The FAQ's Of HRT

What is hormone replacement therapy (HRT)?

As women age her hormone levels will inevitably begin to decrease over time. Hormone Replacement Therapy (HRT) provides women with these necessary hormones to keep them balanced. Generally, when the hormone estrogen is given alone, it is usually referred to as "ERT." When the hormone progestin is used in conjunction with estrogen, it is generally called "HRT." Estrogen, a female hormone, brings about changes in other organs in the body while progesterone prepares the uterus for a pregnancy each month. During perimenopause (the transitional period before menopause) these hormone levels begin to fluctuate, causing very painful symptoms. Undergoing hormone therapy helps to balance these hormones and relieve these symptoms.

What are some benefits of HRT?

HRT is used to relieve short-term symptoms of menopause, such as night sweats, hot flashes, and disturbed sleep, and is thought to be a very effective step toward preventing and/or alleviating bone loss associated with osteoporosis.

Does undergoing HRT have risks?

Yes. Short-term side effects may include unusual vaginal discharge and bleeding, headaches, nausea, fluid retention and swollen breasts. Some women think HRT causes them gain weight, but research shows this to be an unfounded claim.

Long-term risks include cancer. If estrogen is taken alone, it may elevate the risk of endometrial cancer (lining of the uterus), however, adding progestin with estrogen (HRT) can dramatically reduce this risk.

If I undergo HRT for an extended period of time, will I elevate the risk of developing breast cancer?

Many doctors and researchers are skeptical that the relationship between a woman's risk of developing breast cancer and the length of time that she receives HRT is related. Some researchers believe there is little risk of breast cancer with short-term use (3 years or less) of HRT, with estrogen alone or estrogen combined with progestin, while long-term use (more than10 years) has been linked to an increased risk.

Are researchers working to answer some of these confusing questions?

The Institute of Medicine has evaluated the medical research on the use of HRT to prevent heart disease, osteoporosis, and other problems associated with the aging process, and released its findings in 2002. The National Institutes of Health's (NIH) Women's Health Initiative, the largest clinical trial in the U.S., is embarking on an ongoing exploration into the association between HRT and the development of breast and colon cancer, heart disease and osteoporosis. Results from this study were made available in 2005. They provide valuable information on the use of HRT. You should also discuss these issues with your health care provider.

What woman should not use HRT?

Generally, HRT is not recommended for women who have any of the following conditions:

* If you suspect breast cancer or there is a family history of breast cancer

* Vaginal bleeding of an unknown cause

* Chronic disease of the liver

* If you or your family has a history of endometrial cancer or cancer of the

uterus.

* History of venous thrombosis (blood clots in the veins or legs, or in the lung).

This includes women who have had thrombosis or blood clots during

pregnancy or when taking birth control pills. Although the risk of blood clots

in women is very low, HRT increases the risk.

Why is HRT used in spite of the cancer risk?

There are many benefits of HRT for menopausal women. They include reducing uncomfortable hot flashes, night sweats, and vaginal dryness. Many researchers believe that HRT can be a positive factor in the prevention and treatment osteoporosis. The addition of progestin to the treatment has dramatically reduced the risk of endometrial cancer. Because so many questions regarding the risk of breast cancer are not fully answered, many women and their health care providers believe that the benefits still outweigh the risks. However, women who are at high risk for breast cancer, or who have other concerns about the risks, might want to use alternative methods to alleviate menopausal symptoms. Family history of breast cancer, early age of the first menstrual period (menarche), late age of child bearing, high fat diet, obesity, increased breast density on mammograms, and certain benign breast lesions increase the underlying risk of developing a breast cancer. These factors need to be considered when deciding to take HRT. A woman also might consider any family history of osteoporosis or heart disease when making a decision about HRT.