Menopause: Medications

Hormone therapy during and after menopause can involve:
The use of estrogen only (estrogen replacement therapy or ERT). This is also called unopposed estrogen therapy.

The use of both estrogen and progestin (hormone replacement therapy or HRT). This is also called opposed estrogen therapy or combination hormone therapy. HRT can be cyclic or continuous. Cyclic HRT provides daily estrogen with periodic use of progestin. Continuous HRT provides continuous daily dosages of estrogen and progestin.

The term “hormone therapy” is used to refer to any combination of prescription drugs without a prescription involving androgens, estrogen and progestin.

Hormone therapy is used to replace hormones that decline naturally during menopause in order to prevent short-term symptoms and long-term health problems.

Short-term (up to 5 years) hormone therapy is done to relieve the symptoms (such as hot flashes) that occur during and immediately after menopause. Short-term hormone therapy may be recommended depending on:

  • The severity of menopause symptoms
  • The failure of home treatment to control symptoms
  • A woman’s willingness to tolerate the symptoms of menopause

Long-term hormone therapy is done to reduce the risks of developing osteoporosis and heart disease after menopause. Hormone therapy can affect the risk of developing:

  • Heart disease
  • Osteoporosis
  • Endometrial cancer
  • Breast cancer
  • Gallbladder disease

Women who shouldn’t use hormone therapy

Hormone therapy should not be used by women 1, 2, 3:
Who have breast cancer or cancer of the lining of the uterus (endometrial cancer)
With a history of stroke, blood clots or heart attack when using hormones (such as birth control pills)
Who have vaginal bleeding from an unknown cause
Who have active liver disease. These women may be able to use a form of estrogen other than pills such as estrogen delivered from a skin patch (transdermal), vaginal cream, or an injection into a muscle (intramuscular).

The use of hormone therapy by a woman after she has had breast cancer is controversial. The benefits of hormone therapy need to be weighed against the risk of hormone therapy causing the return of the breast cancer. Women who have been successfully treated for breast cancer may consider hormone therapy if:
Menopause symptoms are severe and interfering with lifestyle (such as severe hot flashes).
The risk of heart disease or osteoporosis is extremely high.

Using estrogen-only replacement therapy (ERT) for longer than 1 year is not recommended for women who have a uterus 2.
Long term estrogen-only therapy increases the risk of endometrial cancer (cancer of the lining of the uterus).

Timing of hormone therapy

Options

Two types of hormone therapy are used to treat symptoms of menopause and reduce the risk of long-term health problems.

Estrogen replacement therapy (ERT) involves the use of estrogen only. This treatment method is also called unopposed estrogen therapy. ERT is usually used by women who no longer have a uterus (women who have had a hysterectomy).

Hormone replacement therapy (HRT) replaces estrogen and progesterone (progestin). This treatment method is also called combination therapy or opposed estrogen therapy. HRT can involve use of estrogen and progestin together throughout the month (continuous HRT) or daily use of estrogen with only periodic addition of progestin (cyclic HRT). HRT is usually used by women who still have a uterus.

Androgens (hormones that increase male characteristics) may be used to increase sexual desire in postmenopausal women. Studies that have investigated the use of androgens in postmenopausal women have found inconclusive results.

Considerations

The decision whether to use hormone therapy is a woman’s personal choice.
Hormone therapy considerations
Making the decision

March 11th, 2012 - Posted in Women's Health | | Comments Off

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