Hormone therapy

As women age their hormone levels naturally decrease. This can cause physical and emotional changes that can be troubling, such as hot flashes and mood swings.

Hormone therapy (HT) is sometimes prescribed to boost hormone levels and provide relief. Because it has been the subject of some controversy, many women wonder if HT is a good option for them. The Menopause and Osteoporosis Update 2009 published by SOGC recommends that doctors prescribe HT in the lowest dose required, and for the duration necessary, to treat troubling menopause symptoms. Current research confirms that HT is both a safe and effective way to treat symptoms of menopause. Your health-care provider can help you understand the risks and benefits of different treatments.

How does HT work?

Hormone therapy may be recommended for women with moderate to severe menopause symptoms, or for those who have had a hysterectomy or reached menopause at a young age—before 50. HT helps restore balance in a woman’s body after her ovaries have stopped producing estrogen and progestin. An HT program may involve the use of estrogen alone (estrogen therapy, or ET), or estrogen and progestin in combination (EPT).

A range of treatment options

During menopause, the amount of estrogen in a woman’s body declines. As estrogen helps control unhealthy cholesterol, this change can increase the risk of heart disease. Eighty-eight percent of women aged 55-64 have high cholesterol.

Source: CityA.M., Cholesterol, another silent killer, Oct. 7, 2008

Hormone therapies can involve oral medications, skin patches (transdermal), or gels to address symptoms such as hot flashes. Other HTs are applied directly to problem areas; for example, a cream, tablet or ring may be recommended to deal with vaginal symptoms and restore estrogen. Your physician can help advise you on HT options, as well as alternative therapies, and the impact of lifestyle choices (such as diet, exercise, and consumption of alcohol, tobacco and caffeine) on your symptoms.

The safety of HT

According to the SOGC’s Menopause and Osteoporosis Update 2009 , HT is a safe and effective treatment option for moderate to severe menopausal symptoms such as hot flashes, night sweats, mood swings, insomnia, difficulty concentrating and vaginal dryness. The Consensus Report, which was produced by a team of health professionals that examined current research on menopause and the management of menopause symptoms, specifically advises that:

  • HT is a safe and effective option for short-term use (up to five years) for the treatment of moderate to severe menopausal symptoms such as hot flashes, night sweats, mood swings, insomnia, difficulty concentrating and vaginal dryness. In addition, HT has the secondary benefit of providing protection against osteoporosis and colon cancer.
  • In cases where symptoms recur after short-term HT, women should consult with their health-care provider about the risks and benefits of continuing over the longer term, and the impact on quality of life.
  • Anyone taking hormone therapy—especially women who have been taking the treatment for five years or more—should consult with their health-care provider each year to review dosage, reasons for taking HT, and risks and benefits. If you decide to stop treatment, your health-care provider can advise you how to do so safely.

Side effects

Certain side effects can occur in women who take HT. Forty percent of women undergoing HT treatment have irregular breakthrough bleeding during the first three to six months. In most cases bleeding stops within 12 months, but for some women  it may continue beyond a year. Women taking estrogen therapy may experience breast tenderness, nausea, headache and bloating. These symptoms can often be treated by changing the dosage. HT may not mix well with certain other drugs. Any woman taking HT should consult a health-care provider about drug interactions.

Secondary effects

Combined HT is associated with a reduced risk of colorectal cancer and may slightly increase the risk of ovarian cancer. These effects are rare and should not influence a woman’s decision about the use of HT. Women who have undergone a hysterectomy and no longer have a uterus are typically prescribed estrogen therapy (ET), while other women are more likely to be given EPT (a combination of estrogen and progestin). Progestin offers the added advantage of protecting the uterus’ lining from endometrial cancers. For women with premature ovarian failure, long-term HT can help manage certain health concerns.

Studies suggest that HT can also reduce the risk of developing diabetes. Estrogen can positively impact glucose and insulin metabolism, and in some postmenopausal Type II diabetic women it has improved the glycemic control and serum lipoproteins in their bodies.

Fluctuating or decreasing levels of estrogen can trigger migraine headaches. Although the effects vary, HT can lead to a worsening of migraine headaches.

Hypoactive thyroid disease is common among women, revealing itself most often after menopause. No direct link has been made between the disease and the decrease in estrogen at menopause, and no evidence has emerged to show whether HT use reduces the risk of developing the disease.

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SOGC

"First I read that HT is safe. Then I read that HT increases my risk of breast cancer. It’s hard to know what’s right when everywhere I turn I’m getting conflicting advice. Do I really have options?"

Compared to regular birth control pills, the lower dose of estrogen in very low dose HT pills may be safer for perimenopausal women. (Perimenopause begins about 3 to 5 years before your final period.) Regular birth control pills contain 30 to 50 micrograms of estrogen; low dose HT contain only 20 micrograms of ethinyl estradiol.