Menopause comes to all women. At this time, your body reduces the production of estrogen and progesterone, the hormones that manage your reproductive cycle. The reduced hormone levels in the blood often bring several unpleasant problems. These include night sweats, hot flashes, weight gain, reduced sex drive, vaginal dryness, and mood changes.
The reduced hormone levels are also believed to cause calcium loss from your bones. This loss leaves your bones weak, often causing fractures. Hormonal replacement therapy (HRT) helps reduce the troublesome symptoms and prevents bone demineralization. But hormone replacement therapy length is a critical concern.
What is hormone replacement therapy?
Your doctor will prescribe HRT if you're having an uncomfortable time with the symptoms of menopause. Hormonal replacement therapy consists of pills, sprays, gels, or vaginal products that contain estrogen alone or combinations of estrogen and progesterone (combination HRT).
The symptoms of menopause can last for several years and can significantly reduce your quality of life. Hormonal replacement therapy relieves the symptoms of menopause. Other measures like yoga, hypnosis, acupuncture, stress reduction, dietary supplements, Chinese herbs, and botanical products do not provide the same relief.
If you experience these symptoms with your menopause, you should talk to your doctor. Usually, no tests are needed. Your doctor will prescribe HRT if your symptoms affect you significantly. HRT can be taken continuously or in cycles.
You can take estrogen by itself if you've had a hysterectomy (surgery to remove your uterus). With an intact uterus, your doctor will prescribe a combination of estrogen and progesterone. You can use vaginal creams, pessaries, and rings for local effect. Pills or skin patches are used for systemic effects and the long-term prevention of chronic conditions.
What is the optimal duration of HRT?
The (Food and Drug Administration) FDA recommends that hormonal replacement therapy, whether estrogen-only or in combination with progesterone, should be used at the lowest dose that is effective, and for the shortest duration that fulfills treatment goals.
In general, there isn't a definite duration for HRT. You and your doctor should decide how long you should take it. Once your menopause symptoms pass (which may be several years), you can stop treatment. Stopping hormonal replacement therapy gradually reduces the odds of your symptoms becoming troublesome again. If your symptoms do return, your doctor may restart HRT.
The benefits of HRT
About 70% of women have hot flashes during menopause. As pills or skin patches, estrogen, alone or in combination with progesterone, is the most effective therapy for menopausal hot flashes. HRT also reduces hip fractures, total fractures, and colorectal cancers in women taking it.
About half of all women have genitourinary problems during menopause. These include urinary infections, incontinence (loss of bladder control), painful sex, vaginal dryness, and bleeding during intercourse. Vaginal preparations of estrogen (creams, tablets, or rings) can treat these problems.
The risks of HRT
Breast cancer. Women who have taken HRT for a year or more have a higher risk of breast cancer than those who have never taken it. This risk is reduced once you stop taking the treatment.
Endometrial cancer. This malignancy of the uterus lining is more common in women given estrogen-only HRT. The risk increases with larger doses and longer durations of treatment. Women given combinations of estrogen and progesterone do not have a higher risk of this cancer.
Stroke. Both estrogen-only and combination HRT increases your likelihood of strokes.
Blood clots. Hormonal replacement therapy is associated with blood clots in the veins (thrombosis). These clots can travel to the heart and block the arteries to the lungs (pulmonary embolism). Transdermal gels (estrogen preparations applied to, and absorbed from, the skin) have a lower risk of venous clots.
On average, women live for 30 years after their menopause. At one time, HRT was expected to prevent several disorders associated with old age, including heart disease, dementia, fractures, and cancers. However, we now know that HRT does not have significant benefits in these areas. The US Preventive Task Force no longer recommends long-term hormonal replacement therapy for prevention of these chronic conditions.
Hot flashes and other symptoms may persist for ten years or more during and after your menopause. However, continuing combination hormone replacement therapy for more than 3 to 5 years increases your risk for breast cancer. Be aware of the dangers of HRT, and discuss carefully with your doctor if you need to continue for longer. If your symptoms make it necessary to take prolonged treatment, use the smallest doses that give you adequate relief.
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Journal of the American Medical Association: "Hormone Therapy for the Primary Prevention of Chronic Conditions in Postmenopausal Women. US Preventive Services Task Force Recommendation Statement"
National Health Service: "Hormone replacement therapy (HRT)"
Obstetrics and Gynecology: "Management of Menopausal Symptoms"
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