Hormone Replacement Therapy

A woman’s ovaries are factories for hormone production.  Although they produce many different types of hormones, the two main hormones are estrogen and progesterone.  When the ovaries are surgically removed or stop producing hormones as a normal aging process, a woman can experience symptoms.  Hormone replacement medication is available to treat these symptoms.  Due to the numerous types of hormones, different routes of administration (pills, gels, patches, and creams) and reported risks, the decision to take hormone replacement can be confusing.  A woman’s decision to take hormone replacement must be individualized to address both the benefits and the risks.

The symptoms of menopause (hot flashes, vaginal dryness, and bone density loss) can be adequately treated with estrogen.   Progesterone does not treat any of these symptoms, but must be used with estrogen to prevent cancer of the uterus. Anyone who has had a hysterectomy (removal of the uterus) can get by with estrogen only; anyone still having a uterus will need estrogen and progesterone.  A study in 2001 shows that progesterone will increase the risk of breast cancer.  Even estrogen by itself can increase certain risk, but not the risk of breast cancer.

If you still have a uterus:  If you decide to take hormones, take an estrogen and a progesterone.  This decreases the chance of developing uterine cancer.  These hormones are available together in one pill, or can be taken as two separate pills.  Creams, gels, and patches are available for estrogen replacement. Progesterone creams are available, but the amount necessary to protect from cancer of the uterus has not been studied. 

If you take both estrogen and progesterone, you have an increased risk of developing cancer of the breast, heart attacks, blood clots and strokes.  If 10,000 women are given a prescription for estrogen and progesterone, 8 will develop breast cancer due to the prescription.  Obviously more will get breast cancer, but 8 will get breast cancer due to taking the medication.  The risks of having a heart attack, stroke, or blood clot are equal to or less than the breast cancer risk. 

If vaginal dryness is the only symptom, newer studies have shown that an estrogen vaginal cream used without progesterone does not increase the risk of uterine cancer.

If your uterus has been removed:  Estrogen may be used without progesterone to treat the symptoms of menopause.  Estrogen alone (without progesterone) does not increase the risk of breast cancer.  Estrogen used alone does increase the risk of stroke and blood clots.  If 10,000 women are given a prescription for estrogen, 8 will have a stroke due to the prescription.  More than 8 will have a stroke, but 8 will be due to the medication.

Bioidentical hormones have not been approved by the FDA for the treatment of menopause.  They cannot be shown to be safer or more effective.

In making a decision about hormone replacement therapy, remember:

• If your symptoms are mild and tolerable, don’t take the risks associated with hormones.
• If you take hormones, use the “smallest dose” for the “shortest period of time”, in order to treat your symptoms satisfactorily.
• Only you can decide if the benefit is greater than the risk.