in a variety of methods, including the following:
Estrogen pills can either be taken every day or for 25 days each month. Women who have had a hysterectomy (uterus removed) can take estrogen alone, while those who have not may take a combination pill (estrogen and progestin).
There are two methods—the continuous method and the cyclic method—for taking estrogen and progestin. In the continuous method, a pill that contains both estrogen and progestin is taken daily. Occasionally, irregular bleeding may occur.
The cyclic method involves taking estrogen and progestin separately—with estrogen taken either every day or daily for 25 days of the month and progestin taken for 10 to 14 days of the month. This may cause monthly "withdrawal" bleeding.
estrogen and estrogen/progestin skin patches
Using this method, a patch is applied to the skin of the abdomen or buttocks for 3 or 7 days. The patch is then discarded and a new one is applied. The patch can be left on at all times, even while swimming or bathing, and either the estrogen, or estrogen/progestin combination is delivered through the skin into the bloodstream. Progestin can be taken in a pill form with the patch. The patches may cause monthly bleeding.
Estrogen cream is inserted into the vagina or used locally around the vulva to help with vaginal dryness and urinary problems.
A class of drugs called selective estrogen receptor modulators (SERMs).
For women who are appropriate candidates, this type of therapy can often be customized to provide the most benefits with the least side effects. It is important for women to talk with their healthcare providers about any discomfort or menstrual symptoms experienced with hormone treatment, as treatment approaches and dosages can be adjusted.
October 16, 2017
Menopausal hormone therapy: Benefits and risks, Up To Date, Menopausal hot flashes, Up To Date, Treatment of menopausal symptoms with hormone therapy, Up To Date
Burd, Irina, MD, PhD,Freeborn, Donna, PhD, CNM, FNP