Managing Menopause Hormone Replacement Therapy

To combat the symptoms associated with falling estrogen levels, doctors have turned to hormone replacement therapy (HRT). HRT is the administration of the female hormones estrogen and progesterone. Estrogen replacement therapy (ERT) refers to administration of estrogen alone. The hormones are usually given in pill form, though sometimes skin patches and vaginal creams (just estrogen) are used. ERT is thought to help prevent the devastating effects of heart disease and osteoporosis, conditions that are often difficult and expensive to treat once they appear. The cardiovascular effects of progesterone, however, are still unknown. Hormone treatment for menopause is still quite controversial. Its long-term safety and efficacy remain matters of great concern. There is not enough existing data for physicians to suggest that HRT is the right choice for all women. Several large studies are currently attempting to resolve the questions, though it will take several more years to reach any definitive answers.

In the 1940's when estrogen was first offered to menopausal women, it was given alone and in high doses. Today, after 50 years of trial and error, it is well known that estrogen stimulates growth of the inner lining of the uterus (endometrium) that sheds during menstruation. This growth may continue uncontrollably, resulting in cancer. Today, doctors typically prescribe a lower dose of estrogen. However, few doctors still prescribe estrogen alone to women who have a uterus. Most now prefer to add a synthetic form of progesterone called progestin to counteract estrogen's dangerous effect on the uterus. Progestin reduces the risk of cancer by causing monthly shedding of the endometrium. The obvious drawback to this approach is that menopausal women resume monthly bleeding. Once menopause arrives, most women enjoy the freedom of life without a period. Many are reluctant to begin their cycles again. In addition, there are other unpleasant side effects of progestin which often discourage women from continuing HRT. These include breast tenderness, bloating, abdominal cramping, anxiety, irritability, and depression. Only about 15 percent of women who are eligible for hormone replacement therapy are now receiving it. This leaves 85 percent who either do not want or need it, or do not know about it.

The good news is that researchers are evaluating different schedules of low-dose estrogen and progestin to completely eliminate monthly bleeding. Currently most women receive what is called cyclic HRT. They may take estrogen continually and progestin for the first 12 days of each month. The use of a continuous combined dose, where estrogen and smaller amounts of progestin are taken every day, is also being studied. In theory, this use of progestin stems endometrial growth so no bleeding will occur. Unfortunately, it may take 6 months or more until bleeding finally stops. In many cases, monthly bleeding has been replaced by more bothersome irregular bleeding patterns. Obviously, further research is needed to evaluate and perfect this treatment. Various types of progestins in different dosages, preparations, and schedules are being studied in hopes of reducing its other unpleasant side effects while retaining the known advantages of estrogen.

Previous Page
Menopause Guide Table of Contents
Next Page

Reproduced from the National Institute on Aging, National Institutes of Health.

More About Menopause