Menopause and Hormone Replacement Therapy (HRT)

 Menopause and Hormone Replacement Therapy (HRT)


HRT Menopause

 

Menopause

What is menopause? Menopause - the time when a woman stops having menstrual periods is a natural process. All women go through menopause, but they may experience it quite differently. Some women welcome it, while others feel sad at the passing of their childbearing years. It is important to remember that although women share similar experiences in going through menopause, each woman is unique. Around the time of menopause, a woman's ovaries gradually stop making estrogen and progesterone, the hormones that prepare the body for pregnancy. As these hormones change, a woman's periods may get heavier or lighter. Sometimes periods get more frequent or are skipped. Eventually periods stop altogether. A woman is considered menopausal when she has not had a period for 12 months.


When does menopause happen?

 

The average age at menopause is 51.4 years. Most women go through menopause between the ages of 45 and 55. Women whose periods stop before the age of 40 are said to have a premature menopause, while some women's periods continue into their late 50s. What are the symptoms of menopause? Some women have no symptoms, some women have symptoms but are not bothered by them, and still other women have symptoms that they find quite troubling. The most common symptoms of meno- pause are listed on the next page. Symptoms such as memory problems or feeling sad could have causes that are unrelated to menopause. If you are having these symptoms, it is important that you discuss them with your healthcare provider.


All women go through menopause, but they may experience it quite differently. Some women welcome it, while others feel sad at the passing of their child-bearing years.


Hormone Replacement Therapy (HRT)

HRT refers to the use of prescription drugs to "replace" the hormones that the ovaries quit making at the time of menopause. These hormones are estrogen and progesterone. Estrogen is made synthetically from plants and other sources or obtained from the urine of pregnant horses. Two main types of progesterone are available. The most commonly used forms are made synthetically and called "progestins." A form of progesterone that is nearly identical to the hormone made by the ovaries is also available and called "natural progesterone" or "micronized progesterone." Women who still have a uterus usually take both estrogen and progestin. If taken without progestin, estrogen makes the lining of the uterus (the endometrium) grow and can cause endometrial, or uterine, cancer. Women who take estrogen without progestin must have a yearly endometrial biopsy, in which tissue from the lining of the uterus is evaluated for cancer.


Women who do not have a uterus can take estrogen alone. This is often referred to simply as estrogen replacement therapy, or ERT. Estrogen is most often taken orally, as pills, or absorbed from skin patches placed on the abdomen. Why take HRT? HRT (or ERT) is commonly prescribed to relieve menopausal symptoms. HRT may also be used to treat osteoporosis or to reduce a woman's chances of getting osteoporosis, and there is a possibility that HRT may reduce the risk of coronary heart disease. On the other hand, HRT may increase a woman's chance of getting breast cancer.


What are the effects of HRT on menopausal symptoms? HRT is extremely successful at relieving menopausal symptoms, such as hot flashes, night sweats, and sleep disturbances. When taken only to relieve menopausal symptoms, HRT is used for a relatively short period of time typically from several months to several years. What are the long-term health effects of HRT? In addition to relieving the symptoms of menopause, HRT reduces bone loss and helps prevent thinning of the walls of the vagina. Remember, though, if you are taking HRT for prevention of osteoporosis, it helps the most if you take it for many years. Once you stop taking HRT, you start losing bone again. However, if you begin (or resume) using HRT later in life, it protects against further bone loss. The effect of HRT on heart disease is uncertain, and HRT may also increase your risk of breast cancer.


What are the side effects of HRT? The most common side effects of HRT, and the percentage of women in the United States who experience them, are listed below. If you experience any of these, discuss them with your healthcare provider. In addition to relieving the symptoms of menopause, HRT reduces bone loss and helps prevent thinning of the walls of the vagina.


Common Side Effects of HRT


Percentage of Women Who Develop This Side Effect:


Monthly bleeding (from cyclical estrogen and progestin)

Most women


Irregular spotting (from daily estrogen and progestin) (Women who are having heavy periods and irregular bleeding or bleeding between periods should see a healthcare provider.)

30%-50% (stops permanently for most women within a year)


Breast tenderness or enlargement

12% on unopposed estrogen

33% on estrogen & progestin



Fluid retention

1%-10%


Headaches, including migraine

1%-10%


Dizziness

Less than 1%


Skin discoloration

Less than 1%


Nausea

Unknown


http://www.pueblo.gsa.gov/cic_text/health/hrt/hrt.txt