Menopausal women may experience a variety of symptoms that can range from debilitating to barely noticeable. For years physicians prescribed estrogen or a combination of estrogen and progesterone as a matter of course for their menopausal patients. Hormone therapy was believed to both alleviate menopausal symptoms and help women avoid bone loss and heart disease. More recently, hormone replacement therapy has been found to have some serious risks that should be considered before embarking on this treatment.
Menopause
The North American Menopause Society explains that menopause takes place when a woman menstruates for the last time. As women near menopause, their ovaries produce less progesterone and estrogen. Many women experience symptoms such as hot flashes, difficulty sleeping, a lack of vaginal lubrication, urinary troubles or irritability during their menopausal years. Medical professionals have been giving women hormone replacement therapy, or HRT, to treat menopausal symptoms since the early 1900s.
The Women's Health Initiative
In the 1990s, the National Institutes of Health started to study the impact of hormone therapy in depth using highly regarded research methodology. These research trials are referred to as the Women's Health Initiative, or the WHI. The first results of the WHI came out in 2002. The WHI studied hormone replacement therapy using a drug named Prempro, a combination of estrogen and progesterone, and hormone replacement therapy with estrogen alone using a drug named Premarin.
Estrogen with Progesterone
The WHI found that women who took Prempro had decreased rates of colorectal cancer, fewer fractured spines and fewer broken hips. The WHI also found that those who took Prempro had increased incidences of breast cancer, stroke, dementia and heart disease. Because of these findings, the WHI instructed the women in the study to discontinue taking Prempro and encouraged other women taking Prempro to reconsider that choice.
Estrogen Alone
Estrogen-only therapy had previously been found to increase a woman's chance of uterine cancer. Because of this finding, estrogen-only therapy was typically prescribed just for women who had had their uterus removed. The WHI began to release results for the Premarin trial in 2004. The women taking Premarin were found to have fewer hip fractures, more strokes and more abnormal mammograms.
Deciding About HRT
The Mayo Clinic, the American Congress of Obstetricians and Gynecologists and the American Medical Association encourage menopausal women with questions about hormone replacement therapy to consult with their doctors. To weigh the possible risks and benefits, a woman and her physician ought to consider a number of factors. The severity of the woman's menopausal symptoms; whether they can be treated by alternate means; her family's medical history; and her personal risk factors for breast cancer, stroke and heart disease should all be taken into account.
References
- MayoClinic.com: Menopause: Hormone replacement therapy and your heart
- MayoClinic.com: Menopause: Hormone therapy: Is it right for you?
- MayoClinic.com: Menopause
- MayoClinic.com: Hot flashes
- The American Congress of Obstetricians and Gynecologists: Frequently Asked Questions About Hormone Therapy
- "American Medical Association Complete Guide to Prevention and Wellness: What You Need to Know about Preventing Illness, Staying Healthy, and Living Longer"; American Medical Association; 2008
