Hormone Replacement Therapy

What is hormone replacement therapy (HRT)?

HRT puts back what your body loses during menopause.

Hormone replacement therapy (HRT) replaces your body’s natural hormones — estrogen, progesterone, and, sometimes, testosterone — with man-made hormones. HRT can relieve many of the symptoms of menopause as well as provide important long-term health benefits. The combination of hormones and dosage a doctor prescribes depends on each woman’s needs, tolerance, and risk factors can be determined by lab tests and lab profiles. In addition to its benefits, HRT also has its risks.

Possibly because of the health risks and because women have unanswered questions and unresolved concerns about HRT, the decision whether to choose hormone replacement therapy or not remains a controversial issue. Although 85% of doctors recommend HRT, only 20% of American women over the age of 50 are taking HRT. In order to answer some of the potential questions that you may have about HRT, we’ll look at the benefits, the risks, and some other important facts about hormone replacement therapy.

What are the benefits of hormone replacement therapy?

Benefits can be significant.

Successful hormone replacement therapy (HRT) has many benefits. It:

  • Treats hot flashes, vaginal dryness, and urinary incontinence
  • Reduces urinary tract infections
  • Improves insomnia, moodiness, memory loss, and lack of concentration
  • Regulates periods
  • May relieve arthritis joint pain, keep the skin from aging, and restores energy
  • Increases your protection against heart disease and bone loss (osteoporosis)

Does hormone replacement therapy protect against heart disease?

Hormones help blood flow, cholesterol levels.

For women over 50, heart disease is the number one killer. Prior to the start of menopause, estrogen and progesterone protect us from heart attacks and hardening of the arteries, which precedes many kinds of heart disease. Without these hormones, our risk of cardiovascular disease,particularly strokes, rises sharply. Estrogen can reduce your risk of serious heart disease by almost half. Hormones keep the level of HDL (good) cholesterol high and when it is withdrawn, the level of LDL (bad) cholesterol rises sharply. Some women are at greater risk for heart disease than other women are. The number of risk factors you have, in addition to the severity of your menopausal symptoms, may help you decide if HRT makes sense for you.

Risk Factors for Heart Disease

  • Cigarette smoking
  • High blood pressure
  • Family history of early heart disease
  • Diabetes
  • Sedentary lifestyle

How does hormone replacement therapy protect against bone loss?

Slows down bone loss.

Osteoporosis — severe bone loss — is actually the thinning of your bones, resulting from a lack of calcium. It is a silent disease. Many women don’t know they have it until they break a bone. You may be at risk for osteoporosis by your family history or lifestyle. By age 60, one in four caucasian and Asian women will have a spinal compression fracture. These fractures occur when your bones collapse on each other, due to bone thinning. A bone density x-ray is done at menopause so your doctor can detect any bone thinning problems. If you have problems, you can begin a program of good nutrition, weight-bearing exercises, and calcium supplements. If osteoporosis is suspected or discovered during perimenopause, estrogen therapy can help. It not only slows down bone loss but also may actually reverse osteoporosis by increasing bone density. You should seriously consider Hormone Replacement Therapy if you have several of the risk factors for osteoporosis.

Risk Factors for Osteoporosis

  • Caucasian or Asian
  • Early menopause without HRT
  • Family history of osteoporosis
  • Thinner than average, small boned
  • Surgical menopause
  • Low calcium intake (less than 1500 mg per day)
  • Low vitamin D intake
  • Anorexic, periods stopped due to eating disorder or excessive exercise

If I take hormone replacement therapy, will I get breast cancer?

There is no proof that HRT causes breast cancer.

The most frightening concern with Hormone Replacement Therapy is a possible increased risk for breast cancer. However, so far, studies are inconclusive or conflicting about this. Here are some things we do know. There does not seem to be any increased risk for women who have been on HRT for five years or less to develop breast cancer. This may be due in part to the lower doses of estrogen prescribed today versus much higher doses prescribed in the past.

One study concluded that women on estrogen for at least 15 years increased their risk of breast cancer. Another study showed no increase for women taking a standard 0.625 mg dose, and a third study showed that women currently taking estrogen have increased their risk, but if they stop taking estrogen, their risk level drops to its previous, lower level. This same study of over 100,000 women suggests that estrogen doesn’t cause cancer cells to develop, but it speeds up the growth rate of existing cancer cells.

Based on this information, many doctors feel safe in recommending HRT for women with significant symptoms of menopause and for the protection it gives against heart disease and osteoporosis. Whether or not you take HRT on a long-term basis is another decision. Also, if you haven’t had a mammogram recently, your doctor may recommend that you have one before putting you on HRT to make sure there is no suspicion of existing cancer.

In addition to a “normal” mammogram, you need to take into account the risk factors for breast cancer listed below as well as the other risks associated with Hormone Replacement Therapy following this section. After you and your doctor have gone over the results of your mammogram, your risks for breast cancer, and the other risks associated with Hormone Replacement Therapy, you will be much better prepared to decide if HRT is right for you.

Risk Factors for Breast Cancer

  • Mother or sister with breast cancer
  • Mother or sister diagnosed before age 50 with breast cancer
  • Eat a diet high fat diet


Are there other risks for taking hormone replacement therapy?

HRT is not for everyone.

The long-term health risks associated with HRT for some women are:

  • High blood pressure
  • Liver and gall bladder disease
  • Phlebitis and blood clotting problems

In addition, HRT is not for you if you have previously been diagnosed with breast or endometrial cancer, uterine fibroids, are pregnant, or have undiagnosed or abnormal vaginal bleeding.

What are the side affects of hormone replacement therapy?

It depends on your dose and method of HRT.

Hormone Replacement Therapy usually includes both estrogen and progesterone. Depending on the dose and method of estrogen replacement, you may have nausea, headaches, breast tenderness, and bloating. Progesterone will bring on your periods (but no egg production). These periods are usually light, short, and go away after two to three years. However,
progesterone may cause some fluid retention, moodiness, and headaches.

Getting the right dose and method of hormone replacement therapy

Flexibility and patience are key.

Successful Hormone Replacement Therapy will require patience on your part. There are many different combinations of the hormones (estrogen, progesterone, and testosterone), different methods of taking it (pill, patch, cream, or shots) and different dosing amounts. You may be lucky and get the right therapy the first time. But it could take several months to a year to get the best therapy for you. Needless to say, it’s very important for you and your doctor to communicate clearly and to be flexible until the right treatment plan is found. Don’t despair. It will be well worth it once you find the therapy that works for you.