Hormone Replacement Therapy

In recent years, hormone replacement therapy (HRT) has been offered as an option to help treat menopause-related discomfort and prevent long-term conditions common in post-menopausal women. Evidence shows, however, that risks of HRT outweigh its benefits. Talk to your patients about HRT.

• During menopause, which occurs between the ages of 45 and 55, the ovaries produce lower levels of the sex hormones estrogen and progesterone. As a result, many women experience hot flashes, night sweats, sleeplessness, mood swings, and vaginal dryness. Bone loss, angina and heart attacks are also more common in women after menopause.

• HRT, which provides relief for menopausal symptoms, usually involves treatment with estrogen or estrogen in combination with progesterone. The therapy can double hormone levels in post-menopausal women and decrease the risk of hip and spine fractures and of colon cancer.

• Recent evidence indicates, however, that the overall risks of estrogen plus progestin therapy outweigh the benefits,1 significantly increasing the likelihood of dementia, blood clots, stroke, heart disease and breast2 and ovarian cancer.3 HRT has not been proven beneficial in older women with pre-existing heart disease. Additionally, it doesn’t appear to affect post-menopausal women’s general health, vitality, mental health, or sexual satisfaction.2

• A recent study has also connected a 6.7-percent decline in the rate of new breast cancer cases in post-menopausal women in 2003 to a national decline in the use of HRT (from 61 million prescriptions of Premarin(R) and Prempro(TM) in 2001 to 21 million in 2004).4

• While hormone therapy can have short-term benefits, many menopause-related symptoms will eventually disappear, and many require no treatment. A healthful diet and lifestyle helps to decrease the risk of bone loss and cardiovascular problems. Calcium and vitamin D supplements can help prevent osteoporosis5 and their effects on hip, spine, and wrist fractures, as well as on colon cancer are being tested.

• Soy-based foods and some nutritional supplements can also be helpful in reducing the symptoms of menopause. These include evening primrose, black cohosh, Dong quai, vitamin E, and vitamin B complex. Their benefits and risks are not definitively proven, but are being researched.5 Before taking any dietary supplement, consult with your health care provider.

References
1. JAMA 2002;288:321-333.
2. NEJM 2003;348:1839-54.
3. Lancet, 2007 Apr 19.
4. NEJM 2007 Apr 19;356(16).
5. Amer Acac Nurse Pract 1999;11(5):187-98.