Advancing women’s health through education, advocacy, practice and research. Representing the board-certified obstetrician-gynecologists in New York State.

Hormone Replacement Therapy: Is it Right for You?

June 4, 2007

By: Mary Elacqua, MD, FACOG

Dr. Elacqua is a board-certified obstetrician-gynecologist.

Most women will experience menopause, a marked decrease in estrogen production and the end of the menstrual cycle, between the ages of 45-55. Decreased estrogen levels may cause a variety of uncomfortable symptoms. Hormone replacement therapy restores estrogen thus reversing some of the symptoms associated with estrogen loss. Like most treatments, there are a variety of risks associated with the use of hormones that must be carefully considered. The American College of Obstetricians and Gynecologists (ACOG) recommends the following be considered on an individual basis before beginning a regiment of hormone replacement therapy: personal needs, medical and family history, symptoms and risk of bone loss.

One of the most common and uncomfortable symptoms of menopause are hot flashes. Hot flashes may occur often, lasting several seconds or several minutes. Intense hot flashes cause skin reddening and sweating and may interrupt sleep. Sleep disturbance can affect your mood, health, and ability to cope with daily activities. In addition to hot flashes, vaginal dryness due to changes in the vaginal lining may occur. Vaginal dryness often causes irritation of the urinary tract. Many women with severe vaginal drying and an irritated urinary tract may experience pain during sex, greatly reducing sexual libido. Taking estrogen greatly relieves these uncomfortable and sometimes painful symptoms for many menopausal women. Combined estrogen and progesterone therapy decreases the risk of uterine and colon cancers.

Like any treatment, hormone therapy is not free of risk. Women taking estrogen and progesterone may have a slightly higher risk of developing breast cancer.  This risk increases throughout the time hormones are taken. Hormone replacement may also increase cardiovascular incidents in some post menopausal women. Estrogen therapy may be contraindicated in women with a past history of stroke, heart attack,breast cancer, and a variety of other diseases. When hormones are contraindicated, there are other medications that may treat specific symptoms related to menopause.  Lifestyle changes are a very important way to treat menopause symptoms. Exercising, maintaining a healthy diet and not smoking will help to treat hot flashes, decrease bone loss and may significantly decrease the risk of heart disease and cancer.

Hormone replacement provides effective relief of menopausal symptoms, but it is not for everyone. If hormone replacement is used, ACOG recommends therapy with the lowest effective dose for the shortest period of time necessary. Taking everything into account, how can women determine whether or not hormone replacement therapy is the correct approach for treatment of their menopause symptoms? The benefits of hormone replacement therapy should outweigh the risks: women should work closely with their doctors to make this determination based on their personal needs and medical history.

For more information on this topic please visit www.acog.org.

The information in this column does not dictate an exclusive course of treatment or procedure to be followed and should not be construed as excluding other acceptable methods of practice. As always, women should consult their obstetrician-gynecologist when making health care decisions.