Hormone Replacement Therapy
Definition:
Hormone replacement therapy is a treatment to manage the symptoms of menopause. Menopause is when a woman stops having menstrual periods. This is the end of the reproductive time for women. In the years leading up to menopause, women enter a stage called perimenopause where the hormone, estrogen, can fluctuate. This change in estrogen can cause hot flashes, sleep changes, vaginal changes, and osteoporosis/bone changes in patients. A common sign of perimenopause is a change in a woman’s menstrual cycle. Periods may become shorter or lighter or women may begin to skip periods altogether.
In order to help lessen these symptoms, hormone replacement therapy can be started. Hormone therapy consists of taking estrogen and progestin (if patient still has uterus intact), called “combined hormone therapy”. Using progestin helps lower the risk of uterine cancer if estrogen is used by itself. If the patient does not have a uterus, then they can take estrogen by itself.1
As with any treatment, hormone replacement therapy does come with its own set of risks. It has been shown that it can increase the risk of breast cancer, heart disease, and stroke. It is important to talk with a provider about the risk and benefits in your particular situation. Women who have had or currently have breast cancer, ovarian cancer, endometrial cancer, blood clots to the legs or lungs, or stroke should not normally take hormone replacement therapy.2 Hormone replacement therapy should be used for the shortest amount of time possible with the lowest effective dose and should be re-evaluated by your provider every six months.3
Types:
There are two types of hormone replacement therapy: systemic and local. The main difference is where how these two therapies act in the body.
Systemic Therapy:
Hormones are injected into your body into your bloodstream and go to the organs and tissues where they are needed. The forms of systemic therapy are: pills, skin patches, gels and sprays that are put on the skin. If the patient is only taking estrogen, it may be taken every day or every few days, depending on how it is given. If doing combined hormone therapy, there is cyclic therapy or continuous therapy as well.
Local Therapy:
Local therapy is for women who experience only vaginal dryness. If this is the case, a patient can be prescribed a vaginal ring, tablet or cream that release estrogen into the vaginal tissue. The estrogen helps to increase the thickness to the vaginal wall as well as increase the elasticity of the vagina in addition to relieving dryness and irritation.
Bioidentical Hormones:
There is another type of hormone replacement therapy called bioidentical hormones. These come from plant sources. They are available in commercially products as well as specially compounded formulas from a pharmacist. They have the same risks as FDA-approved hormone therapies, but may have additional risks because of the way that they are made. There is no scientific evidence that they are safer or more effective than the standard hormones used in hormone replacement therapy.1
History:
The use of estrogen in the United States in hormone replacement therapy has had an interesting history. The annual number of prescriptions for estrogen doubled between 1960 and 1975. This was due to a popular book claiming that an “estrogen deficiency” caused many diseases and that estrogen replacement would make you feel younger and happier. Estrogen use fell in 1975 after the results of two, small clinical trials found that estrogen hormone replacement therapy greatly increased one’s risk for endometrial cancer. However, within a decade prescriptions for hormone replacement therapy rose again due to studies that showed by adding progestin to the treatment, the cancer risk was lowered significantly. In 1992, Premarin was the number one prescribed drug in the US. However, in 2002 estrogen prescriptions fell again after the release of unexpected results from a Women’s Health Initiative clinical trial that showed Premarin with progestin was not better than a placebo for survival or for prevention of chronic disease in postmenopausal women.4
Today’s Situation/Diseases that it treats:
Hormone replacement is no longer advised for disease prevention, such as heart disease or memory loss. However, it has been very successful in the treatment of perimenopausal and menopausal symptoms. Despite the health risks it is still the most effective treatment for menopausal symptoms. The benefits of hormone therapy may outweigh the risks if you are experiencing hot flashes, have lost bone mass and/or your periods stopped before the age of 40. Your risks depend on your particular age, when your menopause started and how long you have been going through menopause before starting hormone replacement therapy.5
Hormone replacement therapy is a treatment to manage the symptoms of menopause. Menopause is when a woman stops having menstrual periods. This is the end of the reproductive time for women. In the years leading up to menopause, women enter a stage called perimenopause where the hormone, estrogen, can fluctuate. This change in estrogen can cause hot flashes, sleep changes, vaginal changes, and osteoporosis/bone changes in patients. A common sign of perimenopause is a change in a woman’s menstrual cycle. Periods may become shorter or lighter or women may begin to skip periods altogether.
In order to help lessen these symptoms, hormone replacement therapy can be started. Hormone therapy consists of taking estrogen and progestin (if patient still has uterus intact), called “combined hormone therapy”. Using progestin helps lower the risk of uterine cancer if estrogen is used by itself. If the patient does not have a uterus, then they can take estrogen by itself.1
As with any treatment, hormone replacement therapy does come with its own set of risks. It has been shown that it can increase the risk of breast cancer, heart disease, and stroke. It is important to talk with a provider about the risk and benefits in your particular situation. Women who have had or currently have breast cancer, ovarian cancer, endometrial cancer, blood clots to the legs or lungs, or stroke should not normally take hormone replacement therapy.2 Hormone replacement therapy should be used for the shortest amount of time possible with the lowest effective dose and should be re-evaluated by your provider every six months.3
Types:
There are two types of hormone replacement therapy: systemic and local. The main difference is where how these two therapies act in the body.
Systemic Therapy:
Hormones are injected into your body into your bloodstream and go to the organs and tissues where they are needed. The forms of systemic therapy are: pills, skin patches, gels and sprays that are put on the skin. If the patient is only taking estrogen, it may be taken every day or every few days, depending on how it is given. If doing combined hormone therapy, there is cyclic therapy or continuous therapy as well.
Local Therapy:
Local therapy is for women who experience only vaginal dryness. If this is the case, a patient can be prescribed a vaginal ring, tablet or cream that release estrogen into the vaginal tissue. The estrogen helps to increase the thickness to the vaginal wall as well as increase the elasticity of the vagina in addition to relieving dryness and irritation.
Bioidentical Hormones:
There is another type of hormone replacement therapy called bioidentical hormones. These come from plant sources. They are available in commercially products as well as specially compounded formulas from a pharmacist. They have the same risks as FDA-approved hormone therapies, but may have additional risks because of the way that they are made. There is no scientific evidence that they are safer or more effective than the standard hormones used in hormone replacement therapy.1
History:
The use of estrogen in the United States in hormone replacement therapy has had an interesting history. The annual number of prescriptions for estrogen doubled between 1960 and 1975. This was due to a popular book claiming that an “estrogen deficiency” caused many diseases and that estrogen replacement would make you feel younger and happier. Estrogen use fell in 1975 after the results of two, small clinical trials found that estrogen hormone replacement therapy greatly increased one’s risk for endometrial cancer. However, within a decade prescriptions for hormone replacement therapy rose again due to studies that showed by adding progestin to the treatment, the cancer risk was lowered significantly. In 1992, Premarin was the number one prescribed drug in the US. However, in 2002 estrogen prescriptions fell again after the release of unexpected results from a Women’s Health Initiative clinical trial that showed Premarin with progestin was not better than a placebo for survival or for prevention of chronic disease in postmenopausal women.4
Today’s Situation/Diseases that it treats:
Hormone replacement is no longer advised for disease prevention, such as heart disease or memory loss. However, it has been very successful in the treatment of perimenopausal and menopausal symptoms. Despite the health risks it is still the most effective treatment for menopausal symptoms. The benefits of hormone therapy may outweigh the risks if you are experiencing hot flashes, have lost bone mass and/or your periods stopped before the age of 40. Your risks depend on your particular age, when your menopause started and how long you have been going through menopause before starting hormone replacement therapy.5
- American College of Obstetricians and Gynecologists. 2015. Patient Education Fact Sheet: Hormone Therapy. Accessed on July 7, 2016 http://www.acog.org/~/media/For%20Patients/pfs003.pdf
- The Mayo Clinic. 2015. Menopause. Accessed on July 7, 2016 http://www.mayoclinic.org/diseases-conditions/menopause/in-depth/hormone-therapy/art-20046372?p=1
- National Institutes of Health. 2014. Hormone replacement therapy. Accessed on July 7, 2016 at https://www.nlm.nih.gov/medlineplus/hormonereplacementtherapy.html
- Barrett-Conner, E. (2007). The Estrogen Elixir: A History of Hormone Replacement Therapy in America. New England Journal of Medicine, 357, 1670-1671.
- The Mayo Clinic. 2015. Hormone Therapy: Is it right for you? Accessed on July 7, 2016 http://www.mayoclinic.org/diseases-conditions/menopause/in-depth/hormone-therapy/art-20046372