Hormone Replacement Therapy

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What is HRT?

Hormone Replacement Therapy (known as HRT for short) is a treatment regimen where estrogen and progesterone are given to women in their menopause. The female body normally produces the hormones estrogen and progesterone, both of which drop off when menopause sets in. HRT is then instituted to replace these "lost" hormones to minimize menopausal symptoms and at the same time reduce some health risks.

When does menopause start?

Menopause (physiologic cessation of menstrual periods) usually starts when the woman reaches the age of 50 or 51. Some experience it a little earlier and others a little later. Cardiovascular disease, stroke and osteoporosis become more prevalent among menopausal women.

What are the symptoms of menopause?

Symptoms and onset may vary somewhat in different women, but in general the following are common: hot flushes and sweating, fatigue, irritability, headache, nervousness, anxiety, depression, inability to concentrate, insomnia, memory loss, dizziness, rapid heart rate, constipation, weight gain, vaginal dryness, dyspareunia (painful sex), decreased libido, urinary frequency, etc.

What benefits does HRT confer?

The American Academy of Family Practice reports "women who take HRT after menopause live longer, because hormone replacement reduces risk of health problems such as heart disease, stroke and osteoporosis," besides alleviating the symptoms of menopause.

How does HRT protect women against heart disease?

The estrogen in HRT increases the HDL (High Density Lipoprotein, the good cholesterol), and decreases the LDL (Low Density Lipoprotein, or bad cholesterol) and the Total Cholesterol. It thins the blood to prevent blood clots and also helps prevent constriction (spasm) of arteries. HRT appears to cut the risk of heart attack by half. Those women with a strong family history of heart disease may benefit most from HRT.

How does HRT protect women against osteoporosis?

Osteoporosis is a condition that makes bones weak and fragile, more likely to fracture (break). Estrogen helps the woman absorb and retain calcium better, keeping the bones stronger. This hormone decreases the risk of hip fractures by half and spine fractures by 90%, and may also help shield women against Alzheimer's disease and colon cancer.

What are the dangers of HRT?

It is believed that women on HRT may be at a higher risk of developing breast cancer. The progestin included in the HRT is aimed at reducing the risk of cancer of the uterus, which was higher among women who were taking only estrogen in the earlier version of HRT. Today, HRT includes both estrogen and progestin for those women with their uterus. Those who had hysterectomy (removal of uterus) obviously need not worry about cancer of the uterus and may take estrogen alone. Those on HRT are advised to have a mammogram (X-ray of the breasts) every year to help watch any changes in the breasts.

What other risks are there with HRT?

HRT may also increase the risk of gallstones, liver problems and stroke. Women with a history of breast or uterine cancer, unexplained uterine bleeding, liver disease, recurrent thrombophlebitis (blood clots in the pelvis or legs), or a stroke are not good candidates for hormone replacement therapy.

What are the side effects of HRT?

Women on HRT may develop weight gain, sense of bloating, breast tenderness, vaginal discharge, headaches, mood swings, nausea and vomiting. Some women may have vaginal bleeding a few days each month. The gynecologist or family practitioner can adjust the dose of estrogen to prevent this, if bleeding becomes bothersome.

Is there another option?

Besides HRT, the other choice is using medications to reduce symptoms of menopause, such as taking alendronate (Fosamax) to reduce osteoporosis, creams for vaginal dryness, and a synthetic estrogen called raloxifene (Evista), which appears to help minimize osteoporosis and heart disease without increasing the risk of breast or uterine cancer. But the prudent thing to do is to discuss your particular situation in detail with your physician before embarking on any therapy, because she/he can evaluate your personal condition, weigh the advantages and disadvantages, benefits and risks, and make the recommendation as to which is best for you.

What are we actually weighing here?

Simplistically put, the question is: Does the benefit of HRT (reduction in the risk of heart disease and osteoporosis, hot flushes, night sweats, mood swings, etc.) outweigh the risk of HRT (increased risk of breast cancer, uterine cancer, plus the side effects of the therapy)?

Is there a consensus on HRT?

No, not a total consensus, even in the medical community here or abroad. Obstetrician/Gynecologists vary somewhat in their approach and recommendation as far as hormone replacement therapy is concerned, depending on the patient's particular situation. The variation is also obvious among menopausal women physicians themselves, some of whom take HRT, and the others who do not. However, it is wise to be guided by your trusted physician before making your final decision about HRT.

Once initiated, can HRT be stopped?

Yes, but not without discussing it first with your physician. If for some reason you personally feel hormone replacement therapy is not for you, after you have started taking it, it is essential that you inform your physician of your intention and let him/her advise you accordingly.

How much does the HRT cost?

Each calendar pack of Estradiol valerate and cyproterone acetate (brand name:Climen, estrogen/progestogen combination), for instance, comes with a 21-day supply for one month therapy, costing about P400. Raloxifene, taken once a day, on the other hand, costs about P70 per tablet, or roughly P2100 for a month's supply.

Can the other option be tried first before HRT?

Yes, of course. But, again, before electing to initiate or change any medical regimen, it is most prudent and safest to consult your physician first. He/she can tailor the prescription to your individual needs, after thoroughly discussing with you the pros and cons of each type of replacement therapy. It would be a dangerous mistake to start, or change, any treatment on your own without expert medical consultation and supervision, especially with hormone replacement therapy.

©2003Raoul R. Diez, M.A.O.D.