Hormone Replacement Replaced
Hormone Therapy Focus: Short-Term Treatment of Menopause Symptoms
Young Women with Hysterectomies
The experts seem to agree that there's another group of women who benefit from long-term estrogen therapy.
"It's an entirely different situation for the younger woman with a hysterectomy," Rebar says. "Most of us believe that in those situations of premature menopause, estrogen is truly being used for replacement in women who would naturally have the hormone. But there is no data."
And the Experts Disagree, Too
The NAMS panel also failed to agree on a number of things. These include:
- What is "short-term" HT? What is "long-term" HT? The only agreement on this question is that no uniform time applies to all women.
- Does HT increase the short-term risk of heart disease? It's not clear, although women who already have heart disease should not begin HT.
- How long should a woman with menopausal symptoms take HT?
- Is there a best way to stop taking HT? Some say stop abruptly, some say taper the dose.
- Does it matter whether you take continuous combined estrogen/progestin or continuous estrogen with sequential progestin/progesterone?
- Does HT enhance a woman's quality of life?
How To Talk To Your Doctor
What's a woman to do? Here's Utian's advice.
"What should a doctor say to a patient? I think it is an individualized discussion based on that person's individual profile," he says. "Does she have specific menopausal symptoms? If so, then she is a potential candidate for hormones. If she has only local vaginal symptoms, she is a candidates for local vaginal treatment. And if she is considering HT, has she had breast cancer, thromboembolism, or are there other major risk factors that indicate caution?
"The conversation should be, number one, 'Do I have a reason to take HT?' And, two, 'Am I at increased risk if I did take them?' Then the rest of the conversation should be does she understand the level of risk, the potential benefit versus the potential risk. After that, it's up to her whether or not to take hormones."