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What are the symptoms of menopause? |
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Why use hormone replacement therapy? |
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What about cancer? |
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What other side effects are there? |
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Who should not have hormone replacement therapy? |
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How do I take hormone replacement therapy? |
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What about natural estrogens? |
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What are the symptoms of menopause?
The absence of estrogen in the body may variably affect a woman. Some
women have no symptoms. Other women have one or more of several
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Hot flushes |
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Vaginal dryness |
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Urinary incontinence |
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Mood swings |
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Depression |
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Decreased libido |
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Skin dryness |
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Arthritis-like symptoms |
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Cognitive dysfunction (memory issues)
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Why use hormone replacement therapy?
Studies have shown that estrogen replacement can delay the effects of aging. It has been shown
to help in the following areas: |
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Central Nervous System (CNS) |
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Estrogen is most effective for hot flashes and other CNS symptoms |
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May also help dementia and Alzheimer's |
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Progesterones can help in decreasing hot flashes as well, but are less
effective, therefore requiring higher doses and potentially more side effects |
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Osteoporosis
Estrogen has shown to be effective in decreasing bone breakdown.
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Estrogen supplements should be coupled with increasing dietary calcium and supplements,
and possibly medications called bisphosphonates. |
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Genital thinness and dryness
Estrogen can decrease these irritative symptoms and decrease the risk of urinary tract infection. |
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Cardiovascular
One mechanism by which estrogens protect the heart is by lowering LDL and increasing HDL
(the "good" cholesterol) This was shown in the PEPI trial
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What about cancer?
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Endometrial hyperplasia and endometrial cancer
Long-term use of unopposed estrogen has been associated with endometrial hyperplasia
(abnormal overgrowth of the endometrium) and endometrial cancer.
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Progesterone treatment coupled with estrogens, however, is protective.
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Women with a uterus should receive a form of progesterone replacement therapy. |
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Breast Cancer
There is an increased incidence of breast cancer in women with long-term exposure to estrogen
from internal sources (women with early menses, late menopause, and obesity).
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Some studies have suggested that estrogen from hormone replacement therapy may increase the
risk of breast cancer, but other studies have not shown any association.
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Most studies show that estrogen neither causes nor protects against breast cancer
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Estrogen may be a weak breast cancer promoter in a group of undefined women, if on
estrogen for more then 10 years
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All women, regardless of whether or not they are taking estrogen, should examine their breasts
monthly, and have regular physicals, including a mammogram every 1-2 years after 40 and yearly after 50.
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Progesterones have also been reported to possibly stimulate breast cancer growth, studies are inconclusive
For women with a previous personal history of breast cancer, estrogen replacement therapy should be
considered cautiously, and with the input from an oncologist.
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What other side effects are there? |
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Blood Clots
Two to four-fold increase in risk of blood clots.
Keep in mind risk is very low to begin with.
The increased risk must be weighed against the benefits. |
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Endometriosis
For women with a history of endometriosis, hormone replacement therapy is not contraindicated.
Higher doses of estrogen may cause recurrence of endometriosis for women with an intact uterus |
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Hypertension
No significant increase in blood pressure. |
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Weight gain
No significant increase in weight |
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Bleeding
Most common side effect of hormone replacement therapy, sometimes caused by polyps or
fibroids, and should be evaluated with ultrasound and hysteroscopy.
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