Menopause, Hormone Replacement Therapy, HRT, estrogen, progesterone, Estrogen replacement therapy, ERT

Hormone Replacement Therapy (HRT)

Estrogen Replacement Therapy hit the mainstream in January of 1964 when Newsweek published an article entitled "No More Menopause," based on the work of New York gynecologist Robert A. Wilson. Wilson subsequently authored a book entitled "Feminine Forever" that touted the virtues of estrogen therapy as a fountain of youth that would prevent women from experiencing the "tragedy" of menopause, which would leave them dried up, sexless, and depressed.

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. They can also given in the form of skin patches and vaginal creams (just estrogen).

The use of hormone replacement therapy is highly effective for improving the quality of life of women suffering from acute symptoms of menopause, such as hot flashes, night sweats, insomnia, increased fatigue and irritability, depression, skin changes, vaginal dryness and incontinence. There was significant evidence that HRT provides some long-term protection against cardiovascular disease, osteoporosis and colon cancer. Read about the full benefits of HRT in Benefits of Hormone Replacement Therapy.

Hormone treatment for menopause is still quite controversial. Its long-term safety and efficacy remain matters of great concern. Scientists noted a relationship between the long-term use of HRT and the risk of breast and uterine cancer (the progesterone component of HRT is quite effective at eliminating the excess risk of uterine cancer).

Many women who start on HRT ended up going off it a few months or a few years later because of the side effects.

Typical among the side effects are:

PMS-like side effects such as:

Making them crazy

Tense

Anxious

Bloated

Breasts feel extremely sore

Terrible headaches. To combat the headaches, they start taking medications that make them feel terribly tired.

Other side effects of HRT are:

Depression

Mood swings

Weight gain

Fluid retention

High blood pressure

Increased risk of stroke

Increased risk of breast and ovarian cancer

What kept the majority of women who would have tried ERT otherwise was the discovery that it was found to cause pre-cancerous or cancerous changes in the uterine lining of nearly a third of the women taking it. The reason is that estrogen stimulates cell division, including cells in the uterine lining, breasts, and ovaries. The risk of uterine cancer was soon overcome by adding synthetic progestins (since natural progesterone cannot be patented there is no profit in it for drug companies), which resulted in a menstrual period each month in which any damaged uterine lining cells could be shed. ERT had become HRT, at least for women who still had an intact uterus.

HRT and Cancer

In 1995, the results of the largest study to date were published in the prestigious New England Journal of Medicine. Postmenopausal women using HRT for five or more years have a 30-40 percent greater risk of developing breast cancer than do women who do not use hormones. On the other hand, HRT users have a 29 percent reduction in colon cancer risk. HRT has also been linked with an increase in the risk of ovarian cancer. Ovarian cancer is difficult to detect until it is relatively far advanced. HRT was also implicated in a variety of other health problems, ranging from asthma to high blood pressure. Thus, the fountain of youth has its own risks. Perhaps that is the reason why 85% of women who can benefit from HRT does not take it.

A 1995 study in the American Journal of Respiratory and Critical Care Medicine reported that women on HRT were 50 percent more likely to develop adult-onset asthma than those who did not take hormones. The negative aspects of HRT are usually dismissed by its proponents with the argument that since more women die from heart disease than breast or ovarian cancer, and since HRT protects against osteoporosis and colon cancer, a woman is still better off with HRT in the long run, unless she has a family history of breast cancer.

For many people this is not a consolation. It is being between devil and the deep sea. Thus the choice of women whether to undergo HRT is not an easy one.

Estrogen is known to stimulate the growth of the inner lining of the uterus (endometrium) that sheds during menstruation. This growth may continue uncontrollably, resulting in cancer. It is generally administered in small doses to minimize this complication. Generally, for women who have a uterus, a synthetic form of progesterone called progestin is added to estrogen to counteract estrogen's dangerous effect on the uterus. Progestin reduces the risk of cancer by causing monthly shedding of the endometrium. The drawback to this approach is that menopausal women resume monthly bleeding. Other unpleasant side effects of progestin 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.

Next Topic: Benefits of Hormone Replacement Therapy

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