Important Facts About Post Menopausal Hormone Replacement Therapy (HRT)

In women, the hormone estrogen plays a key role in the reproductive system as well as maintaining healthy bones, heart, and blood vessels. Estrogen and progesterone are made mainly by the ovaries, and the production of these hormones gradually decreases as women age. With the onset of menopause, the ovaries stop making enough estrogen to thicken the uterine lining. In most women, the menopause naturally occurs between 45 and 55 years of age, but surgical removal of the ovaries or other medical conditions may cause it to occur earlier.

Menstrual periods stop during menopause, but what else happens to women during menopause?

Up to 75% of women will experience "hot flashes." These hot flashes are a sudden feeling of heat that spreads from the neck and chest over the entire body. Hot flashes may occur a few times a month or several times a day. Hot flashes can even occur at night and disturb sleep.

At menopause, the protective effects of estrogen are lost, increasing the risk of heart disease (heart attack) and thinning of the bones (osteoporosis), while causing dryness of the vaginal walls and changes of the urinary tract.

Can some of the symptoms of menopause and health problems associated with low estrogen be prevented?

Yes. Hormone replacement therapy (HRT) is a treatment in which estrogen, and often progestin, is taken to relieve the symptoms of low levels of female hormones.

What are the Benefits of HRT?

HRT is beneficial for any disorder caused by the sudden decrease in estrogen production, which occurs at menopause. The benefits of HRT include:

1. Reduces the symptoms of "hot flashes."
2. By keeping bones strong, can help prevent osteoporosis - osteoporosis refers to thinning or weakening of bones. All people experience some thinning of the bones at 35-40 years old, and thinning of bones or osteoporosis makes people susceptible to broken bones.
3. Decrease pain and irritation caused by vaginal dryness. At menopause, the decrease in estrogen production may cause dryness, burning, or itching in and around the vagina. These symptoms may be alleviated by HRT.
4. Reduce cholesterol- HRT raises high-density lipoprotein ("good cholesterol"), while lowering low-density lipoprotein ("bad cholesterol"). Elevated levels of low-density lipoprotein or "bad cholesterol" may increase the risk of heart attacks. Thus, HRT appears to reduce or prevent heart attacks by lowering cholesterol levels.

Patients Who are Candidates for HRT Treatment:

1. post-menopausal women
2. women who have had a hysterectomy (surgical removal of their uterus and ovaries)

What are the Risks of HRT?

HRT has been associated most frequently with the following medical problems:

1. Cancer of the uterus may be slightly increased. Using estrogen alone causes the lining of the uterus to grow and can increase the risk of endometrial cancer. To reduce this risk, your doctor may prescribe another hormone called progestin (a synthetic hormone that acts like progesterone).
2. Development of blood clots is slightly increased. When blood clots form in blood vessels, the blood clots can cut off blood flow to organs like the lung or brain and lead to severe damage of these organs.
3. Breast cancer may be increased. Some research studies suggest that the use of HRT may increase the risk of breast cancer. However, other research studies suggest there is not association. No definitive statements can be made about these issues.
   Women should consult with their doctor about the risks and benefits of HRT before making a decision about the use of this therapy.

What Gastrointestinal (GI) Disorders May Be Prevented with HRT?

HRT appears to reduce the risk of colon cancer. Post-menopausal women who use HRT appear to have a decreased risk of colon cancer compared to post-menopausal women who do not use HRT.

What GI Disorders May Be Worsened with HRT?

The use of HRT is associated with the following GI symptoms:

• nausea (9-11% of women)
• diarrhea (6-8% of women)
• abdominal pain (5-6% of women)

Also, research studies indicate that women who use HRT may have a slightly increased risk of forming gallstones. When stones form in the gallbladder (a storage sac for bile, a digestive enzyme), then the gallbladder may become inflamed and need to be removed surgically. However, this risk appears to be modest: less than 1 in 250 post-menopausal women who use HRT developed gallbladder inflammation compared to 1 in 500-1000 post-menopausal women who did not use HRT.

When taking HRT, you should follow your doctor’s advice carefully and get regular checkups. If you have any unexpected vaginal bleeding, you should call your doctor right away. Follow-up visits will include blood pressure check, breast and pelvic exams and a Pap test.