Is “Hormone Replacement” Safe?

Posted on Jul 5, 2012 in The Doctor Is In by eParisExtra

Q: I am a 50 year old woman and am suffering from postmenopausal hot flashes. My doctor is recommending hormone replacement therapy, but I am scared of its risks. What should I do?

Until a few years ago, hormone replacement therapy (estrogen +/- progestin) used to be a standard treatment for postmenopausal women with hot flashes and other menopausal symptoms. Hormone replacement therapy (HRT) was also believed to have a number of other health benefits.

All this changed when a large trial found that the treatment actually posed more health risks than benefits (for one particular type of hormone therapy), especially when given to older postmenopausal women.

Still, HRT remains a good choice for certain women, depending on their risk factors.

How does HRT help?

• Helps hot flashes – Systemic estrogen, which comes in various forms (pill, skin patch, gel, cream or spray), remains the most effective treatment for relief of hot flashes and night sweats.
• Estrogen can also ease vaginal symptoms of menopause, such as dryness, burning and discomfort with intercourse.
• Low-dose vaginal preparations of estrogen, which come in cream, tablet or ring form, can effectively treat vaginal symptoms and some urinary symptoms, while minimizing absorption into the body.

NOTE: For women who experience menopause naturally (still have the uterus), estrogen is typically prescribed along with progesterone or progestin. This is because estrogen alone, when not balanced by progesterone, can increase the risk of uterine cancer. Women who have had their uterus removed (hysterectomy) don’t need to take progestin.

What are the risks of HRT?

In a large clinical trial, a combination estrogen-progestin pill (Prempro) increased the risk of certain serious conditions, including:

• Heart disease
• Stroke
• Blood clots
• Breast cancer

However, the risks of hormone therapy may vary depending on whether estrogen is given alone or with a progestin, and depending on your current age and age at menopause, the dose and type of estrogen, and other health risks such as your risks of heart and blood vessel (cardiovascular) disease, cancer risks and family medical history.

Who are good candidates for HRT?

The following two groups of women are perfect candidates:

• Experience moderate to severe hot flashes or other menopausal symptoms and otherwise healthy.
• Stopped having periods before age 40 (premature menopause) or lost ovarian function before age 40.

Who should NOT take HRT?

• Women with current or past history of breast cancer, ovarian cancer, or endometrial cancer.
• History of blood clots to the legs or lungs.
• History of stroke or liver disease should usually not take hormone therapy.

All of the above information should be considered and discussed with your doctor in deciding whether hormone therapy might be an option for you.

This information is strictly an opinion of Dr Prakash, and is not intended to replace the advice of your doctor. Dr Chris Prakash is a contributing columnist, and author of eParisExtra’s “The Doctor is In” column. He is a medical oncologist at Texas Oncology Paris. He is board certified in Internal Medicine, Oncology and Hematology. He lives in Paris, TX with his wife and two children, and can be reached at 9037850031, or Sucharu.prakash@usoncology.com