Hormone Replacement Therapy

Estrogen are the hormones responsible for female sex characteristics. Estrogen deficiency begins in the premenopausal years and progresses as a woman goes through menopause. Most of the signs and symptoms of menopause result from the decrease in estrogen production. Hormone replacement therapy (HRT) or just estrogen replacement therapy (ERT) is used to diminish menopausal signs and symptoms and help prevent other medical problems.

MEDICATION

  • HRT usually consists of an estrogen hormone plus a progesterone (progestin) hormone. The two hormones combined protect against endometrial cancer, a risk with estrogen taken alone. Estrogen therapy alone may be used for women who have had a hysterectomy.
  • The dose and form and regimen for the medications will be determined depending on the individual patient’s requirements, age and reason for the replacement therapy. Most frequently, patients take both medications daily continuously (others may take them on a cyclic schedule during the month).
  • Doses or schedules may need to be adjusted to completely resolve the symptoms of menopause. The medications can be supplied in oral form or skin patch (for estrogen). Also, an estrongen cream is available that can be prescribed to relieve vaginal symptoms.
  • For long-term protection from osteoporosis and cadiovascular disease, HRT must be taken indefinitely.
  • If a scheduled dose is missed, take it as soon as possible. If it is almost time for the next dose, skip the missed one. Don’t double an oral dose and never wear more than one patch at a time.
  • If nausea is a problem, take the tablets with food or immediately after a meal. The nausea usually disappears with continued use.

EFFECTS OF THERAPY

  • Relieves hot flashes (sweating episodes) and vaginal symptoms of irritation and dryness that can cause pain and discomfort during sexual intercourse.
  • Prevention of osteoporosis.
  • Helps prevent cardiovascular disease.
  • The therapy may ease the emotional and nervous symptoms of menopause (e.g., depression, irritability or insomnia) associated with other postmenopausal symptoms such as hot flashes. Medical evidence is uncertain that HRT will keep a woman feeling young or promote soft or unwrinkled skin.

PRECAUTIONS

  • Previous reaction or allergic response to estrogens or other medications or food.
  • Smoking or taking other prescription or nonprescription medications.
  • Family history of bone disease, cancer, endometriosis, epilepsy, fibroids, gallbladder disease, heart or circulatory disease, stroke, kidney or liver disease, migraine headaches or excess of calcium in the blood.
  • A woman and her doctor should discuss the benefits and risks with hormone therapy in terms of her individual medical history, general health, age, and other circumstances.

CONTRADICTIONS

  • Breast cancer (depending on when the diagnosis was made).
  • Past history or active blood-clotting disorder (thrombophlebitis) is generally not a contraindication, but should always be discussed with the doctor.
  • Known or suspected pregnancy.
  • Endometrial cancer (depending on when the diagnosis was made).
  • Undiagnosed vaginal bleeding. It needs to be evaluated before hormone treatment is initiated.

RISKS, POSSIBLE SIDE EFFECTS OR ADVERSE REACTIONS

  • HRT is generally well tolerated. The most common undesirable side effect is abnormal uterine bleeding, which usually diminishes in time. Notify your doctor if it does occur.
  • Swollen feet or legs.
  • Mood changes.
  • Breast tenderness or pain.
  • Pelvic cramping.
  • Fatigue.
  • Depression.
  • Headaches.
  • Symptoms of a blood clot-sudden or severe headache, sudden loss of coordination, sudden loss or change in vision, pains in the chest, groin, or leg (especially the calf), sudden unexplained shortness of breath, sudden slurring of speech, weakness or numbness in arm or leg.
  • Medical studies indicate no increased risk of breast cancer with hormone replacement therapy.
  • Note: The usual dosages of hormone replacement therapy for menopausal symptoms are kept low and less likely to cause side effects or adverse reactions as are the higher doses used in oral contraceptives or used to treat some cancers.

FOLLOW-UP EXAMINATIONS

Women taking hormones should have an annual pelvic examination including a Pap smear test, and a mammogram.