When a woman enters menopause, her levels of estrogen drop and troublesome symptoms begin. Hormone replacement therapy (HRT) can suppress symptoms by boosting the estrogen levels while also providing protection against heart disease and osteoporosis (bone weakening). There are two types of hormone treatments: hormone replacement therapy (HRT) and estrogen replacement therapy (ERT). HRT is the administration of estrogen and progesterone; ERT is the administration of estrogen alone. Only women who have had a hysterectomy (removal of the uterus) can take estrogen alone, since taking this "unopposed" estrogen can cause uterine cancer. The combination of progesterone and estrogen in HRT eliminates the risk of uterine cancer.
Experts once disagreed on whether HRT increases or decreases the risk of developing breast cancer. A Harvard study concluded that short-term use of hormones carried little risk, while HRT used for more than five years among women 55 and over seemed to increase the risk of breast cancer. In 2002, the Women's Health Initiative (WHI) quieted much of the disagreement, particularly concerning long-term use of HRT. Use of combined estrogen and progestin therapy was stopped in the large trial when invasive breast cancer risk hit a threshold among participants. The risks of HRT were determined to outweigh the benefits. Use of combined HRT also increased risk of coronary heart disease, stroke and even dementia.
Following the WHI, many physicians have cautioned women to discuss the benefits and risks of HRT with their doctors on an individual basis. In some cases, the benefits of short-term use of HRT still may outweigh the risks.
Women remain poor candidates for hormone replacement therapy if they:
Women would make a good candidate for HRT if they:
need to prevent osteoporosis
have had their ovaries removed
have significant symptoms
need short-term symptom relief
Aside from the findings of the WHI concerning risks of HRT, side effects of treatment include bloating, breakthrough bleeding, headaches, vaginal discharge, fluid retention, swollen breasts, or nausea. A 2001 study reported that HRT might worsen asthma in post-menopausal women who had asthma prior to menopause. Some side effects can be lessened or prevented by changing the HRT regimen.
The decision should be made by a woman and her doctor after taking into consideration her medical history and situation. Women who choose to take hormones should have an annual mammogram, breast exam, and pelvic exam and should report any unusual vaginal bleeding or spotting (a sign of possible uterine cancer).
Belinda Rowland, Teresa G. Odle, The Gale Group Inc., Gale, Detroit,