DESCRIPTION
Estrogen replacement therapy (ERT) refers to taking regular doses of estrogen to
replace natural estrogen that decreases with menopause. Menopause means having
no menstrual periods for at least six months to one year. Menopause is part of a
natural aging process and not a disease. For many women menopause is an easy
transition; however, some women have a variety of symptoms that are related to
lack of estrogen. If you are one of these women, you may benefit from some type
of hormonal replacement.
Estrogen is one of the two major female hormones. The other is progesterone. For
women who still have their uterus, progesterone is added to the estrogen to
reduce the risk of cancer of the uterus. Treatment with both estrogen and
progesterone is called hormone replacement therapy (HRT) or combination therapy.
Estrogen and progesterone are available as tablets, creams, skin patches,
vaginal suppositories and shots.
BENEFITS OF ERT OR HRT
Estrogen helps to relieve menopausal symptoms. ERT and HRT can reduce hot
flashes, sweating, sleep disturbances and vaginal irritation. Estrogen is used
for prevention and treatment of osteoporosis. Osteoporosis is a skeletal
disorder that reduces the density of bone, thus making you prone to fractures.
Bone loss begins around age 35 and accelerates rapidly at menopause. You are at
greatest risk of the disorder if you are Caucasian, thin and fair skinned, if
you smoke, or if your mother had osteoporosis. Calcium supplements can also help
to cut down on bone loss.
Estrogen also helps to reduce the risk of heart disease. The risk of heart
disease dramatically increases for a woman who has gone through menopause. If
you have high blood pressure, diabetes, high cholesterol or a family history of
heart disease, estrogen therapy may reduce your risk for heart disease.
RISKS OF ERT AND HRT
The long-term effects of ERT and HRT are not yet fully known. Most studies have
focused on the use of estrogen alone, and different studies have produced
conflicting results. Therefore, it is important for you to talk with your health
care provider about the potential advantages and risks of ERT or HRT.
Constant exposure of the lining of the uterus to estrogen without progesterone
is associated with a higher risk of uterine cancer. To lower the risk, your
physician may prescribe lower doses of estrogen combined with progesterone (HRT).
Studies are still being done to determine the risk of breast cancer with ERT and
HRT. It is best to discuss this possible risk with your physician, especially if
you have a family history of breast cancer.
SIDE EFFECTS OF ERT AND HRT
- Uterine bleeding and vaginal discharge
- Bloating, fluid retention and weight gain
- Breast tenderness and enlargement
- Nausea
- Headache
- Mood swings
- Gallstones
SIDE EFFECTS OF HRT
Vaginal bleeding may occur with HRT. When you stop HRT, or during the days in
the cycle when you are not taking hormones, you will usually have some bleeding.
The bleeding typically lasts two or three days and is not usually accompanied by
cramps or bloating. If your physician has prescribed a daily estrogen and
progesterone regimen, without cycles, you will experience little or no bleeding.
PRECAUTIONS
If you have any of the following conditions or diseases, you should not take ERT
or HRT:
- Unexplained vaginal bleeding
- Liver disease
- History of blood clots or strokes
- Endometrial or breast cancer
If you have any of the following diseases or conditions, you may
want to avoid ERT or HRT:
- Uterine fibroids
- Endometriosis
- Fibrocystic breast disease
- Migraine headaches
- Gallbladder disease
- Family history of breast cancer
- Uncontrolled high blood pressure
- You smoke
GENERAL CONSIDERATIONS
If you are considering ERT or HRT:
- Have your doctor check your HDL and LDL cholesterol levels.
- Get a mammogram before you begin ERT or HRT to check for breast cancer
- Stop smoking
If you are already taking ERT or HRT:
- Ask your doctor about any special precautions or side effects to consider
- If you are taking HRT, tell your doctor if bleeding occurs at any time
other than the days when you do not take the hormones
- If you are taking ERT, and your uterus has not been removed be sure to
have a yearly well-woman exam
- Have you cholesterol checked periodically
- Check your blood pressure regularly
ALTERNATIVES TO ERT OR HRT
Although HRT is the most common therapy for menopause, there is another option.
The main alternative is EvistaŽ (raloxifene), a new drug that imitates some of
the beneficial effects of estrogen, without the risks of breast or uterine
cancer. Evista has similar beneficial effect on bone density as compared to ERT
or HRT. Evista carries the same risk of blood clots as HRT for those patients
who are at risk. Evista may actually produce hot flashes in some women.
NATURAL HORMONE SUPPLEMENTS
Natural hormones (phytoestrogens) are those chemicals that are derived from yam
or soybean plants. Soy in particular contains plant-produced chemicals known as
isoflavones that exert weak estrogen effect in the body. These isoflavones do
not act exactly like the estrogens produced by the body or those used in HRT.
Soy products are known to cause stomach upset and gas. Natural hormone
supplements are popular; however, few have proven sustained benefit for control
of menopausal symptoms. Although some data are available for soy-based products,
there are no convincing data regarding heart disease or osteoporosis.
