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Hormone Replacement Therapy in Women: A Look at the Options
Amy Scholten, MPH
Hormone replacement therapy (HRT) is sometimes used on a short-term basis to relieve unpleasant menopausal symptoms, such as hot flashes, vaginal dryness, and irritability. On a long-term basis, some women have used HRT based on the idea that it would reduce the risk of
heart disease. However, results of studies on estrogen replacement therapy (ERT) and estrogen plus progestin suggest that the risks of long-term HRT may outweigh the benefits for many women.
HRT can include the hormones estrogen alone, or the combination of estrogen and progesterone. If you're considering HRT for the first time, or want to talk to your doctor about changing the regimen you're presently on, here's a rundown of options.
Estrogen Only (ERT)
Therapies containing just estrogen are commonly referred to as estrogen replacement therapy, or ERT. Because of the increased risk of
(lining of the uterus), long-term ERT is usually only offered to women who have had uterus removal through
ERT can be administered in a variety of ways, including oral medications, patches, creams, and gels.
delivers estrogen so that it circulates throughout the body, whereas
delivers estrogen to a particular area of the body, such as the vagina to treat vaginal dryness or vaginal atrophy.
Potential Side Effects of ERT
Uterine bleeding (if uterus is present)
Stomach cramps or abdominal bloating
Swelling of hands, feet, or lower legs due to retaining fluid
Endometrial cancer (if progesterone isn't taken with ERT)
Gallbladder problems, including
(for orally administered ERT)
Estrogen Plus Progesterone (HRT)
Hormone replacement therapy (HRT) is treatment that combines ERT (estrogen only) with a form of the hormone progesterone. This may consist of natural progesterone or a synthetic progesterone, called progestin. Both forms are also called progestogens.
There are several HRT schedules and methods of delivery available, including:
—This treatment provides estrogen for 25 days each month, adding progesterone on the last 10-14 days out of 25, followed by 3-6 days of no therapy. This way, both hormones are "cycled." Cyclic HRT may cause uterine bleeding (a menstrual period) when the progesterone cycle ends. Hot flashes are also more likely to return on the days when no hormones are taken.
—This treatment provides estrogen every day, with progesterone added 10–14 days of each month. Like cyclic HRT, the main side effect is uterine bleeding (in the form of a period).
—This treatment provides both estrogen and progesterone every day. The daily dose of progesterone is much lower than the daily dose in cyclic therapy, which may result in a lower total dose over the course of the month. Breakthrough uterine bleeding occurs in some women on this schedule, but usually stops within the first year of therapy.
—This treatment provides estrogen every day, with progesterone added intermittently in "on-off" cycles. The cumulative monthly dose of progestogen is about half of that of a continuous-combined pattern. .
Potential Risks of HRT
Potential side effects and risks of HRT are basically the same as those listed for ERT. Long-term HRT may slightly, but significantly, increase the risk of
strokes, blood clots, heart attacks, and
breast cancer, gallstones, and gallbladder disease. Adding progesterone, however, eliminates the increased risk of endometrial cancer caused by estrogen alone. This applies to women who have not had their uterus removed.
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