Hormone Replacement Therapy: Where are We Now?

Much has been written about hormone therapy in the recent past, especially about studies suggesting that postmenopausal hormone replacement therapy may increase health risks. Although it was believed from previous studies that hormone therapy was protective against heart disease, strokes and other medical problems, recent studies have indicated otherwise and have caused understandable concern among those patients using it.

At the present time, only two benefits are securely attributed to hormone replacement therapy – relief from menopausal symptoms and bone density preservation. While no other medication, supplement or practice has been shown to be as effective as estrogen for treating symptoms, we now have very powerful medications to prevent and treat osteoporosis. In the end, estrogen therapy should probably be reserved for short term therapy of severe perimenopausal symptoms, and then at the lowest dose that gives adequate relief.

If you and your doctor decide that hormone replacement is for you, there are now a number of options. It should be remembered, however, that whenever any estrogen is given to a woman with a uterus for a significant amount of time, a progesterone-type medication must also be given, to avoid increasing the chance of cancer of the uterus.

Estrogen may be given as a pill, by way of a patch, as a gel applied to the skin, as a vaginal cream, or in the form of a soft plastic vaginal ring that stays in place for up to a month. While a pill may be the most convenient way to take hormones, variations in absorption from the intestine, and in how the hormones are broken down by an individual’s liver may make one of the other delivery methods more suitable for many women. Much has been written about hormone therapy in the recent past, especially about studies suggesting that postmenopausal hormone replacement therapy may increase health risks. Although it was believed from previous studies that hormone therapy was protective against heart disease, strokes and other medical problems, recent studies have indicated otherwise, and have caused understandable concern among those patients using it.

The dose of estrogen prescribed should be tailored to the patient’s symptoms, aiming for the lowest effective dose. Occasionally, blood levels may be checked when there is a question of continuing symptoms despite what should be adequate medication. Realizing that almost all women experience a natural gradual tapering off of menopausal symptoms, your doctor will try decreasing your dose after a suitable period of time. Eventually, you should be able to do well without hormone therapy. Whenever a dose decrease is contemplated, however, realize that symptoms may increase for a time, and that this can be decreased by a gradual “weaning” to the new dose.

Hormone replacement therapy is certainly not for everyone, but may be helpful for some women having severe menopausal transition symptoms. Please do not hesitate to ask questions of your health care provider on this complex subject.

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