Hormone Therapy for Women

Hormone Therapy for Women

Many menopausal women face the choice of taking hormone replacement therapy for their symptoms of hot flashes, night sweats and vaginal dryness.  But who should take hormone replacement, and who should not?  In 2002, the Women’s Health Initiative (WHI) came out with new data that evaluated potential risks of hormone replacement in menopausal women.  Patients and physicians can use this information to evaluate the risks and benefits of therapy for each woman.

During menopause, levels of estrogen and progesterone decrease, which causes unpleasant symptoms like hot flashes, vaginal dryness and mood swings.  It can also cause weakening of the bones, which can lead to osteoporosis. 

Benefits of Hormone Therapy

Estrogen (or combinations of estrogen & progesterone) is effective at alleviating these troublesome symptoms.  While its long-term use is no longer standard, short-term use may confer protection against osteoporosis and colorectal cancer.  If taken early in the post-menopausal years, it may also decrease the risk of heart disease. 

Risks of Hormone Therapy

The WHI study found that women taking Prempro (a combination estrogen-progestin) had a slightly increased risk of heart disease, breast cancer, stroke and blood clots.  For women taking Premarin (estrogen only), the study found no increased risk of heart disease or breast cancer.  (Women without a uterus can take estrogen-only pills, while women with a uterus require progesterone with the estrogen to prevent uterine cancer.)

Indications for Therapy

Estrogen is indicated for women with moderate to severe hot flashes or other menopausal symptoms, to be taken in the lowest effective dose for as short a time as possible.  Low doses, topical estrogens and estrogen-only pills can be very safe, and they can be a good option for improving perimenopausal quality of life. 

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