Hormone replacement therapies are used to minimize the symptoms of menopause. Night sweats, hot flashes, mood swings, insomnia, vaginal dryness and heart palpitations commonly accompany the decline in estrogen that accompanies menopause. The decision whether to use hormone replacement therapy is one best made individually, in consultation with a physician to evaluate the possible risks and benefits. Different types of hormone replacement therapies vary according to the types of hormones used, the dosing schedule and the route of administration.
Cyclic Combination Therapy
Cyclic combination hormone therapy involves taking oral estrogen and progestin interspersed with short breaks from hormone therapy. Doctors often recommend cyclic hormone therapy for women just beginning menopause. The American College of Obstetricians and Gynecologists explains that estrogen therapy is typically taken daily for approximately 25 days. Progestin is added to the daily regimen approximately midway through the treatment cycle. Upon completion of the treatment cycle, a three- to five-day treatment break occurs, which may be accompanied by vaginal bleeding.
Progestin is a synthetic form of the natural hormone progesterone. Progestin prevents an abnormal buildup of uterine lining tissue caused by the administration of estrogen. Progestin dosing for several days followed by withdrawal of the hormone causes sloughing of the uterine lining tissues, much like what occurs naturally with menstruation. To reduce the risk for cancer of the uterine lining, the American Congress of Obstetricians and Gynecologists recommends progestin for all women with a uterus who opt for hormone replacement therapy. Women without a uterus do not require progestin as part of a hormone therapy regimen.
Continuous Combination Therapy
Continuous combination therapy utilizes estrogen and progestin taken daily without breaks. Pills or transdermal skin patches are typically used to administer the hormones. The National Institutes of Health publication "Facts About Menopausal Hormone Therapy," notes that continuous combination therapy is frequently accompanied by irregular vaginal bleeding. For most women, bleeding stops within the first year of treatment.
Estrogen Only Therapy
Women who have had the uterus removed may opt for estrogen only hormone therapy. Systemic administration is used to relieve the symptoms of menopause and to help prevent bone loss associated with low estrogen. Nasal sprays, pills, vaginal rings and skin patches are available. The American Congress of Obstetricians and Gynecologists advises that for women with predominantly vaginal symptoms such as dryness, itching, burning, painful intercourse or frequent urinary tract infections, topical estrogen gels and creams can provide local symptom relief with little absorption of the hormone into the circulation. Because topical estrogens do not enter the circulation in appreciable amounts, hot flashes, mood swings and other systemic manifestations of low circulating estrogen are unrelieved by this form of hormone therapy.
