Hormone Therapy Safe in Menopause Management
replacement therapy (HRT) is
acceptable and relatively safe for healthy, symptomatic, recently postmenopausal
women, according to a new consensus
by 15 leading medical organizations involved in women's health.
Hormone replacement therapy (HRT) is a treatment used to relieve symptoms
of menopause. It replaces the female hormones, estrogen alone or estrogen
and progesterone in combination that are no longer produced after menopause.
Signs of Menopause
Common changes you might notice are:
Vaginal dryness, urinary problems
Mood Changes especially depression
Other problems like memory lapses, headaches,
Types of Hormone Replacement Therapy?
There are two main types of hormone replacement therapy:
Estrogen Therapy: Doctors prescribe a low dose of estrogen to be taken
as a pill or patch every day. Estrogen may
also be prescribed as a cream. You should take the lowest dose of estrogen
needed to relieve menopause symptoms. Estrogen therapy as a single agent is
sufficient in women who have undergone hysterectomy. Local estrogen therapy
is effective and preferred for women whose symptoms are limited to vaginal
dryness or discomfort with intercourse; low-dose vaginal estrogen therapy is
recommended in this setting.
Progesterone/Progestin-Estrogen Hormone Therapy: Also
called combination therapy, this form of HRT combines doses of estrogen and
progesterone (progestin is a synthetic form of progesterone). Estrogen and a
lower dose of progesterone also may be given continuously to prevent the
regular, monthly bleeding that can occur when combination HRT is used. The
current recommendation is to take the lowest dose of hormone therapy for the
shortest time possible. Like all prescription medications, HRT should be
re-evaluated each year. Progestogen therapy is required to prevent endometrial
cancer when estrogen is used
systemically in women with a uterus.
Specific recommendations in the consensus statement includes
(The new guidelines and rationale were issued jointly by the North American Menopause Society (NAMS), the American Society for Reproductive Medicine, and the Endocrine Society.)
The decision to use HRT must be individualized based on specific patient
factors and anticipated risks and benefits. These include quality-of-life
priorities, age, time since menopause, and risk for blood clots, heart
disease, stroke, and breast
For healthy, relatively young women (younger than 59 years or within 10
years of menopause) with moderate to severe menopausal symptoms, systemic
HRT is an acceptable option and is the most effective treatment.
Low-dose vaginal estrogen is the preferred treatment for women who have
only vaginal dryness or discomfort with intercourse.
To prevent uterine cancer in women who still have a uterus, HRT should
include progesterone or a similar progestogen, as well as estrogen. Women
who have undergone hysterectomy can be given only estrogen.
Estrogen-only and estrogen-progestogen HRT are associated with increased
risk for stroke and of venous thromboembolism (deep venous thrombosis and
pulmonary embolus), as are hormone-based contraceptives. However, the risk
is rare in women aged 50 to 59 years.
Use of continuous estrogen with progestogen therapy for at least 5
years, and possibly even for shorter duration, is associated with an
increased risk for breast cancer. When HRT is discontinued, this risk
Duration of Therapy
The lowest dose of hormone therapy should be used for
the shortest amount of time to manage menopausal
Although fewer than 5 years is recommended for estrogen
with progestogen therapy, duration should be
individualized. For estrogen therapy alone, more
flexibility in duration of therapy may be possible.
There are reports of increased risk of breast cancer
after 10 to 15 years of use in large observational
studies with estrogen alone.
Although research is ongoing and these recommendations
may be modified over time, there is no question that
hormone therapy has an important role in managing
symptoms for women during the menopausal transition and
in early menopause.
Dated 24 July 2012