Hormone Therapy

Share on emailShare What are estrogen and progesterone?

Estrogen and progesterone are hormones that are produced by a woman's ovaries.

Why does the body need estrogen?

Estrogen thickens the lining of the uterus, preparing it for the possible implantation of a fertilized egg. Estrogen also influences how the body uses calcium, an important mineral in the building of bones. In addition, estrogen helps maintain healthy levels of cholesterol in the blood. Estrogen is necessary in keeping the vagina healthy.

As menopause nears, the ovaries reduce most of their production of these hormones. Lowered or fluctuating estrogen levels may cause menopause symptoms such as hot flashes, and medical conditions such as osteoporosis.

What is hormone therapy (HT)?

Hormone therapy (HT) is a treatment that is used to supplement the body with either estrogen alone or estrogen and progesterone in combination. When the ovaries no longer produce adequate amounts of these hormones (as in menopause), HT can be given to supplement the body with adequate levels of estrogen and progesterone. HT helps to replenish the estrogen, relieving some of the symptoms of menopause and helping to prevent osteoporosis.

Why is progesterone taken?

Progesterone is used along with estrogen in women who still have their uterus. In these women, estrogen-- if taken without progesterone--increases a woman's risk for cancer of the endometrium (the lining of the uterus). During a woman's reproductive years, cells from the endometrium are shed during menstruation. When the endometrium is no longer shed, estrogen can cause an overgrowth of cells in the uterus, a condition that can lead to cancer.

Progesterone reduces the risk of endometrial (uterine) cancer by making the endometrium thin. Women who take progesterone may have monthly bleeding, or no bleeding at all, depending on how the hormone therapy is taken. Monthly bleeding can be lessened and, in some cases, eliminated by taking progesterone and estrogen together continuously. Women who have had a hysterectomy (removal of the uterus through surgery) usually do not need to take progesterone. This is an important point, because estrogen taken alone has fewer long-term risks than HT that uses a combination of estrogen and progesterone.

What are the types of HT?

There are two main types of HT:

• Estrogen Therapy (ET): Estrogen is taken alone. Doctors most often prescribe a low dose of estrogen to be taken as a pill or patch every day. Estrogen may also be prescribed as a cream, vaginal ring, gel or spray. You should take the lowest dose of estrogen needed to relieve menopause symptoms and/or to prevent osteoporosis. This type of HT is used if a woman has had a hysterectomy.
• Estrogen Progesterone/Progestin Hormone Therapy (EPT): Also called combination therapy, this form of HT combines doses of estrogen and progesterone (progestin is a synthetic form of progesterone). This type of HT is used if a woman still has her uterus.

What are the benefits of taking HT?

HT is prescribed to relieve:

• Hot flashes
• Vaginal dryness that can result in painful intercourse
• Other problematic symptoms of menopause, such as night sweats and dry, itchy skin

Other benefits of taking HT include:

• Reduced risk of developing osteoporosis and reduced risk of bone breakage
• Improvement of mood and overall sense of mental well-being in some women
• Decreased tooth loss
• Lowered risk of colon cancer
• Lowered risk of diabetes
• Modest improvement in joint pains
• Lower death rate for women who take hormone therapy in their 50s.

What are the risks of taking HT?

While HT helps many women get through menopause, the treatment (like any prescription or even non-prescription medicines) is not risk-free. Known health risks include:

• An increased risk of endometrial cancer (only if a woman still has her uterus and is not taking a progestin along with estrogen).
• Increased risk of blood clots and stroke. However, in women within 5 years of menopause there was no statistically significant increase in stroke risk. Also, studies suggest that using estrogen delivered from the skin via a patch/cream might further lessen the risk of blood clots.
• Increased chance of gallbladder/gallstone problems.
• Increased risk of dementia if hormone therapy is started after a woman has been in menopause for 10 years. It is not yet known if it might be beneficial for women who start HT in their 50s.

Most of our understanding about the benefits and risks of hormone therapy on the heart and breast come from the Women’s Health Initiative (WHI) study (one of the largest studies done on hormone therapy):

HT and the heart

Recent analysis of WHI actually shows that the risk of heart disease may be related more to the advanced age of the participants as opposed to the HT. The study also found that HT given to younger women, at the onset of menopause, appeared to decrease the risk of heart disease. More specifically:

An increased risk of heart disease is only seen in women taking long-term estrogen-progestin combination therapy (EPT) if they start HT in their mid-60s. There does not seem to be an increased risk of heart disease when women in their 50s start EPT. Estrogen alone (ET) has not been shown to increase the risk of heart disease. Analysis of the age since menopause actually shows a decrease in the risk of heart disease when ET was started in younger women (those just beginning menopause).

Currently, it is not recommended to use hormone therapy solely for the purpose of preventing heart disease. However these studies give us reassurance that when women just newly approaching menopause need HT for a short time, it is safe to do so in terms of long term heart disease risk.

HT and breast cancer

Diagnosis of breast cancer increases when combination EPT is used beyond 3-5 years. This means that out of 10,000 women who use estrogen progestin therapy for more than 5 years, there will be 8 additional breast cancers diagnosed. In contrast, the WHI study showed women who use estrogen alone had no increase in risk of breast cancer even after 11 years of use. In fact, fewer breast cancers were seen in the group taking estrogen alone, though this was not statistically significant. When a woman comes off of hormone th