Hormone Replacement Therapy 

Controversy over hormone replacement therapy:

Estrogen replacement therapy (ERT), the use of estrogen to supplement that which is no longer being produced by the body, and hormone replacement therapy (HRT), in which estrogen and progestin (a synthetic progesterone) are used in combination, have been the subject of great controversy over the years. And, because there is a risk versus benefit ratio in the supplementation or replacement of these hormones, the debate still continues. In addition, the high doses of estrogen therapy given when ERT began being used 50 years ago, gave hormone replacement therapy a bad reputation.

Today, the debate still continues and the choice to continue HRT if a woman has already started or to start HRT as a woman enters perimenopause and menopause is more controversial than ever. During the summer of 2002, the National Heart, Lung, and Blood Institute (NHLBI) halted a major clinical trial of the risks and benefits of combined estrogen and progestin in healthy menopausal women, due to findings of an increased risk of invasive breast cancer among its participants. The trial also found increases in risk of coronary heart disease, stroke, and pulmonary embolism. The study was scheduled to run until 2005.

The National Women’s Health Information Center (NWHIC), Office of Women’s Health, US Department of Health and Human Services, in response, offers the following suggestions for women who are currently taking hormone replacement therapy:

• The most important thing a woman can do in deciding to continue hormone replacement therapy is discuss the current research with her physician and healthcare team.
  
  
• Women need to be aware that taking a combined progesterone and estrogen regimen is no longer recommended to prevent heart disease. A woman should discuss other alternatives of protecting the heart with her physician.
  
  
• Women should discuss with their physicians the value of taking combined progesterone and estrogen replacement therapy to prevent osteoporosis. There may be alternative treatments based on a woman's unique health profile.
  
  
• Women need to understand that this latest research does not affect women who have had their uterus removed by hysterectomy, who are usually prescribed estrogen alone. Those findings are not yet available.

Always consult your physician for more information.

What is hormone replacement therapy?

When a woman reaches menopause, the production of estrogen and progesterone decreases significantly. HRT is a means of replacing these hormones that are no longer being produced by the body. This type of therapy is usually commenced at menopause or may be started while a woman is in the perimenopausal phase, nearing menopause. In years past, many physicians would recommend that women take HRT for the rest of their lives to realize the maximum benefits; however, in light of the most current research, HRT is not advised for all women. It is crucial that the decision to take HRT be made on an individual based after a complete review of a woman’s medical history.

How is hormone therapy replacement administered?

According to the American Medical Association, HRT can be administered in a variety of methods, including the following:

For women who are appropriate candidates for HRT, this type of therapy can often be customized to provide the most benefits with the least side effects. It is important for women to talk with their physician about any discomfort or menstrual symptoms experienced with HRT, as treatment approaches and dosages can be adjusted.