Hormone replacement therapy

WEB EXCLUSIVE / AUGUST 2005
POSTGRADUATE MEDICINE
Update of a handout originally published in April 2003

Download this Patient Note in PDF format

As menopause approaches, you may begin to have hot flashes, night sweats, vaginal dryness, and poor sleep as your body makes less of the hormone estrogen. In the past, your doctor might have recommended hormone replacement therapy (HRT) with estrogen alone or estrogen plus the hormone progestin for relief of troublesome symptoms of menopause and to protect against osteoporosis (thinning of the bones) and colorectal cancer.

Before 2002, most physicians thought that HRT also protected women against heart disease, and they prescribed it for nearly 13 million patients in the United States. But that year findings of a study called the Women's Health Initiative showed that HRT may actually increase the risk of heart attack and stroke. Since then, several other studies have further pointed out the risks of HRT. You probably have heard of these findings in the news, and you may be confused about what they mean for you.

What have studies revealed about HRT?
The Women's Health Initiative showed that women who start taking estrogen plus progestin have a slightly higher risk of heart attack and stroke caused by blood clots. In addition, women who take this therapy for more than 5 years appear to have a higher risk of breast cancer. Many women have stopped taking HRT as a result of these findings, and many doctors have changed the way they prescribe it. For most physicians, the main reason to prescribe HRT is as a short-term therapy to relieve severe menopausal symptoms.

Should I continue HRT?
If you already take HRT, discuss with your doctor the advantages and disadvantages of continuing it. The decision to continue or stop HRT may be based on the reason you started taking it, the type you are taking, how long you have been taking it, and what you think about HRT.

If you started HRT only to reduce your risk of osteoporosis or heart disease, your doctor probably will gradually reduce your dose until you stop taking it altogether. If you have been taking HRT to control menopausal symptoms, your doctor may consider reducing the dose to see if your symptoms come back. And if they return, he or she may have you continue HRT but at the lowest possible dose or may consider other therapy. If you find that you simply feel better when you take HRT, your doctor may or may not recommend that you continue taking it.

If you and your doctor decide that you should stop taking HRT, it is important to tell your doctor if you start to have menopausal symptoms again. Also, your doctor may measure the thickness of your bones from time to time to determine whether you might benefit from other kinds of drugs to help reduce the risk of osteoporosis.

Should I start HRT?
Your doctor probably will not suggest that you start HRT if your menopausal symptoms are mild. If you have severe symptoms, your doctor may recommend that you try HRT for a short time; if your symptoms do not improve within several weeks, he or she may give you a higher dose of HRT or consider other, different types of medications to reduce the symptoms.

How can I reduce my risk of osteoporosis and colorectal cancer without HRT?
There are a number of ways to reduce your risk of osteoporosis and colorectal cancer that may not be as risky as HRT. In the case of osteoporosis, eating a diet high in calcium and vitamin D (aim for 1,500 milligrams [mg] of calcium and 400 to 800 international units [IU] of vitamin D per day), doing regular weight-bearing exercises (for example, walking or lifting weights), and not smoking can help slow bone mineral loss. If you are at special risk for osteoporosis, your doctor may recommend that you take a drug made especially to prevent it. In the case of colorectal cancer, eating a high-fiber diet may help deter this disease and following your doctor's advice on screening tests may detect it at an early, and more likely curable, stage if it does occur.

If not HRT, what are my choices?
Women with bothersome menopausal symptoms may want to consider nonhormonal treatments. Some women wear layers of clothing that can be removed during a hot flash, use a fan, sip cold drinks, or use relaxation techniques. Others have had success with soy products and herbal products such as black cohosh. Using herbal products is not without risk, however, and they may not work well with the other medications you take. Before starting them, talk with your doctor.

This information is not a substitute for medical treatment.

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