Estrogen Replacement Therapy
As a woman approaches menopause, one of the
questions that she must ask herself is “Should I consider hormone replacement therapy?”
The media has made us all aware of the
controversies surrounding the use of estrogen in postmenopausal women. There
is no single answer that is right for every woman. The best we can do is to
make women aware of the risks and benefits of treatment and of alternatives and
then to examine each woman’s situation, preferences, medical condition and
family history and help her to make the best decision for herself .
Benefits of Estrogen Replacement Therapy
1) Decreased loss of bone mineral density and
reduced incidence of osteoportic fractures. 2) Lowering of cholesterol and LDL
and increase of HDL resulting, we believe, in a decreased risk of
atherosclerotic heart disease. 3) Delayed onset of Alzheimer’s symptoms. 4)
Decreased incidence of colon cancer 5) Control of hot flashes 6) Improvement in urinary continence 7)Improved
sense of well being 8) Preservation of memory 9) Prevention of vaginal atrophy
and dryness. 10) Maintenance of younger looking skin.
Disadvantages of Estrogen Replacement Therapy
1) Possible vaginal bleeding or continuation of
menstrual periods 2) Increased risk of developing uterine cancer IF taken
without a progesterone by women who still have a uterus. 3)Increased risk
of thrombophlebitis, especially during the first year of treatment
and possible increase risk stroke and of nonfatal heart attacks in women on
combination therapy (estrogen plus progestin) 4) Breast
tenderness 5) Possible increased risk of developing
breast cancer
Products
There are many different estrogens and
progestins available today. No one preparation or combination is right for ALL
women. When initiating hormone replacement therapy, the practitioner generally
starts with a hormone or combination of hormones that she feels is well accepted
by many patients. It is important to realize that some women will feel fine and
have no side effects regardless of what hormone preparation they are given but
others will be sensitive to some of the preparations and not to others. It is
essential that patient and doctor are willing to work with each other until
the optimum treatment regimen for each woman can be established.
Regimens
While no woman wishes to continue to have
menstrual bleeding after menopause, it is not always possible to avoid bleeding
on estrogen replacement therapy.
There are several different regimens for
administering combined estrogen and progesterone therapy. The goal of therapy
is to find the method that will cause the least amount of undesired side
effects for each individual woman while still providing the most benefits.
Older women often do well with a regimen where a
low dose of estrogen and a low dose of progesterone are taken together each
day. This is called continuous therapy. Theoretically, this method causes the uterine
lining to thin down enough that there should be no vaginal bleeding. This works about 85 %
of the time in older women. . The others will experience anything ranging from
occasional spotting to heavy continuous bleeding. The frequency and severity of
bleeding will determine weather this regimen is tolerable to a specific woman.
Young, perimenopausal or recently menopausal
women almost never do well on the continuous regimen. They generally have heavy,
unpredictable bleeding on it so other methods of therapy are better for them, at
least the first few years.
If the bleeding is more than occasional light
spotting on a continuous regimen or if the woman being started on therapy is
relatively young then it is best to use a regimen where the estrogen is given on
a daily basis and the progesterone is given at a higher dose but for only part
of the month. This cyclic method of administering hormone replacement
therapy more closely mimics what naturally occurs in a pre-menopausal woman’s
body. With cyclic regimens, the woman can expect a period each month but at
least she knows when that will occur. The bleeding will generally be light, and
because we are expecting it to occur, we do not worry that there may be some
underlying abnormality causing the bleeding.
When a woman starts on any form of hormone
therapy, she may have a little unexpected spotting for the first few months as
her body is adjusting to the treatment. If she has been on the same medications
for more than six months and experiences any unexpected bleeding then she should
consult with her physician as there may be some real pathology in her uterus,
cervix or vagina. Often, medical evaluation of abnormal bleeding will entail
only physical exam and an ultrasound performed with a vaginal probe, both
painless procedures. If, however, the exam or ultrasound reveal any
abnormalities, other procedures may be indicated.
Women may experience some breast tenderness and
bloating on hormone therapy. These effects often resolve after the first few
months of treatment. Changes in mood and changes in sex drive may also occur.
If negative effects do not go away after a month or two, often they can be
reduced or relieved by changing the formulation or the treatment regimen of the
medication rather than stopping therapy. .
There is no magic pill that will guarantee
perfect health or perpetual youth. The use of estrogen replacement therapy as
part of a life style that includes healthy diet, the judicious use of dietary
supplements, exercise, limited alcohol consumption and avoidance of tobacco use
will all work together to help each woman to stay as well as she can for as long
as possible
