Hormone replacement therapy is a viable option for some women.  As with any other therapy, there are pluses and minuses.  There is controversy around HRT.  All those TV reports are not about you.  You really need to talk with your doctor about your specific risks and benefits. 

Does the mere thought of menopause strike fear in your heart?  Or do you look forward to the freedom from periods and pregnancy it offers?  Whatever your mindset, there are two things to consider:

• No two women will experience menopause in the exact same way.  Some will have no or very few symptoms; some will have symptoms that are bothersome but not disruptive; and some will have the severe symptoms that are the stuff of menopause horror stories.  (See the Second Opinion episode on Menopause (Episode 112) for more information.)

•  There is no single right answer on whether or not to use hormone therapy.

Today, the only FDA approved indication for hormone replacement therapy (HRT) is for the treatment of menopausal symptoms, such as hot flashes, vaginal dryness, mood swings, sleep disorders, urinary problems and decreased sexual desire.  Since the Women's Health Initiative (WHI) results were published in 2002, physicians no longer recommend it for secondary prevention of other conditions, even though research has confirmed it can help increase bone mineral density, reducing risk for bone fracture, and it may lower risk for colorectal cancer.  (See the introductory page for this topic for more information.) 

Hormone replacement therapy can refer to the use of estrogen alone or to a combination of estrogen and a progestin. Occasionally, testosterone may be added to treat decreased libido.  There is a whole alphabet soup of abbreviations:  ERT (estrogen replacement therapy) and ET (estrogen therapy) for estrogen only; EPT (estrogen progestin therapy) for combination estrogen and progestin; HRT (hormone replacement therapy), HT (hormone therapy) and menopausal hormone therapy (MHT) for any of the above.

Choosing whether or not to use hormone therapy will depend on:

• The severity of your symptoms
• Your medical history
• Your current health status

Like almost all medications, hormone replacement therapy has side effects.  Some are merely bothersome; some are potentially serious.  In the bothersome category are monthly bleeding, spotting, bloating, breast tenderness, abdominal cramps, headaches, skin discoloration, and emotional side effects like anxiety, irritability, and depression.  In the serious category are increased risks for heart disease, breast cancer, stroke and blood clots, gallbladder disease, Alzheimer's disease and other dementias. 

The WHI study concluded that for every 10,000 women taking estrogen and progestin, there would be (annually):¹

• Eighteen more cases of blood clots (including pulmonary embolism)
• Eight more cases of invasive breast cancer
• Seven more cases of heart disease (mostly nonfatal)
• Eight more strokes

For every 10,000 women taking estrogen alone, there would be (annually):¹

• Twelve more strokes
• Six more cases of blood clots

You may be a good candidate for HRT if you are recently menopausal and do not have a history of heart disease, breast cancer or blood clots.  You will want to avoid HRT if you have active or past breast or uterine cancer, liver disease, gallbladder disease, a history of blood clots or stroke, heart disease or multiple risk factors for heart disease (such as diabetes, high blood pressure, etc).  

Before deciding about HRT, you may want to work with your doctor to explore alternatives.  They include:

• Lifestyle changes.  These include eating a healthy diet, regular physical exercise, maintaining a healthy weight, not smoking and limiting how many alcoholic beverages you drink. 
  
  
• Certain antidepressants. These have not been approved for this use, but clinical trials have shown them to be a moderately effective treatment for relief of hot flashes.
  
  
• Botanicals and the dietary supplement DHEA (dehydroepiandrosterone).  The National Center for Complementary and Alternative Medicine says that while there is very little scientific evidence to support the effectiveness of these remedies, it is possible that some may provide relief to some women.  However, they can have side effects and can also interact with other botanicals or supplements or with drugs.² 
  
  
• Acupuncture.  The National Center for Complementary and Alternative Medicine is supporting several studies looking at the effect of acupuncture on the occurrence and severity of hot flashes in postmenopausal women.²

Another debate that exists on the horizon for HRT is in the form of bio-identical hormones.  After the WHI results were published in 2002, women began looking for alternatives to conventional HRT.  Suzanne Somers published a book in 2004 that raised the profile of bio-identical hormones with the public.  The problem is that the term "bio-identical" is used to describe two very different categories of products:   

• FDA-approved, plant-based hormones.  Quality and safety is regulated.
  
  
• Made-to-order hormones created by compounding pharmacies.  Although the ingredients are approved by the FDA, the compounds are not.  The dosage can change with each batch and they have not been tested for purity, potency, efficacy or safety.

To date there is no scientific proof to show that bio-identical hormones are safer to use than the synthetic hormones of conventional HRT.³

Despite all the controversy and confusion, the medical community agrees, in general, that HRT is still the most effective medical tool they have for helping women cope with the symptoms of menopause.  Notwithstanding, there are steps you should take before and while using hormone replacement therapy.  Talk to your doctor about:

• Your personal risk-to-benefit ratio
  
  
• Lifestyle changes or medications to prevent osteoporosis, high cholesterol levels, heart disease, stroke, breast cancer, etc.
  
  
• Lifestyle changes to augment HRT in symptom control
  
  
• Whether a pill, patch, cream or ring is best for you
  
  
• What check-ups and screenings you will need and how often (blood pressure, pelvic and breast exams, mammograms)
  
  
• If dosage can be lowered as you age (in general, symptoms become less severe the longer you are past menopause)

Since research on HRT is ongoing and symptoms change, women should revaluate their treatment plans every year.

¹ The National Institutes of Health, Postmenopausal Hormone Therapy.
² National Center for Complementary and Alternative Medicine, Menopausal Symptoms and CAM.
³ Robert B. Jaffe, MD, Leslie Salomone, MD and Richard J. Santen, MD; Bioidentical (Natural) Hormones and Menopause, The Journal of Clinical Endocrinology & Metabolism Vol. 90, No. 11

Learn more about Hormone Replacement Therapy:

Key Point 1: Research brings out new and sometimes confusing information all the time.  It can be frustrating for patients and doctors alike.  You need to stay in touch with your doctor to make sure that your care is as up to date as possible.