So this is menopause. You are 52 years old and have not had a period in a year. That's good. You are still having some hot flashes, but generally they are not too bad. You wake up early too often, and that makes you tired during the day. What worries you is this - your mother is 77. She just fell and broke her hip. Her doctor says she has osteoporosis. What can you do to keep that from happening to you in the future?

Doctors sometimes prescribe the hormones estrogen and progestin, in a treatment called hormone replacement therapy (HRT), to ease the signs of menopause. It may also protect you against more serious illness in the future.

Many women take HRT. Some women should not. It may or may not be the right choice for you.

First, it's a good idea to know what happens to your body with menopause. At this time, your body makes less of the female hormones, estrogen and progesterone. After menopause, you are free from concerns about monthly menstrual periods and getting pregnant. But during the years around menopause you might have annoying symptoms.

These may include hot flashes (a sudden flush or warmth, often followed by sweating), sleep problems, or vaginal dryness. Many women have little or no trouble with menopause. Some have moderate to severe discomfort. Estrogen loss also puts you at risk for more serious health problems. These include heart disease, stroke, and osteoporosis. Heart disease is the leading cause of death for women over the age of 50. It kills more women than lung and breast cancer combined.

Bone loss is common as people age. However, if there is a great loss, osteoporosis may develop. This is a serious condition. Bones weaken and break easily. It threatens about 28 million Americans. Eighty percent of them are women, and most are over 50 years of age.

What Is HRT?

Doctors usually prescribe HRT which combines estrogen and progestin (a form of progesterone). Estrogen can and should be used alone (estrogen replacement therapy or ERT) for women who have had their uterus, including the cervix, removed (by hysterectomy).

Estrogen alone comes in many forms. You can use the pill or tablet form, vaginal creams, vaginal ring insert, implants, or shots. There are also patches that stick to the skin. The body absorbs estrogen from the patch through the skin. Progestin usually is taken in pill form, sometimes in the same pill as the estrogen. It is also available as an IUD (intrauterine device), a vaginal gel, and shots. The form your doctor suggests may depend on your symptoms. For instance, estrogen creams are used for vaginal dryness.

The vaginal ring insert treats vaginal dryness and may help urinary tract symptoms, such as problems holding urine. Pills or patches, however, are used to provide additional relief from menopause symptoms such as hot flashes or to prevent bone loss. There are different schedules for taking HRT in pill form. You could take estrogen every day for a set number of days, add progestin for 10-14 days, and then stop taking one or both for a specific period of time.

You would repeat the same pattern every month. This cyclic schedule often causes regular monthly bleeding like a light menstrual period. Or you could take estrogen and progestin together every day of the month without any break. This continuous pattern can stop monthly bleeding after about six months of treatment. However, problem spotting may continue for longer. Talk with your doctor about the schedule that is best for you.

Why Should I Think About HRT/ERT? Taking HRT/ERT for a short time (perhaps for a few years) may help relieve the annoying symptoms, such as hot flashes, that you may be having during menopause. Taking such hormone supplements for a longer time:

·will also help delay osteoporosis,

·may protect against heart disease,

·should improve your cholesterol levels, and

·may also help your memory.

What Are The Risks of HRT/ERT? Both HRT and ERT can have side effects. You could have bloating, breast tenderness, cramping, irritability, depression, and sometimes spotting or a return of monthly periods for a few months or years. By changing the amount of hormone, the way it is taken, or the timing of the dose, your doctor may be able to control these side effects. They may disappear over time also. Many women now live 25, 30, or more years after menopause. Could taking hormone therapy for many of those years be helpful to women? Would it be safe?

Women and their doctors need to know the benefits and risks of using HRT or ERT for many years. Studies are now being done to provide the answers. Some of the known or suspected risks are:

Endometrial cancer.

Estrogen supplements, particularly in high doses, can lead to endometrial cancer, a cancer of the lining of the uterus.

Most doctors now suggest lower doses of estrogen, along with a form of progesterone, for women who still have a uterus.

The progesterone protects against this form of cancer. Women who have had their uterus and cervix removed can use estrogen alone.

Breast Cancer.

An important question about HRT and ERT is presently under study: Does HRT/ERT increase your risk of breast cancer? Although the answer is not known now, many doctors believe that if you are not at high risk for breast cancer, you can safely use HRT or ERT.

They believe that the benefits of this therapy to the heart and bones are more important than the risks in many women. This is especially true for women with a family history of osteoporosis.

Blood clots.

Another possible risk of HRT, ERT, and the osteoporosis drug raloxifene for some women is blood clots in their veins. The chance of developing these clots is small for women not using these hormones or drugs.

There is a significant increase in your chance of blood clots if you take any of these.

Hormonal Therapy

Here is what scientists can say so far about the advantages and disadvantages of hormone replacement therapy (HRT) and estrogen replacement therapy (ERT). Research is ongoing.

Pro

·HRT and ERT reduce the risk of osteoporosis.

·HRT and ERT relieve hot flashes and night sweats.

·HRT and ERT may reduce the risk of heart disease.

·HRT and ERT may improve mood and psychological wellbeing.

Con

·ERT, especially without the use of a progestin, increases the risk of cancer of the uterus (endometrial cancer).

·HRT can have unpleasant side effects, such as bloating or irritability.

·HRT and ERT may increase risk of breast cancer; long-term use may pose the greatest risk.

·In women at risk of blood clots, HRT and ERT may be dangerous.

What are SERMs?

SERMs (selective estrogen receptor modulators) are a new type of medicine. Raloxifene (approved by the Food and Drug Administration to prevent osteoporosis) and tamoxifen (approved for breast cancer treatment and prevention) are examples of SERMs.

They are designed to do some of the good things estrogen does such as protecting bone density. However, they may not have some of the negative side effects. For example, tamoxifen appears to protect against developing breast cancer. Raloxifene does not seem to increase the chance of endometrial cancer as estrogen alone or tamoxifen might. Women on tamoxifen should see their gynecologist regularly to be sure their uterus is normal.

These two SERMS do, however, have a risk of blood clots similar to estrogen. Also, raloxifene and tamoxifen can make hot flashes worse. Scientists are continuing to work on developing better SERMs to use for menopause in the future.

Should I Use Hormone Therapy?

This question is best answered after talking with your doctor (general practitioner, internist, or gynecologist). He or she can tell you if you should consider HRT or ERT. You probably should not use these supplements if you have liver disease, high levels of triglycerides (a type of fat in the blood), or a history of blood clots in your veins. Women with a family history of breast cancer might also want to get the opinion of their cancer doctor.

The first step is to decide how much you are bothered by menopause symptoms such as hot flashes. You will also need to think about your medical history, your risk of heart disease, osteoporosis, and breast cancer, and your family history of these illnesses. Any decision about HRT or ERT that you make now is not final. You can start or end the treatment anytime, but if you stop it, the protective effects of these therapies will stop as well. Your decision about hormone therapy should be reviewed each year with your doctor at your annual checkup. After menopause, it is important to continue yearly breast and vaginal exams, Pap tests, and mammograms, as well as a general physical exam.

Resources

For further information on menopause and hormone replacement therapy contact:

American College of Obstetricians and Gynecologists (ACOG)

409 12th Street, SW
Box 96920
Washington, DC 20090
202-484-8748
Internet website: http://www.acog.org

North American Menopause Society

Box 94527
Cleveland, OH 44101
216-844-8748
Internet website: http://www.menopause.org

(Courtesy of the National Institute of Aging)




		Menopause & Menstruation
	Hormone Replacement Therapy (Courtesy of the National Institute of Aging) So this is menopause. You are 52 years old and have not had a period in a year. That's good. You are still having some hot flashes, but generally they are not too bad. You wake up early too often, and that makes you tired during the day. What worries you is this - your mother is 77. She just fell and broke her hip. Her doctor says she has osteoporosis. What can you do to keep that from happening to you in the future? Doctors sometimes prescribe the hormones estrogen and progestin, in a treatment called hormone replacement therapy (HRT), to ease the signs of menopause. It may also protect you against more serious illness in the future. Many women take HRT. Some women should not. It may or may not be the right choice for you. First, it's a good idea to know what happens to your body with menopause. At this time, your body makes less of the female hormones, estrogen and progesterone. After menopause, you are free from concerns about monthly menstrual periods and getting pregnant. But during the years around menopause you might have annoying symptoms. These may include hot flashes (a sudden flush or warmth, often followed by sweating), sleep problems, or vaginal dryness. Many women have little or no trouble with menopause. Some have moderate to severe discomfort. Estrogen loss also puts you at risk for more serious health problems. These include heart disease, stroke, and osteoporosis. Heart disease is the leading cause of death for women over the age of 50. It kills more women than lung and breast cancer combined. Bone loss is common as people age. However, if there is a great loss, osteoporosis may develop. This is a serious condition. Bones weaken and break easily. It threatens about 28 million Americans. Eighty percent of them are women, and most are over 50 years of age. What Is HRT? Doctors usually prescribe HRT which combines estrogen and progestin (a form of progesterone). Estrogen can and should be used alone (estrogen replacement therapy or ERT) for women who have had their uterus, including the cervix, removed (by hysterectomy). Estrogen alone comes in many forms. You can use the pill or tablet form, vaginal creams, vaginal ring insert, implants, or shots. There are also patches that stick to the skin. The body absorbs estrogen from the patch through the skin. Progestin usually is taken in pill form, sometimes in the same pill as the estrogen. It is also available as an IUD (intrauterine device), a vaginal gel, and shots. The form your doctor suggests may depend on your symptoms. For instance, estrogen creams are used for vaginal dryness. The vaginal ring insert treats vaginal dryness and may help urinary tract symptoms, such as problems holding urine. Pills or patches, however, are used to provide additional relief from menopause symptoms such as hot flashes or to prevent bone loss. There are different schedules for taking HRT in pill form. You could take estrogen every day for a set number of days, add progestin for 10-14 days, and then stop taking one or both for a specific period of time. You would repeat the same pattern every month. This cyclic schedule often causes regular monthly bleeding like a light menstrual period. Or you could take estrogen and progestin together every day of the month without any break. This continuous pattern can stop monthly bleeding after about six months of treatment. However, problem spotting may continue for longer. Talk with your doctor about the schedule that is best for you. Why Should I Think About HRT/ERT? Taking HRT/ERT for a short time (perhaps for a few years) may help relieve the annoying symptoms, such as hot flashes, that you may be having during menopause. Taking such hormone supplements for a longer time: ·will also help delay osteoporosis, ·may protect against heart disease, ·should improve your cholesterol levels, and ·may also help your memory. What Are The Risks of HRT/ERT? Both HRT and ERT can have side effects. You could have bloating, breast tenderness, cramping, irritability, depression, and sometimes spotting or a return of monthly periods for a few months or years. By changing the amount of hormone, the way it is taken, or the timing of the dose, your doctor may be able to control these side effects. They may disappear over time also. Many women now live 25, 30, or more years after menopause. Could taking hormone therapy for many of those years be helpful to women? Would it be safe? Women and their doctors need to know the benefits and risks of using HRT or ERT for many years. Studies are now being done to provide the answers. Some of the known or suspected risks are: Endometrial cancer. Estrogen supplements, particularly in high doses, can lead to endometrial cancer, a cancer of the lining of the uterus. Most doctors now suggest lower doses of estrogen, along with a form of progesterone, for women who still have a uterus. The progesterone protects against this form of cancer. Women who have had their uterus and cervix removed can use estrogen alone. Breast Cancer. An important question about HRT and ERT is presently under study: Does HRT/ERT increase your risk of breast cancer? Although the answer is not known now, many doctors believe that if you are not at high risk for breast cancer, you can safely use HRT or ERT. They believe that the benefits of this therapy to the heart and bones are more important than the risks in many women. This is especially true for women with a family history of osteoporosis. Blood clots. Another possible risk of HRT, ERT, and the osteoporosis drug raloxifene for some women is blood clots in their veins. The chance of developing these clots is small for women not using these hormones or drugs. There is a significant increase in your chance of blood clots if you take any of these. Hormonal Therapy Here is what scientists can say so far about the advantages and disadvantages of hormone replacement therapy (HRT) and estrogen replacement therapy (ERT). Research is ongoing. Pro ·HRT and ERT reduce the risk of osteoporosis. ·HRT and ERT relieve hot flashes and night sweats. ·HRT and ERT may reduce the risk of heart disease. ·HRT and ERT may improve mood and psychological wellbeing. Con ·ERT, especially without the use of a progestin, increases the risk of cancer of the uterus (endometrial cancer). ·HRT can have unpleasant side effects, such as bloating or irritability. ·HRT and ERT may increase risk of breast cancer; long-term use may pose the greatest risk. ·In women at risk of blood clots, HRT and ERT may be dangerous. What are SERMs? SERMs (selective estrogen receptor modulators) are a new type of medicine. Raloxifene (approved by the Food and Drug Administration to prevent osteoporosis) and tamoxifen (approved for breast cancer treatment and prevention) are examples of SERMs. They are designed to do some of the good things estrogen does such as protecting bone density. However, they may not have some of the negative side effects. For example, tamoxifen appears to protect against developing breast cancer. Raloxifene does not seem to increase the chance of endometrial cancer as estrogen alone or tamoxifen might. Women on tamoxifen should see their gynecologist regularly to be sure their uterus is normal. These two SERMS do, however, have a risk of blood clots similar to estrogen. Also, raloxifene and tamoxifen can make hot flashes worse. Scientists are continuing to work on developing better SERMs to use for menopause in the future. Should I Use Hormone Therapy? This question is best answered after talking with your doctor (general practitioner, internist, or gynecologist). He or she can tell you if you should consider HRT or ERT. You probably should not use these supplements if you have liver disease, high levels of triglycerides (a type of fat in the blood), or a history of blood clots in your veins. Women with a family history of breast cancer might also want to get the opinion of their cancer doctor. The first step is to decide how much you are bothered by menopause symptoms such as hot flashes. You will also need to think about your medical history, your risk of heart disease, osteoporosis, and breast cancer, and your family history of these illnesses. Any decision about HRT or ERT that you make now is not final. You can start or end the treatment anytime, but if you stop it, the protective effects of these therapies will stop as well. Your decision about hormone therapy should be reviewed each year with your doctor at your annual checkup. After menopause, it is important to continue yearly breast and vaginal exams, Pap tests, and mammograms, as well as a general physical exam. Resources For further information on menopause and hormone replacement therapy contact: American College of Obstetricians and Gynecologists (ACOG) 409 12th Street, SW Box 96920 Washington, DC 20090 202-484-8748 Internet website: http://www.acog.org North American Menopause Society Box 94527 Cleveland, OH 44101 216-844-8748 Internet website: http://www.menopause.org (Courtesy of the National Institute of Aging) Copyright 2002 Brandwynne Corporation. All rights reserved. Thank you for your trust.

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