By Neil Correia, MD ~
If you’re approaching or have begun menopause, you may be wondering about whether you should consider hormone replacement therapy (HRT). Here’s some information about the benefits and risks of hormone replacement therapy.
About Menopause
Most women will begin menopause sometime between the ages of 45 and 54. If you go for 12 months without having a menstrual period, then you are considered to be in menopause. During this time, you should not be bleeding or even spotting. If you have both ovaries removed, you will go into menopause at the time of the surgery, regardless of your age.
Menopause, both natural and surgical, means your body will have to adjust to having lower estrogen levels. Some women won’t have many symptoms while others will have more severe symptoms. The main symptoms related to menopause are hot flashes (a feeling of heat spreading through your body), night sweats and sleep disturbances. You also may experience vaginal dryness or urinary tract infections.
Benefits and Risks
HRT has certain benefits for women during menopause. Estrogen helps relieve symptoms such as hot flashes, night sweats, sleep disturbances and vaginal dryness related to the body producing less estrogen. Some studies indicate that HRT helps prevent bone loss that can lead to osteoporosis; however, other research studies haven’t confirmed this. Side effects of HRT may include bleeding, bloating, breast tenderness or enlargement, headaches, mood swings and nausea.
There have been several major studies concerning the effects of HRT on heart disease. Two clinical trials, the Postmenopausal Estrogen/Progestin Interventions Trial (PEPI) and the Heart and Estrogen-Progestin Replacement Study (HERS), looked at how estrogen and estrogen plus progestin affected a woman’s risk of heart disease. The PEPI study found that women on HRT saw a reduction in LDL (bad) cholesterol and an increase in HDL (good). The HERS study tried to see if HRT prevented a second heart attack, but no reduction was found during the four-year study. The HERS study did find an increased risk of blood clots among women taking HRT.
In 1991, the National Institutes of Health launched the Women’s Health Initiative (WHI), which was one of the largest studies of its kind. More than 161,000 women participated in the study, which looked at two common HRT drugs, Prempro and Premarin to see if these drugs had health benefits. The studies were to continue until 2005 but were stopped because of the early findings. The study found that women taking estrogen along with progestin had an increased risk of developing breast cancer (out of 1,000 women, an additional eight cases of breast cancer could be predicted). The combination therapy also increased a woman’s risk for heart attack, stroke and blood clots. The risk of heart attack was high during the first year of treatment and continued for several years afterwards. On the other hand, combination therapy seemed to decrease the risk of hip and other fractures and colon cancer.
The estrogen-only study indicated an increased risk of stroke and blood clots. The study did not find a statistically significant increased risk for heart disease or colorectal cancer, and the findings on breast cancer were uncertain.
A study in the April 4, 2007 issue of the Journal of the American Medical Association reports that when you start hormone replacement therapy may have an effect on your risk of heart disease. Women who start HRT closer to menopause may have less risk of heart disease compared to those who begin treatment further from menopause. The study authors say that hormones may be “a reasonable option for the sort-term treatment of menopausal symptoms.”
Should I or Shouldn’t I
Many women look at all of these studies and throw up their hands in total confusion. Only you and your doctor can determine whether HRT is right for you. When you talk to your doctor, you will want to have information that will help you make an informed decision. This information should include:
- Your family history of breast cancer (mother, daughters, sisters, grandmother)
- Any family history of colorectal cancer
- Your family history of heart disease and stroke (include who had what type of cardiovascular disease and the approximate age it began)
- Your personal health history including whether you smoke (or did smoke), other medications you may be taking, other diseases and conditions like diabetes, high blood pressure, etc.
You also should talk to your doctor about what symptoms you are having and how those affect your life. There may be other options available that can treat just the symptoms.
If you would like to discuss these issues, please feel free to contact Dr. Correia, at 805-296-7816
Dr. Neil Correia,MD is with FCPP Women’s Health, Templeton. He is residency trained in the specialty of obstetrics and gynecology and is dedicated to providing comprehensive obstetric and gynecological care to his patients. He is a Junior Fellow with the American Congress of Obstetricians and Gynecologists. He treats conditions such as high-risk pregnancy, complicated labor and delivery, Cesarean sections, hot flashes, menopause and ovarian cancer.
