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Hormone therapy, called HT and formerly called hormone replacement therapy, or HRT, is the use of man-made or natural hormones to treat a person whose body is no longer making enough of certain hormones. It is often prescribed for women in menopause, or for women who have had their ovaries removed. HT for menopause usually consists of the hormones estrogen and progesterone taken together.

If a woman's uterus has been removed she may take estrogen alone, since the purpose of adding progesterone is to decrease the risk of uterine cancer, and with the uterus removed this will not occur. Estrogen/progestin therapy is known as EPT, and estrogen therapy alone is called ET.

What is the information for this topic?

HT has both benefits and risks.

Menopause Estrogen levels drop when women enter menopause or have their ovaries removed.

Low levels of estrogen produce the common symptoms of menopause:

• painful intercourse, a condition known as dyspareunia
• hot flashes
• mood changes with irritability
• night sweats
• sleep disorders
• vaginal dryness
• short-term memory changes

HT is often given to reduce these symptoms and is by far the most effective treatment (the gold standard) for these symptoms.

Women who have had their uterus and ovaries removed generally take estrogen alone. Women who still have their uterus need progesterone along with estrogen. This is because taking estrogen alone can increase the risk of cancer of the uterus.

Recent studies have looked at the link between HT and memory in women. Some recent findings include:

• Estrogen use after menopause did not reduce a woman's risk for Alzheimer's disease, although women were not admitted into the study until they were at least 65 years of age which may have effected the results.
• HT did not slow the rate of long-term memory loss in women after menopause.

Perimenopause Perimenopause is the time when a woman may be having sporadic periods but has not yet reached menopause. Women are sometimes given oral birth control pills at this time. These medicines control irregular menstrual periods and symptoms of menopause. They typically contain both estrogen and progesterone at higher doses than are used in HT.

Because a woman may continue to ovulate during perimenopause, it is still possible for her to become pregnant. Because the hormone doses in HT are not high enough to prevent pregnancy, a woman who wants to avoid pregnancy should use birth control until a blood test (a follicle stimulating hormone level) shows that menopause is present, or until she does not have a period for 12 months in a row. After that, she may switch to the lower doses of hormones in HT.

Benefits of HRT

The potential benefits of HT include:

• decrease in LDL, which is also called the bad cholesterol
• decrease in total blood cholesterol
• increase in HDL, also known as the good cholesterol
• prevention of bone fractures in the hip and spine from osteoporosis
• relief of hot flashes and vaginal dryness
• slowing of bone loss and osteoporosis
• a slight decrease in colorectal cancer

Because HT improves the levels of lipids in the body, this therapy was often prescribed for menopausal women to decrease their risk of heart disease. However, experts found that there was also an increase in stroke and heart attack in women taking HT if they started it after age 59. So, in 2002, the Women's Health Initiative recommended that women not be started on HT just to prevent heart disease.

Risks of HTResearch has shown several risks associated with taking HT or ET:

• HT(ET) increases the risk of breast cancer slightly. There is no increased risk until after four years of consecutive use. Estrogen replacement therapy (ET) alone had been found to have no increased risk of breast cancer associated with its use according to the latest analysis of the Women's Health Initiative data.
• HT slightly increases a woman's risk for stroke and heart attack
• HT can increase a woman's risk for gallbladder disease.
• HT and ET can increase a woman's risk of blood clots, such as deep venous thrombosis and pulmonary embolism.
• If a woman still has her uterus, taking estrogen alone increases the risk of cancer of the uterus. Adding progesterone reduces her risk to that of women who do not take ET.

Deciding about HTA woman can choose from several strategies to cope with menopause and perimenopause, such as:

• Do nothing.
• Take birth control pills to control irregular periods during perimenopause.
• Take HT or ET during menopause to improve symptoms.
• Use natural alternatives to HT, such as foods high in phytoestrogens. These, however, have not been shown to provide the same degree of benefit in symptom and disease prevention as HT or ET.
• Use estrogen creams or tablets for vaginal dryness. These products do not help with other symptoms of menopause

Overall, the decision to use HT should be based upon the proven benefits and risks of HT. Women should discuss the benefits and risks with their healthcare professionals. Together, they can choose the best course of action.