Female Hormone Replacement Therapy

If you still have your uterus, taking estrogen without progesterone, another pregnancy-related hormone, raises your risk for cancer of the endometrium, the lining of the uterus. Since the cells from the endometrium aren’t leaving your body during your period any more, they may build up in your uterus and lead to cancer. Progesterone lowers that risk by thinning the lining.
Once you know the hormones that make up HRT, think about which type of HRT you should get:

• Estrogen Therapy: Doctors generally suggest a low dose of estrogen for women who have had a hysterectomy. Estrogen comes in different forms. The daily pill and patch are the most popular, but the hormone is also available in a pin, gel, or cream.
• Estrogen/Progesterone/Progestin Hormone Therapy: This is often called combination therapy, since it combines doses of estrogen and progestin, the synthetic form of progesterone. It’s meant for women who still have their uterus.

Side effects are a primary drawback of using HRT. While some of the side effects associated with HRT are relatively minor, others are more serious.
Potential minor side effects of HRT include:

• fluid retention
• acne
• increased urination
• breast enlargement
• worsening of sleep apnea in patients who have this sleep disorder
• changes in the amount of cholesterol in your body
• increases in your red cell count
• infertility

The benefits of hormone therapy depend, in part, on whether you take systemic hormone therapy or low-dose vaginal preparations of estrogen.

• Systemic estrogen therapy remains the most effective treatment for relief of troublesome menopausal hot flashes and night sweats. Estrogen can also ease vaginal symptoms of menopause, such as dryness, itching, burning and discomfort with intercourse. Although the Food and Drug Administration (FDA) still approves estrogen for the prevention of the bone-thinning disease called osteoporosis, doctors usually recommend medications called bisphosphonates to treat osteoporosis.
• Low-dose vaginal preparations of estrogen can effectively treat vaginal symptoms and some urinary symptoms, while minimizing absorption into the body. Low-dose vaginal preparations do not help with hot flashes, night sweats or protection against osteoporosis.

For women who experience menopause naturally, estrogen is typically prescribed along with progesterone or progestin (progesterone-like medication). This is because estrogen alone, when not balanced by progesterone, can stimulate growth of the lining of the uterus, increasing the risk of uterine cancer. Women who have had their uterus removed (hysterectomy) don’t need to take progestin.

Women with current or past history of:

• Breast cancer
• Ovarian cancer
• Endometrial cancer
• Blood clots to the legs or lungs
• Stroke or liver disease

Women who aren’t bothered by menopause symptoms and started menopause after age 45 do not need hormone therapy to stay healthy. Instead, talk to your doctor about strategies to reduce the risk of conditions such as osteoporosis and heart disease, which might include lifestyle changes and medications other than hormone therapy for long-term protection.

The following measures may help ease symptoms:

• Consume less caffeine
• Consume less alcohol
• Consume less spicy food
• Consume more Maca supplements
• Don’t smoke
• Exercise regularly
• Wear loose clothing
• Sleep in a well-ventilated, cool room

Some SSRI type antidepressants can help treat hot flashes. The antihypertensive drug, clonidine, may help reduce the symptoms of hot flashes.

Anecdotal accounts say that consuming ginseng, block cohosh, red clover, soya beans and Kava help with menopausal symptoms. Experts say scientific studies are needed to confirm this.

Talk to your doctor about these strategies:

• Find the best product and delivery method for you. You can take estrogen in the form of a pill, patch, gel, vaginal cream, or slow-releasing suppository. If you experience only vaginal symptoms related to menopause, estrogen in a low-dose vaginal cream or tablet is usually a better choice than an oral pill or a skin patch.
• Minimize the amount of medication you take. Use the lowest effective dose for the shortest amount of time needed to treat symptoms, unless you’re younger than age 45, in which case you need enough estrogen to provide protection against long-term health effects of estrogen deficiency. If you have lasting menopausal symptoms that significantly impair your quality of life, your doctor may recommend longer-term treatment.
• Seek regular follow-up care. See your health care provider regularly to ensure that the benefits of hormone therapy continue to outweigh the risks, and for screenings such as mammograms and pelvic exams.
• Make healthy lifestyle choices. Include physical activity and exercise in your daily routine, eat a healthy diet, maintain a healthy weight, don’t smoke, limit alcohol, manage stress, and manage chronic health conditions such as high cholesterol or high blood pressure.

If you haven’t had a hysterectomy and are using systemic estrogen therapy, you’ll also need a progestin. Your doctor can help you find the delivery method that offers the most benefits and convenience with the least risks and cost.

During the first 1 to 2 weeks you’ll experience:

• Increased mental quickness.
• An increased zest for life.
• Decreased irritability.
• More even moods.
• Diminished hot flashes.
• Improved sleep.

• Improved energy levels (if you’re active and eating well).
• Greater sex drive.
• Improved ability to control weight.
• Better muscle tone (if you’re active enough).
• Improved bone density.