The Pros and Cons of Hormone Replacement Therapy
Trying to keep up with the latest on hormone replacement therapy (or HRT) can be tough.
"Women don't know what to believe anymore," says Shelley R. Salpeter, MD, director of medicine consultation services at Santa Clara Valley Medical Center in San Jose, Calif.
Experts debate the risks and benefits of hormone replacement therapy, but everyone, including the FDA, agrees that it definitely helps with two conditions: the symptoms of menopause and osteoporosis.
Here are the pros and cons of using hormone replacement therapy, as well as some alternatives:
||Alternatives to Hormone Replacement Therapy
- Hot flashes
- Night sweats
- Vaginal dryness
- Sleep problems
- Mood changes
|Considered the best treatment for these symptoms (when severe), in women who are perimenopausal or postmenopausal.
||Slight increased risk of breast or uterine cancer (risk is decreased if estrogen AND progesterone are used or if the woman has had a hysterectomy), and heart attack or stroke, in some women. May not be recommended for women who have a family or personal history of heart disease, stroke, blood clots, or breast cancer.
||Some antidepressants can help with mood changes, sleep problems, and reduce hot flashes and night sweats.
Treating each symptom directly.
Some women use herbal remedies like black cohosh, but studies have not shown that they help. With time, most women's menopausal symptoms will subside.
Osteoporosis (thinning bones)
||Highly effective in reducing the risk of osteoporosis. May be good for women who cannot use other medicines that protect bone health.
||Same as above.
Using hormone replacement therapy for prevention of osteoporosis alone -- not to treat menopausal symptoms -- is not recommended by the FDA. However, some women and their doctors may choose to use it for this reason.
Bisphosphonates, which reduce the breakdown of bone.
SERMs, a new class of synthetic estrogen that does not have the same negative effects as estrogen.
Calcium and vitamin D supplements, and weight bearing exercise.
Synthetic parathyroid hormone, which stimulates growth of bone.
RANKL inhibitor (Prolia), which reduces bone turnover and resorption.
Hormone Replacement Therapy & Disease Prevention
Hormone replacement therapy was once used to prevent heart disease, dementia, Alzheimer's disease, and other conditions. But it is rarely used that way now. In at least some women, it may increase the risks of these conditions.
Some doctors use HRT in cases where a woman has a combination of symptoms that hormone replacement therapy can relieve. For instance, while using HRT for osteoporosis alone is not generally recommended, it may be used in a woman for that reason.
"If a woman in early menopause has low bone density, high cholesterol, mood changes, and sleep problems, she could just take one medicine -- estrogen -- instead of four," says Lynne T. Shuster, MD, director of the Women's Health Clinic at the Mayo Clinic in Rochester, Minn.
The key is to work closely with your doctor. Before deciding on hormone replacement therapy, go over the specific risks and benefits in your case. Keep in mind your age, lifestyle, and risk for disease. Then get regular checkups to make sure that you should continue with HRT.