Hormone Replacement Therapy Q&A

1. Should I stop taking hormone replacement therapy (HRT)?

It depends on how long you’ve been taking it and why. Here are some facts to help you decide:

You may be taking HRT to relieve menopause symptoms. At one time, doctors also used to prescribe HRT to manage diseases like osteoporosis and heart disease in women past menopause. But in 2002, a Women’s Health Initiative study found that women who took the most common form of HRT, a combined estrogen and progesterone pill, had a higher risk of heart disease, stroke, and blood clots.

HRT and Menopause Symptoms: Research shows that a small dose of HRT is still the best way to reduce uncomfortable symptoms in early menopause. Women younger than 60 have the lowest risks, especially if they use the estrogen-only formula for a short time, applying it to their skin instead of taking by mouth.

Several years of treatment is usually enough to relieve symptoms. So if you’ve been on HRT for more than 5 years, talk with your doctor about tapering off. But you should remember that after stopping, you can expect the hot flushes to return.

HRT and Heart Disease: Doctors no longer prescribe hormones to manage heart disease or other chronic conditions like osteoporosis. If you’re taking HRT to reduce the risk of heart disease, ask your doctor about gradually stopping it.

Before the WHI study, doctors prescribed HRT for heart problems. Some earlier studies showed that women who took hormones had lower rates of heart disease and other chronic diseases. The women may have just been healthier and had better access to medical care.

The WHI study and follow-ups confirmed that HRT didn’t reduce the risk of heart disease; it increased it in healthy, postmenopausal women.

HRT and Osteoporosis: As with heart disease, you should weigh the benefits of using hormones with other risks. To reduce osteoporosis, doctors often suggest lifestyle changes such as regular weight-bearing exercise. You can also try medicine like Fosamax and Evista, or calcium and vitamin D supplements.

Or you may look at other choices, such as statins, which reduce cholesterol in the blood, but also treat osteoporosis and heart disease.

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2. Is any type of hormone therapy safer than others?

Experts are still not sure. You and your doctor should talk about which form of HRT might be right for you.

Low-dose hormone replacement therapy: Studies show that lower doses of hormone replacement therapy offer the same benefits without as many risks. In a new study by the Fred Hutchinson Cancer Research Center, where the WHI research took place, women who took low-dose estrogen had 53% fewer hot flashes and night sweats.

Estrogen alone: This is the suggested treatment for women who’ve had a hysterectomy to remove their uterus. Women who take estrogen alone have fewer risks of breast cancer and other disorders. Still, doctors caution that taking estrogen alone can increase your risk of stroke and uterine cancer.

Bio-identical estrogen patches, creams, or vaginal rings: These forms of estrogen are similar to what the body makes. Unlike a pill, they enter the body through the skin or walls of the vagina. In this way, they bypass the liver, reducing the risk of serious blood clots or gallbladder disease. There is still a risk of both, but it will be less than if you were taking the equivalent dose of oral hormones.

3. What else can I do to prevent menopause symptoms?

Soy or black cohosh: Soy and black cohosh supplements contain phytoestrogens, plant materials that may act like estrogen in the body. Some studies haven’t found any proof that these “natural” therapies reduce menopause symptoms. Supplements aren’t regulated or approved by the FDA, and phytoestrogens may increase risks for certain diseases.

Antidepressants : Studies show antidepressants like Prozac and Effexor reduce hot flashes. One study found that venlafaxine, the main ingredient in Effexor, reduced hot flashes and night sweats by 48%. The results were similar to those for low-dose estrogen but without the risks.

Lifestyle changes: Here are some other ways to cope with menopause symptoms:

  • Dress in layers so you can remove clothes as needed.
  • Avoid hot and spicy foods and beverages.
  • Use cotton sheets, and wear clothes that allow your skin to breathe.
  • Limit caffeine and alcohol.
  • Use relaxation techniques such as yoga.
  • Don’t smoke.
  • Get regular exercise.

Don’t forget to check with your doctor. The best plan for you might be to do nothing at all.

WebMD Medical Reference Reviewed by Traci C. Johnson, MD on August 12, 2016

Sources

SOURCES:

Garnet Anderson, MD, director, public health sciences division, Fred Hutchinson Cancer Research Center, Seattle.

Familydoctor.org.

Joffe, H. JAMA Internal Medicine, July2014.

John Hopkins Medicine: “Introduction to Menopause.”

Manson, J. Fertility and Sterility, April 2014.

Manson, J. Journal of the American Medical Association, Oct. 2, 2013.

JoAnn E. Manson, MD, chief, preventative medicine division, department of medicine, Brigham and Women’s Hospital, Boston.

National Cancer Institute: “Menopausal Hormone Therapy and Cancer.”

National Center for Complementary and Alternative Medicine: “Menopausal Symptoms and Complementary Health Practices.”

National Institute on Aging: “Hormones and Menopause.”

News releases, Fred Hutchinson Cancer Research Center.

Newton, K. Annals of Internal Medicine. Dec. 19, 2006.

North American Menopause Society: “Hormone Therapy for women in 2012.”

Office on Women’s Health, U.S. Department of Health and Human Services: “Natural/alternative treatment & lifestyle changes.”

American College of Obstetricians and Gynecologists: “2011 Women’s Health Stats & Facts.”

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