Hormone  Replacement Therapy (HRT)
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What to Consider... When Evaluating Hormone Replacement Therapy

What to Consider When Evaluating Hormone Replacement Therapy.
When deciding whether to use hormone replacement therapy and which therapy to use, the following factors need to be taken into consideration... Your age, Your medical history, The reason for treatment, and the severity of menopausal symptoms.

Possible side effects
Your family history of estrogen-dependent cancers, such as cancers of the breast or uterus.

Your risk for heart disease.
Risk factors include:
Family history, Cholesterol levels, Triglyceride levels

Kinds of Hormone Replacement Therapies
There are many types and forms of hormone replacement therapy available. Hormone replacement can be taken in the form of an injection, patch, pill or cream. Each method has its own benefits and risks. Different doses and brands may cause side effects. If you’re using hormone therapy but are having difficulties with it, talk with your doctor about other methods or dosages. Several months of adjusting may be needed to find the right hormone combination for you.

Estrogen Replacement Therapy (ERT)
ERT replaces the hormone estrogen that is no longer made in the ovaries at menopause. Estrogen helps prevent or lessen many menopausal symptoms. When estrogen is used alone, it is called "unopposed" estrogen therapy. This type of estrogen replacement is usually given to women who have had their uterus removed (hysterectomy). If you have your uterus, but decide to take estrogen without the protection of a form of progesterone (the female hormone that helps keep the uterus lining healthy), you will need regular ultrasounds or uterine biopsies (tissue samples). These are quick office tests that help your doctor check the amount of growth along your uterine walls.

Progesterone Replacement Therapy
This replaces the hormone progesterone that lessens at menopause. Progesterone levels normally rise during the second half of the menstrual cycle. Some pre- and peri-menopausal women may be able to regulate their periods with a form of progesterone therapy. Progesterone may also offer relief from hot flashes and help keep bones healthy.

Combined Hormone Therapy, Opposed Estrogen Therapy
This replaces both estrogen and progesterone. Estrogen and progesterone work in hundreds of areas in your body, including the brain, bones, breasts, blood vessels, reproductive organs, urinary organs, skin, mucous membranes and the endocrine system. While estrogen helps lighten many menopausal discomforts, it also causes growth of the lining of the uterus. This thickening of the uterine lining is a risk factor for cancer. Taking a form of progesterone helps prevent uterine cancer by protecting the uterine wall from the tissue build-up that can occur when estrogen is taken alone. Hormone replacement therapy also helps keep bones strong. A combination of estrogen and progesterone replacement is the most widely used therapy for women who have their uterus. There are two forms of HRT:
"Natural" hormones are medications that are chemically identical to what the body produces :
"Synthetic" hormones are medications that are similar but not identical to the hormones naturally produced in the body. Talk with your doctor about the risks and benefits of each type.

Testosterone Replacement Therapy
This replaces the hormone testosterone that can also decrease at menopause. Replacing testosterone offers some relief from menopausal hot flashes in women who do not respond well to estrogen. Testosterone can also provide some women with a greater energy level, a higher sex drive and an improved sense of well-being. (It is important to remember that sexual desire is due to more than hormones. Think about other possible reasons for lessened interest depression, tiredness or changes in your relationship with your partner). The women who are most likely to respond to testosterone therapy are those whose ovaries have been surgically removed or who had low levels of testosterone before menopause.

The Benefits of Hormone Replacement Therapy
Hormone replacement therapy is given to lessen the short-term discomforts of menopause and decrease the long-term risks of decreased estrogen levels. Research has indicated the following as potential benefits of hormone replacement therapy:
Relief of menopausal symptoms such as hot flashes, night sweats, poor sleep and vaginal dryness Prevention of bone loss (osteoporosis) Increased sense of well-being through relief of physical symptoms Improved memory and possible delayed onset or lowered rate of Alzheimer’s disease. Possible lowered risk of colon cancer Decreased rate of urinary accidents and urinary tract infections Protection of dental health Decreased rate of macular degeneration (a leading cause of blindness) Improved balance, resulting in less falls and potential fractures.

Potential Side Effects of Estrogen Replacement:
Increased breast lumpiness or tenderness, Irregular vaginal bleeding (depends on method taken), Stomach upset, Higher blood pressure (although rare), Return of endometriosis (overgrowth of uterine lining), Severe headaches, Gall bladder disease (mainly with oral estrogen), Formation of blood clots, Increased risk of breast cancer, Uterine cancer (if not used with progesterone).

Potential Side Effects of Progesterone Replacement
Stomach upset, Irregular vaginal bleeding or spotting, Edema (swelling due to water retention).


Potential Side Effects of Combined Estrogen and Progesterone Replacement
Formation of blood clots Premenstrual-like syndrome Changes in sex drive Headaches Fluctuating blood sugar levels Edema (swelling due to water retention)

Potential Side Effects of Testosterone Replacement
Edema (swelling due to water retention), Increased risk for heart disease, Depression or emotional irritabilit,y Abnormal liver function, Changes in menstrual periods

Reasons to Avoid Hormone Replacement Therapy
Hormone Replacement Therapy may not be best for you if you have:
Heart or circulation problems, History of cancer of the breast or uterus, History of blood clots or stroke, Abnormal vaginal bleeding, Liver or gall bladder disease (discuss non-oral hormone replacement methods with your doctor), Active thrombophlebitis (inflammation of a vein that develops before a blood clot is formed), Any condition that could be made worse by fluid retention, including seizures, headaches, and heart, kidney and liver disease.

Article is courtesy of Thrive Online.

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Last modified on Sept. 30, 2001

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