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hormone replacement therapy Alternative Names HRT, estrogen replacement therapy, ERT Definition Hormone replacement therapy, called HRT, is the use of man- made or natural hormones to treat a person whose body is no longer making enough of certain hormones. It is often prescribed for women in menopause. It is also given to women who have had their ovaries removed. HRT for menopause usually consists of the hormones estrogen and progesterone taken together. Estrogen may also be taken alone. This is called estrogen replacement therapy, and is also known as ERT. What is the information for this topic? HRT has both benefits and risks. Menopause Estrogen levels drop when women enter menopause or have their ovaries removed. Low levels of estrogen produce the common symptoms of menopause: painful intercourse, a condition known as dyspareunia hot flashes mood changes night sweats sleep disorders vaginal dryness HRT is often given to reduce these symptoms. Women who have had their uterus and ovaries removed generally take estrogen alone. Women who still have their uterus need progesterone along with estrogen. This is because taking estrogen alone can increase the risk of cancer of the uterus. Recent studies have looked at the link between HRT and memory in women. Here are some recent findings. Estrogen use after menopause did not reduce a woman's risk for Alzheimer's disease. HRT did not slow the rate of memory loss in women after menopause. Perimenopause Perimenopause is the time when a woman may be having sporadic periods but has not yet reached menopause. Women are sometimes given oral contraceptives at this time. These medicines control irregular menstrual periods and symptoms of menopause. They typically contain both estrogen and progesterone at higher doses than are used in HRT. Because a woman may continue to ovulate during perimenopause, it is still possible for her to become pregnant. A woman who wants to avoid pregnancy should use birth control until a blood test shows that menopause is present. Or, she should use birth control until she does not have a period for 12 months in a row. After that, she may switch to the lower doses of hormones in HRT. The hormone doses in HRT are not high enough to prevent pregnancy. Benefits of HRT These are the potential benefits of HRT: decrease in LDL, which is also called the bad cholesterol decrease in total blood cholesterol increase in HDL, also known as the good cholesterol prevention of bone fractures in the hip and spine from osteoporosis relief of hot flashes and vaginal dryness slowing of bone loss and osteoporosis slight decrease in colorectal cancer HRT improves the levels of lipids in the body. Because of this, this therapy was often prescribed for menopausal women to decrease their risk of heart disease. However, experts found that there was also an increase in stroke and heart attack in women taking HRT. So, in 2002, the Women's Health Initiative recommended that women not be started on HRT just to prevent heart disease. Risks of HRT Research has shown several risks associated with taking HRT or ERT. HRT and ERT increase the risk of breast cancer HRT slightly increases a woman's risk for stroke and heart attack HRT can increase a woman's risk for gallbladder disease. HRT and ERT can increase a woman's risk of blood clots, such as deep venous thrombosis and pulmonary embolism. If a woman still has her uterus, taking estrogen alone increases the risk of cancer of the uterus. Adding progesterone reduces her risk to that of women who do not take ERT. Deciding about HRT A woman can choose from several strategies to cope with menopause and perimenopause, such as: Do nothing. Take birth control pills to control irregular periods during perimenopause. Take HRT or ERT during menopause to improve symptoms. Use natural alternatives to HRT, such as foods high in phytoestrogens. These, however, have not been proven to have all of the same benefits as HRT or ERT. Use estrogen creams for vaginal dryness. Creams do not help with other symptoms of menopause. Overall, the decision to use HRT should be based upon the proven benefits and risks of HRT. Women should discuss the benefits and risks with their doctors. Together, they can choose the best course of action.

Author: Terry Mason, MPH Date Written: 06/15/00 Reviewer: Melinda Murray Ratini, DO Date Reviewed: 08/15/02 Potential conflict of interest information for reviewers available on request