Hormone Therapy for Women

Hormone therapy (HT), is used to treat symptoms associated with menopause. Hormone therapy can be affected by your age, your personal medical history, and the severity of your menopausal symptoms. Discuss with your healthcare provider the risks and benefits of hormone therapy, as well as the various forms of HT.

What is the difference between estrogen and progesterone

Progesterone and estrogen are hormones produced by the ovaries of a woman.

What is estrogen?

Many body functions are affected by estrogen, including:

• Thickens your uterus lining, preparing it to allow the possible implantation a fertilized egg
• How calcium is used by your body, an important mineral for bone building
• Helps maintain healthy blood cholesterol levels
• Keeps your vagina healthy
• Prevents osteoporosis

What is progesterone used for?

Many body functions are affected by progesterone, including:

• Preparation of your uterus to conceive a fertilized egg. Also helps you maintain your pregnancy
• Blood pressure regulation
• It improves mood and sleep

What is hormone therapy (HT), exactly?

Your ovaries stop producing high levels of estrogen or progesterone as you enter menopause. Uncomfortable symptoms can result from changes in hormone levels. Menopause symptoms that are common include:

• Hot flashes
• Night sweats or cold flashes
• Vaginal dryness; discomfort during sex
• Urinary urgency is feeling the need to pee
• Trouble sleeping (insomnia)
• Mood swings, mild depression, or irritability
• Dry skin, dry eyes and dry mouth

Hormone therapy (HT), is a treatment that boosts hormone levels and helps with some symptoms of menopause. Talking to your healthcare provider about whether or not HT therapy should be considered is a good idea. There are both health benefits and potential risks to taking HT.

What types of hormone therapy (HT), are there?

There are three types of hormone therapy (HT):

• Estrogen Therapy – Estrogen can be taken by itself. Doctors will often prescribe estrogen as a daily pill or patch. You may also receive estrogen as a cream or vaginal ring, spray, pellet, or gel.
• Estrogen Progesterone/Progestin Hormone Therapy (EPT) – Also called combination therapy, this form of HT combines doses of estrogen and progesterone (or progestin, a synthetic form of progesterone).
• Testosterone Therapy – Testosterone is also present in women and may help relieve some symptoms of menopause.

What does it matter if I have a uterus or not?

If your uterus is still intact: Along with estrogen, progesterone can be used. The risk of cancer of the endometrium (the lining and lining of your uterus) increases if estrogen is taken without progesterone. Your endometrium cells are destroyed during menstruation. If your endometrium stops being shed, estrogen can cause an increase in the number of cells in your uterus. This can lead to cancer.

Endometrial (or uterine) cancer is lessened by progesterone. It thins the endometrium. You may experience monthly bleeding if you are taking progesterone. It all depends on how your hormone therapy is administered. You can reduce or eliminate monthly bleeding by taking estrogen and progesterone together.

If your uterus is no longer in use (after a hysterectomy):

Progesterone is not usually required. This is important because estrogen taken by itself has fewer long-term side effects than HT which uses a combination progesterone and estrogen.

PROCEDURE DETAILS

What are some common postmenopausal hormones that are commonly used?

This list contains the names of some hormones that are postmenopausal, but not all.

Estrogen

• Pills

  Brand names: Cenestin(r), Estinyl(r), Estrace(r), Menest(r), Ogen(r), Premarin(r), Femtrace(r)

• Creams

  Brand Names: Estrace(r), Ogen (r), Premarin[r]

• Vaginal Ring

  Brand Names: Estring(r), Femring(r), (treats hot flashes and vaginal symptoms).

• Vaginal tablet

  Brand names : Vagifem(r). Imvexxy (r)

• Patch

  Brand Names: Alora(r), Climara(r), Minivelle[r], Estraderm[r], Vivelle[r], Vivelle-Dot[r], Menostar[r])

• Spray

  Brand Name: Evamist(r)

Combination EPT

• Pills

  Brand Names: Activella(r), FemHRT(r), Premphase(1r), Prempro(1r), Angeliq(2r), Bijuva(3r)

• Patch

  Brand Names: CombiPatch(r), ClimaraPro(r)

Vaginal dehydroepiandrosterone (DHEA)

• Vaginal Insert

  Brand Name: Intrarosa(r)

RISKS/BENEFITS

What are the advantages of hormone therapy (HT)?

Hormone therapy (HT), is used to treat menopausal symptoms, including:

• Hot flashes
• Painful intercourse due to dryness of the vaginal canal
• Other symptoms that can be problematic with menopause include night sweats, dry itchy skin

Other benefits of taking HT include the following:

• There is a lower risk of osteoporosis, and fewer chances of breaking bones
• Some women experience a better mood and a greater sense of mental well being
• Reduced tooth loss
• Colon cancer at a lower risk
• Diabetes risk is lower
• A modest improvement in the symptoms of joint pains
• Women who receive hormone therapy in their 50s have a lower death rate

What are the potential risks associated with hormone therapy (HT)?

Hormone therapy (HT) – Does not come without risks. There are known health risks:

• Endometrial cancer is more likely if your uterus is still intact and you aren’t taking progestin
• Increased risk of stroke and blood clots
• Increased chance of gallbladder/gallstone problems
• Hormone therapy that is initiated after middle age can increase the risk of developing dementia. A lower risk of dementia and Alzheimer’s disease if hormone therapy is started in midlife
• Long-term combination use can increase breast cancer risk

What are the facts about hormone therapy and the potential for heart disease?

Scientists continue to discover more about the effects of HT in the heart and blood vessels. Large clinical trials have been conducted to address questions regarding HT and heart disease. Some showed positive results in women who began HT within 10 year of menopause. Others had negative effects for those who started HT after 10 years. Some studies raise more questions about the benefits of HT.

The American Heart Association issued a statement regarding the use of HT based on these data. They state:

• It is not recommended to use hormone therapy solely for the purpose of preventing heart disease, specifically stroke or heart attack.

What are the facts about hormone therapy and breast cancer risk?

Combining hormone therapy can increase your chances of developing breast cancer. These are some of the most important findings:

• Combination hormone therapy was associated with a rare increase in breast cancer risk, which is less than one case per 1,000 years.
• Women who had hysterectomies with estrogen-only therapy showed a small reduction in breast cancer.

Hormone therapy (HT) is not recommended for everyone.

If you:

• Have had or have breast cancer
• Have abnormal vaginal bleeding
• Are at high risk of blood clots, or have had blood clots
• Are at increased risk of developing vascular disease, such as stroke or heart attack in the past
• Have suspect or know that you are pregnant
• Liver disease.

What side effects are there from hormone therapy (HT)?

Hormone therapy can have side effects, just like all medicines. These are the most common side effects.

• Monthly bleeding is possible if you are a woman with a uterus, and you take cycled progestin (estrogen for 25 to 24 days/month, progesterone last 10 to 14 days/month; 3 to 6 days without therapy].
• Spotting irregularities.
• Tenderness in the breasts
• Mood swings

What can I do to reduce the side effects of hormone therapy?

These side effects usually aren’t serious and you don’t need to stop taking your HT. Ask your healthcare provider if you are experiencing side effects. You should not make any changes to your medication or discontinue taking it without consulting your doctor.

RECOVERY and OUTLOOK

What length of hormone therapy (HT), should I be taking?

Hormone therapy is generally available for as long as you wish. You should also continue regular monitoring with your healthcare provider in order to review your treatment plan every year. Your provider will discuss whether it is safe to continue taking hormone therapy if you have a new condition.

Note from Iowa Women’s Health Center

It is important to make a personal decision about whether or not you want to try hormone therapy. Hormone therapy may not be right for you. At an appointment specifically designed for this purpose, you can discuss the benefits and risks of hormone therapy with your healthcare provider. To make the best decision for you, it’s important to take the time to discuss all issues and answer any questions. Consider your age, your family history, and the severity of your menopause symptoms.

Talk about the pros and cons for each type and form of HT, as well as non-hormonal options like diet changes, exercise, weight management, meditation, and other options.