HORMONE REPLACEMENT THERAPY

Hormone Replacement Therapy

Hormone Replacement Therapy

Introduction

Hormone-replacement therapy (HRT) is a physician-prescribed program of treatment for women who are experiencing hormonal imbalances, during or after the occurrence of menopause. It usually refers to supplementing the body with the hormones estrogen and progesterone, which naturally decline during menopause, to treat the symptoms that follow.

HRT works by supplementing the body with estrogen or with a combination of estrogen and progesterone, relieving some of the menopausal symptoms. Other beneficial effects of HRT include promoting the amount of HDL (“good”) cholesterol and decreasing the amount of LDL (“bad”) cholesterol in the blood. HRT slows or stops the loss of bone mass and density (osteoporosis), and may even increase bone density. HRT may be given in the form of either naturally derived or synthetically produced estrogen. Less potent forms of natural estrogen, termed phytoestrogens, are derived from plants and can also be used in HRT. The two most common regimens are cyclic HRT and continuous HRT.

Menopause and HT

Menopause is the permanent cessation of menstruation due to the loss of ovarian follicular function. The perimenopause refers to the time period immediately preceding menopause when fertility wanes and menstrual cycle irregularity increases. This period continues until 12 months after cessation of menses, at which time the woman is considered menopausal. The mean duration of the perimenopause is 4 years, while signs consistent with the perimenopause may precede the final menses by 2 to 8 years.

There is strong evidence that the transition to menopause is associated with vasomotor symptoms (hot flashes and night sweats). For instance, in one U.S. study, nearly 60% of women reported hot flashes in the 2 years before their final menses. There is also reasonable evidence that this period can cause sleep disturbances in some women. However, there is inconclusive or insufficient evidence that a decrease in ovarian mass is the major cause of mood swings, depression, impaired memory and the ability to concentrate, somatic symptoms, urinary incontinence, or sexual dysfunction. Notably, symptom intensity, duration, frequency, and effects on quality of life are highly variable.

The decision to use postmenopausal HT for the treatment of the symptoms and conditions listed above is complicated. Although many women rely on their health care providers for a definitive answer to the question of whether to use postmenopausal hormones, balancing the benefits and risks for an individual patient is challenging, especially when the individual risk for HT-associated morbidity cannot be precisely quantitated. Despite this context and until the earlier years after the turn of the 20th century, many were prescribed HT as a means of alleviating vasomotor symptoms, for which its effectiveness has been well demonstrated. However, HT was increasingly promoted as a potential preventive strategy against disorders that accelerate after menopause, such as osteoporosis and atherosclerotic CVD.

These positions were based on results primarily from observational cohort studies. Although previous observational studies suggest that HT prevents cardiovascular and other chronic diseases, some of the apparent benefits may have resulted from differences between women who opt to take postmenopausal ...