Hormone Therapy (cont.)
What are the side effects and risks of hormone therapy
(HT)?
Women can experience side effects during hormone
therapy; these can be divided into more minor side effects, and more serious side effects. The more
minor side effects are more common than the serious side effects, and are
generally perceived by women as "annoying." These symptoms include:
It is still controversial which of these side effects
are due to the estrogen component as compared to the progesterone component.
Therefore, 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).
Contrary to common belief, recent research has confirmed
that women who take commonly prescribed doses of hormone therapy (HT) are no more likely to gain
weight than women not taking hormone therapy (HT). This is probably because menopause or aging
itself is associated with
weight gain, regardless of hormone therapy.
The more serious health concerns for
women undergoing hormone therapy (HT) include:
- Hormone therapy (HT) increases the risk of vein
clots in the legs (deep vein
thrombosis
) and blood clots in the lungs
(pulmonary embolus) by about
2 or 3 fold. However, it is important to
remember that these conditions are extremely rare in healthy women. Thus, the
true increase in risk for healthy women is minimal. Women with a personal or
family history of these clots should
review this issue when considering hormone therapy (HT).
- Uterine Cancer (endometrial
cancer): Research shows that women who have their uterus and use estrogen
alone are at risk for endometrial cancer. Today, however, most doctors
prescribe the combination of estrogen and progestin. Progestin protects
against endometrial cancer. If there is a particular reason why a woman with a
uterus cannot take some form of progesterone, her doctor will take sample
tissue from her uterus
(endometrial biopsy) to check for cancer annually while she is taking estrogen.
Women without a uterus (including women who have had a hysterectomy) have no
risk of endometrial cancer.
- Breast cancer:
Recent research indicates that hormone therapy (HT), and especially EPT, increases the risk of
breast cancer, although the increase in risk is very small. For example, the
Women's Health Initiative, a reliable large study of hormone therapy (HT) in menopausal women,
predicted that there were approximately 8 extra cases per 10,000 women who
took hormone therapy (HT) for 1 year, compared to women taking a placebo pill. The increase in
risk of breast cancer associated with hormone therapy (HT) likely
increases with duration of use and is especially increased with 5 or more years
of use.
- Heart disease: Even
though hormone therapy (HT) lowers the bad LDL cholesterol and
raises the good HDL cholesterol,
hormone therapy (HT) increases the risk of heart attacks in women who already
have heart disease, as well as in women who do not have known heart disease.
Hormone therapy (HT) does not prevent heart attack based on recent research from the
Women's Health Initiative.
- Abnormal vaginal bleeding: Women on
hormone therapy (HT) are more
likely than other postmenopausal women
to experience abnormal vaginal bleeding.
What is called "abnormal bleeding" depends on the type of hormone therapy (HT). With cyclic
therapy, in which 5monthly bleeding is expected, bleeding is abnormal if it
occurs when it is not expected or is excessively heavy or long in duration. With
daily continuous therapy, irregular bleeding can last for 6 months to a year,
therefore, irregular bleeding that lasts for more than a year is considered
abnormal. When abnormal bleeding occurs, a doctor usually takes a sample of the
lining of the uterus to rule out an abnormality or cancer in the uterus. This
procedure is usually done in the office. After the evaluation is done, if
nothing is found to be wrong, hormone therapy (HT) doses will often be adjusted to minimize
further abnormal bleeding.
- Stroke: Hormone
therapy (HT)
slightly increased the risk of stroke in women studied in the Women's Health
Initiative. The WHI predicted that there were 8 extra strokes per 10,000 women
taking hormone therapy (HT) for one year, compared to women taking a placebo (sugar pill).
Because of the possibility of increased breast cancer, stroke, and heart
disease risks, women who have no major menopause
symptoms may choose to avoid hormone therapy (HT). The effects of other types of
hormone therapy (HT) (aside from
the Women's Health Initiative types) on breast cancer risk are still unclear.
Next: How is hormone therapy (HT) prescribed? »
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