Hormone Replacement Therapy: Facts, Myths, Alternatives and Sexuality

Hormone Replacement Therapy Weighing the Benefits and Risks

No one looks forward to menopause. Kind of like the flip side of puberty, menopause is when a woman's body starts decreasing its production of female hormones. Along with that comes a slew of unpleasant symptoms, such as hot flashes, anxiety, depression, and sleeplessness.

For many years, doctors recommended hormone replacement therapy to deal with these symptoms and restore a little normalcy for the woman going through menopause. They also prescribed it for women at high risk for Alzheimer's, osteoporosis and other diseases, and many women considered it the answer to their prayers.

However, recent studies have shown that the risks may outweigh the benefits, and the topic of HRT has become both confusing and controversial. If you're thinking that hormone replacement therapy might be right for you, you'll obviously have to talk to your doctor first. But before you get that far, here are some things you might want to know to help you decide.

What It Is

Simply put, hormone replacement therapy helps replace the estrogen and progesterone that decline in women's bodies as they age. These hormones are in abundance during the childbearing years, but their production dwindles as they become less necessary.

There are two types of hormone therapy: HRT and ERT. HRT (hormone replacement therapy) provides a combination of both estrogen and progestin, while ERT (estrogen replacement therapy) replaces only the estrogen in a woman's body. The progestin in HRT helps decrease the risk of endometrial cancer, which is why ERT is typically used only by women who have had a hysterectomy.

Some women also take androgens in addition to the estrogen. Androgens, mostly testosterone, are prescribed for women who are undergoing surgical menopause or who are experiencing loss of libido and other symptoms of testosterone deficiency during natural menopause.

Benefits of Hormone Therapy

Hormone replacement therapy has both short-term and long-term benefits. In the short run, it can relieve many of the symptoms of menopause, such as hot flashes, sleeplessness and mood swings.

Many patients at risk for Alzheimer's or colon cancer have embraced HRT, as it decreases the risk of both of those diseases. In fact, one study showed that women were two and a half times less likely to develop Alzheimer's after taking HRT for more than ten years.

Hormone therapy also can slow or stop the loss of bone mass associated with osteoporosis when taken for longer periods of time, which also could be good news for some women.

For a while, many experts believed that HRT also reduced the risk of heart disease, but new studies show that it actually might slightly increase the risk (if you see that listed as a possible benefit, you might be dealing with outdated information).

Side Effects

While HRT has many benefits for the menopausal woman, it's no miracle drug. To begin with, there are several short-term side effects. Many of them mimic premenstrual symptoms since you're dealing with the same hormones. You might experience tenderness in your breasts, abdominal pain, vaginal discharge and bleeding, bloating, and mood changes such as anxiety, irritability or depression.

Many women have also reported experiencing dizziness or drowsiness, headaches, diarrhea, and vaginal dryness. (Some women believe that HRT also causes weight gain; however, that one is simply the fault of a slower metabolism.)

Many of these symptoms are specifically related to the progestin and can be reduced by adjusting the dose or schedule, using a different type of progestin, or switching to estrogen-only ERT if there is an acceptably low risk of cancer of the uterus.

Long-Term Risks

Unfortunately, there's more to consider than just the side effects. In July of 2002, many women were shocked to hear that the hormones that seemed like such a miracle could possibly be doing them more harm than good.

A major study was underway investigating the long-term effects of hormone therapy but was suddenly halted when the researchers discovered some startling news: an increase in the risk of breast cancer, stroke, heart attacks and blood clots among study participants.

HRT has also been linked to increased risk of endometrial cancer, ovarian cancer, and gallstones.

Researchers still need to determine exactly what amount of risk we're dealing with, but for women considering hormone therapy, the seriousness of these diseases have certainly given them pause -- especially those for whom menopausal symptoms are annoying but not unbearable.

HRT and Breast Cancer

While the specific effects of HRT on the occurrence of breast cancer are not yet known, there definitely seems to be a correlation, especially with the combination estrogen-progestin treatment. Some researchers believe that there is little or no increased risk with short-term use, but with consistent use over many years, that risk does seem to greatly increase. However, recent studies show that if you use HRT for only a few years, the risk begins to dissipate about six months after you stop taking it.

Taking combination HRT can also affect your breast density, which can make mammograms more difficult to read. And naturally denser breasts are more prone to breast cancer -- although it is not known whether breasts that are denser as a result of HRT carry the same risks.

While there is no definite proof that HRT causes breast cancer, the risk is certainly something to consider, especially if you have a family history or other factors that put you at a higher risk.

Who Should Not Take HRT

Clearly the decision to take HRT should not be made lightly, but some people are at greater risk than others if they are already predisposed to certain conditions. Hormone therapy is not recommended for women who have any of the following conditions:

  • Vaginal bleeding from an unknown cause
  • Suspected breast cancer or history of breast cancer
  • History of endometrial cancer or cancer of the uterus
  • Chronic disease of the liver
  • History of blood clots in the veins, legs or lungs

Alternatives to HRT

If you're worried about the negative side effects of HRT, you'll be happy to know you have some options that might help you cope with the symptoms of menopause (although there are no alternatives to estrogen for the prevention of Alzheimer's or colon cancer).

To begin with, antidepressants like Prozac and Zoloft can be very effective in treating depression and mood swings, and they may also help with hot flashes. Clonidine, a drug typically used for high blood pressure, can also alleviate hot flashes. There are several options for treating osteoporosis, and certain cholesterol-lowering drugs are proven to be effective for reducing the risk of heart disease.

Of course, there are natural remedies, as well. Researchers have studied the effectiveness of vitamin E therapy, acupuncture, wild yam and progesterone cream, but results have been unimpressive. However, foods that contain phytoestrogens, such as soy products and flaxseed, might help relieve hot flashes and night sweats, and vitamin E is said to relieve hot flashes, as well.

Last but not least, there's the one tried-and-true method that no one disagrees with: plain old common sense and basically just taking good care of your body. Here are some tactics everyone should try:

  • Exercise, eat lots of fruits and vegetables and lose weight if you need to.
  • Make sure your bones get plenty of calcium for osteoporosis.
  • Yoga and meditation are powerful relaxation therapies that can lead to a better overall sense of well-being.
  • For vaginal dryness, a good water- or silicone-based lubricant can help immensely.
  • If you're bothered by hot flashes, try dressing in layers and avoiding spicy foods and caffeine.

Herbal Remedies

Another option that's available to you is herbal remedies -- although there's not much research to back up their claims since they aren't regulated by the FDA. Still, they might be worth looking into. If you do decide to try them, let your doctor know in case there are any interactions with other drugs you might be taking.

  • St. John's wort is a popular treatment for mild depression.
  • Valerian root should help you sleep and is far gentler than traditional sleeping pills.
  • Red clover can diminish hot flashes and may even slow bone density loss.
  • Black cohosh may also be beneficial in treating hot flashes and other symptoms.
  • Ginseng is believed to reduce stress and boost immunity.
  • Chasteberry helps with breast pain and some other PMS-like symptoms.
  • Evening primrose is said to ease breast pain and other symptoms, though results have been mixed.
  • Dong quai is supposed to treat hot flashes, but in some studies has done no better than a placebo.

What to Think About

By now you probably have a sense of whether hormone replacement therapy might be right for you. The severity of your menopausal symptoms, your ability to tolerate them and the effect of alternative treatments are all important factors. You'll also want to consider how long you plan to take the hormones and your risk level for conditions that might be increased or decreased by HRT.

Of course, you'll need to talk to your doctor before you can make a final decision. So if you think you might want to try HRT, schedule an appointment to discuss all the risks and benefits and how they fit in with your personal health.