Hormone Therapy

1 What is a Hormone Therapy (Estrogen Therapy, Estrogen/Progestin Therapy)?

In this article, the term "hormone therapy" or "HT" is replacing the outdated terminology "hormone replacement therapy" or "HRT."

During menopause, the body produces less of the female hormones, estrogen, and progesterone so the monthly menstrual periods to stop and gradually eliminate the possibility of becoming pregnant.

Because of the fluctuations in hormone levels, some women can have troublesome symptoms like hot flashes (a sudden sensation of warmth, sometimes associated with flushing, and often followed by sweating), sleep disturbance and vaginal dryness. Also, the lower estrogen levels of menopause can lead to progressive bone loss especially rapidly in the first five years after menopause.

  • Hormone therapy (HT) can be helpful for women with hot flashes and sleep disturbance by estrogen given in short-term with progestin because alone estrogen can cause uterine cancer (endometrial cancer) in women who have a uterus. It can be taken in pill, as a patch, or in gel form. Women who are at risk of, or who have been diagnosed with osteoporosis should take non-estrogen medication.
  • Estrogen therapy (ET) can be helpful for women who have only vaginal symptoms like vaginal dryness or itching and it can be taken in oral pills, skin patches, gel, or vaginal forms (vaginal rings, vaginal tablets, or vaginal cream). It is only recommended for women who have had their uterus removed (hysterectomy).

Women with a medical history of breast or uterus cancer and deep vein thrombosis (blood clots in the veins) should not take HT.

The doctor will decide which therapy is best for the women depending on her symptoms and a schedule for taking HT. Women who are taking HT must have a medical checkup every year including breast exam and mammogram.

Women who do not want to take HT can use non-hormonal medications although HT is by far superior to other medications. For example, to reduce dryness women can use a water soluble surgical jelly (not petroleum jelly).

The minor side effects of HT can include breast pain, nausea, and headaches but physicians still do not know does the estrogen or progesterone cause it so if side effects persist for a few months, the doctor will often alter either the progesterone or the estrogen part of the hormone therapy (HT).

Recent researches confirm that the problem of women who are taking HT with gaining weight is not related with TH but because of menopause or aging.

The more serious health concerns for women undergoing hormone therapy (HT) include:

  • Increasing risk of vein clots in the legs (deep vein thrombosis) and blood clots in the lungs (pulmonary embolus) but this is extremely rare in healthy women with no a personal or family history of clots
  • Uterine cancer (endometrial cancer) but research shows that is only in women who have their uterus and use estrogen alone, so today most doctors prescribe the combination of estrogen and progestin
  • Breast cancer, although the increase in risk is very small and increases with duration of use and is especially increased with 5 or more years of use
  • Heart disease
  • Abnormal vaginal bleeding (occurs when it is not expected or is excessively heavy or long in duration) but HT doses can be adjusted to minimize it
  • Stroke, although the risk is very small
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