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Jun162014

Hormone Replacement Therapy: Frequently Asked Questions

The average woman starts experiencing symptoms of menopause at the young age of 47! That means that we could spend almost half our life in menopause. This symptoms include hot flushes, night sweats, poor sleep, low energy, low sex drive, vaginal dryness and weight changes. In this blog post we would like to answer the most common questions regarding hormone replacement therapy.

What is hormone replacement therapy (HRT)?

HRT is a treatment used to supplement estrogen and progesterone during the menopause years. After menopause, levels of this hormones significantly decrease causing the symptoms that most menopausal women notice.

Should every menopausal woman be on HRT?

No. Hormone replacement is indicated only for the treatment of “symptomatic women”. Treatment should be of the lowest effective dose for the shortest possible duration. Also, some patient have contraindications to therapy. These include: patients with active breast cancer or history o breast cancer, history of stroke, history of blood clots in their legs or lungs, abnormal vaginal bleeding that has not been evaluated and  liver disease.

Do I need to use estrogen only or estrogen and progesterone?

Women who still have their uterus should take both estrogen and progesterone. Estrogen, when taken without progesterone, may increase the risk of cancer of the lining of the uterus. Progesterone reduces this risk by making the lining thin.

What are the benefits of HRT?

  •  Treatment of the most common symptoms of menopause (hot flashes, vaginal dryness, mood swings, insomnia).
  •  Reduces the risk of bone loss.
  • Lowers the risk of colon cancer.
  • Decreased tooth loss.

What are the risks associated with HRT?

Like any medication, prescription or over the counter, HRT is not risk-free. Known risks include:

  • Increased risk of stroke and blood clots. However, the increase in risk of clots is not statistically significant in women how start using HRT within 5 years of menopause. Studies also suggest that using estrogen through the skin (patch or cream) may further eliminate this slightly increased risk.
  • Increased risk of dementia if HRT is started in women who have been in menopause longer than 10 years.
  • Breast cancer risk also may slightly increase in women taking both estrogen and progesterone. This risk has been observed in women using combination HRT for over 3-5 years. For every 10,000 women on HRT there will be an additional 8 cases of breast cancer. This is the main reason that HRT should be used at the lowest possible dose for the shortest possible duration.

Due to the fact that the above risks are all more common in older patients, it is important that those women who decide to use hormone replacement do so as close as possible to the onset of menopause.

What is Bio-identical hormone replacement therapy?

The term bio-identical usually refers to those hormones that are identical to the estrogen and progestins that are normally found in women. These are Estradiol and progesterone.

Many commercially available products like Premarin and Prempro contain many different types of estrogen that are not  identical to those naturally found in women. This products are effective and extensively tested but many patients prefer to use the bio-identical alternative.

Estradiol and progesterone are available in many forms. They can be “compounded” by a specialty pharmacy, they are also available in the local pharmacies and are produced by some bigger pharmaceutical companies. Those that are commercially available are equally bio-identical and are more likely to be covered by insurance.  Estrogen and progesterone are available in pills, creams and patches.

Each patient’s symptoms and hormone replacement needs are different. To find out if hormone replacement or bio-identical hormone replacement is right for you contact us to make an appointment.

The author of this article, Bonni Titcomb, ARNP, has over 20 years of experience with both traditional and bio-identical hormone replacement and would love to help you through this transition and help you make the best choice for your individual needs.

Tags: HRT, Hormone Replacement, Hormone Replacement Therapy, Hot Flashes, Night Sweats, Poor Sleep, Low Energy, Low Sex Drive, Vaginal Dryness, Weight Changes

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