Hormone replacement therapy (HRT) is a treatment in which hormones are prescribed to treat certain medical conditions. It is most commonly used to treat symptoms of menopause. The hormones used in HRT are synthetic (created in a lab), but they function like natural hormones.
Postmenopausal hormone therapy—often referred to as hormone therapy—is a broad term that describes the use of estrogen, or estrogen-progestin in combination, to replace the hormones no longer produced by the body after menopause. The goal of hormone therapy is to relieve menopausal symptoms. It can also help prevent bone loss.
At one time, hormone therapy was also used for prevention of coronary heart disease and osteoporosis; however, results from large-scale randomized trials by the Women’s Health Initiative (WHI) in 2002 showed that HRT raised the risk of breast cancer, heart attack, blood clots and stroke. The clinical trials were stopped, and women tossed away their hormones.
In 2004, new WHI data showed that women taking estrogen alone were not at increased risk for developing breast cancer or heart attacks, although the risk for blood clots and strokes was unchanged. In recent news, studies on women in their 50s and within 10 years of onset of menopause suggested that estrogen therapy alone may exert a protective effect on women’s hearts.
If you’re starting to feel confused, you’re not alone. Even researchers sometimes struggle with sorting out the seemingly conflicting reports to find answers. What is the best age for women to start HRT? How long should treatment last? Is a combination HRT always better than estrogen alone?
Studies are ongoing, but one thing is clear—physicians today have a better understanding of the risks and benefits associated with HRT and are able to customize the prescription to the patient. Plus, new formulations are available that may minimize risk while helping to alleviate menopausal symptoms.
Types of HRT
There are two types of hormone therapy. The first employs estrogen, a hormone that gradually decreases with age and during menopause. Estrogen replacement has benefits, but it also increases the risk of uterine cancer. Because of this, HRT using estrogen alone is usually reserved for women who have had hysterectomies.
The second type is combination HRT¾this includes estrogen, as well as progestin, a synthetic version of progesterone. It is the progestin that “blocks” the negative effects of estrogen on the uterus.
When is the best time to begin HRT?
The best time to begin HRT depends on why a woman and her doctor have selected it as a treatment option. For some women, hot flashes, sleep disturbances and vaginal dryness are severe and require medical management. For other women, menopausal symptoms are mild and are taken in stride. The best outcomes are generally achieved if HRT is initiated as soon as symptoms begin. Short-term use of HRT (up to 5 years) is not considered dangerous; however, most physicians suggest that HRT be discontinued when it is no longer needed for symptom control.
Osteoporosis and HRT
Hormones, specifically estrogen, play a big role in preserving bone and preventing age-related osteoporosis. As hormone levels decline in menopause, risk for bone loss increases. Studies have shown that HRT reduces the risk of fractures and improves bone mineral density in the hip, arms and spine. To have any significant effect on bone density, HRT should be started within five years of the onset of menopause. Unfortunately, HRT does not have a long-term protective effect, as benefits last only as long as a woman is taking the medication.
Despite strong data from the WHI that HRT reduces fracture risk, physicians generally won’t prescribe it solely to improve bone mineral density, primarily because of the negative outcomes identified in the studies. Bisphosphonates are available as front-line therapy and only those women with osteoporosis unresponsive to other therapies are considered for HRT.
Summary of HRT
Hormone replacement therapy is a viable treatment option for women experiencing troublesome symptoms of menopause such as hot flashes, sleep disturbances and vaginal dryness. In fact, many experts believe the benefits of HRT may outweigh the risks.
Every woman needs to discuss the potential benefits, risks and side effects with her doctor before deciding if HRT is right for her. Age, type of menopause (natural or surgical) and time since menopause all play significant roles in the risks associated with this type of treatment.
Hormone replacement therapy is available in tablets, creams, transdermal (skin) patches and injections. Side effects associated with HRT are generally minimal and short-lived. Women should undergo a checkup that includes blood pressure, breast and pelvic exam, as well as a general physical assessment before starting HRT.
When taken for a short period of time and in the lowest dose that still relieves symptoms, HRT can confer many benefits during menopause.