Hormones and Menopause: Tips from the National Institute on Aging


Cathy had been waking up during the night feeling hot and sweaty. That left her tired all day. Then she began to feel hot on and off during the day also, so she went to see her doctor. The doctor told her she was having hot flashesa sign that she was going through perimenopause, the time around menopause. Her doctor talked about different ways to control the symptoms. One was using estrogen for a short time. Cathy and her doctor talked about the risks, as well as the benefits. Cathy said she remembered something in the news about using hormones around menopause. She was uncertain. Whats a woman to do?

A hormone is a chemical substance made by a gland or organ to regulate various body functions. To help control the symptoms of menopause some women can take hormones, called menopausal hormone therapy (MHT). MHT used to be called hormone replacement therapy or HRT. Some women should not use MHT. There are many things to learn about hormones before you make the choice that is right for you.

Cathys doctor told her to call back for a prescription if she decided to try using hormones to control her symptoms. After reading pamphlets from her doctors office, Cathy talked to her friends. Lily, who had surgery to remove her uterus and ovaries, has been taking estrogen since the operation. Sandy said shes had a few hot flashes, but isnt really uncomfortable enough to want treatment. Melissas doctor thinks she should not use estrogen because her younger sister has breast cancer. Each friend had a different story. Cathy needed more information.
Which hormones are used for menopause?

Cathy has a lot of questions, starting with the basicswhat is menopausal hormone therapy?
During perimenopause, the months or years right before menopause, levels of two female hormones, estrogen and progesterone, in a womans body go up and down irregularly. This happens as the ovaries struggle to keep up with the bodys needs. The symptoms of menopause might result from these changing hormone levels. After menopause, when a womans ovaries make much less estrogen and progesterone, the symptoms of menopause may continue. Menopausal hormone therapy may help control these symptoms. A woman whose uterus has been removed can use estrogen alone to control her symptoms. But a woman who still has a uterus must take progesterone or a progestin (a synthetic progesterone) along with the estrogen. This will prevent unwanted thickening of the lining of the uterus and also cancer of the uterus, an uncommon, but possible result of using estrogen alone.
Why take these hormones? Why not?

Cathys doctor said the plus side of taking estrogen is that it is the most effective treatment for hot flashes, night sweats, and vaginal dryness. And it will help keep her bones strong. Cathy thought that those certainly seemed like good reasons to use MHT. But she wondered, is there a down side?

Menopause is a normal part of life. It is not a disease that has to be treated. Women may decide to use menopausal hormone therapy because of its benefits, but there are also side effects and risks to consider. Two good reasons to think about menopausal hormone therapy are:

* treating some of the bothersome symptoms of menopause,
* preventing or treating osteoporosis.

But for some women there are noticeable side effects:

* breast tenderness,
* spotting or a return of monthly periods,
* cramping,
* bloating.

By changing the type or amount of the hormones, the way they are taken, or the timing of the doses, your doctor may be able to control these side effects. Or, over time, they may go away on their own.

For some women there are also serious risks (see chart). These risks are why you need to think a lot before deciding to use menopausal hormone therapy.

Although the risks are small for any one woman, you need to take them into account. Much of the following chart on benefits and risks is based on one important clinical trial, the Womens Health Initiative (WHI). This study looked at estrogen (conjugated equine estrogens) used alone or with a particular progestin (medroxyprogesterone acetate). Some other types of estrogen, progesterone, or progestin may have been tested in smaller clinical trials to see if they have an effect on heart disease, breast cancer, or dementia. Others have not.

Benefits and Risks of Menopausal Hormone TherapyJuly 2006

See chart at:

http://www.niapublications.org/tipsheets/hormones.asp

Because the average age of women participating in the trial was 63, more than 10 years past the average age of menopause, some experts now question whether the WHI results apply to women around the time of menopause. The WHI study found that in every 10,000 women using estrogen plus progestin, there would be 7 more heart attacks than in every 10,000 women not using these hormones. Other research has suggested that if MHT is begun around the time of menopause, it might provide protection from heart disease, but not if a woman waits too long. This is a subject for further study.

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