Hormone Replacement Therapy
Women entering menopause, or the change of life, have questions about taking hormones (such as estrogen) to help with their symptoms. These often include hot flashes, night sweats and vaginal dryness. Your body makes estrogen, but slows down production of estrogen during menopause. Estrogen may be taken by itself (called unopposed estrogen) or in combination with another female hormone, progestin. These hormones also have been prescribed to help women prevent osteoporosis (thinning of the bones) and possibly to prevent heart disease. However, recent studies have raised questions about the long-term effects of hormone replacement therapy. In the August 21, 2002, issue of JAMA, there are two articles about hormone replacement therapy and its benefits and risks.Reasons To Consider Hormone Replacement Therapy
Short-term use of hormones (less than five years) may help women cope with symptoms of menopause. Hormone replacement therapy may ease hot flashes, make night sweats better, and help with dryness and thinning of tissue in the vaginal area. Problems with mood and thinking also may be helped with hormone replacement therapy during menopause — this may be related to improved sleep.
Hormone replacement therapy can prevent osteoporosis. Your doctor may suggest a bone density test to look for osteoporosis. Regular exercise, adequate intake of calcium, and not smoking are also important for preventing osteoporosis. Hormones may not be helpful for treating osteoporosis, if you already have it. Your doctor may recommend other medicines if you already have osteoporosis.
Risks of Hormone Replacement Therapy
Even short-term use of hormones may be associated with risks, such as blood clots (especially in women who smoke) and cholecystitis (inflammation of the gallbladder). Recent studies indicate that some women taking combination hormone therapy (estrogen and progestin) may be at slightly higher risk for a heart attack or a stroke.
Preventing heart disease and strokes used to be reasons that doctors prescribed hormones for women beginning menopause. However, studies are now showing that hormones may not protect women from heart disease or heart attacks or strokes. Improving other risk factors, such as smoking, being overweight, diabetes, and high cholesterol levels, is more important than hormone treatment to prevent heart disease, heart attacks or strokes.
Long-term use of hormone replacement therapy, for more than five years, may be associated with a greater risk of breast cancer. This could be especially important for women with other risk factors for breast cancer such as prior breast cancer, a family history of breast cancer, or older age.
Women who use unopposed estrogen may have buildup of the lining of the uterus and an increased risk of cancer of the uterus. Doctors recommend that women who still have their uterus (have not had a hysterectomy) take a combination of estrogen and progestin, and not unopposed estrogen, to prevent this risk if they take hormone therapy.
Talk With Your Doctor
Ask your doctor about hormone replacement therapy if you are concerned about your symptoms of menopause. She or he can discuss your personal risks and benefits of hormone replacement at this time in your life. Don’t be afraid to talk with your doctor about any alternative remedies you may be considering. Those alternatives may be helpful for you, but they may interact with other medications you are taking.
For More Information
American College of Obstetricians and Gynecologists
(202) 638-5577
www.acog.org
American Medical Women’s Association
www.amwa-doc.org
National Library of Medicine
www.nlm.nih.gov/medlineplus
Medem: Healthcare Information
www.medem.com
Inform Yourself
To find this and previous JAMA Patient Pages, go to the Patient Page Index on JAMA‘s Web site at www.jama.com. They are available in English and Spanish.
Related JAMA Patient Page
- JAMA Patient Page: Osteoporosis — Prevent Hip Fractures (October 13, 1999)
Sources: American College of Obstetricians and Gynecologists, American Medical Women’s Association
Janet M. Torpy, M.D., Writer
Cassio Lynm, M.A., Illustrator
Richard M. Glass, M.D., Editor
(JAMA. 2002; 288: 916)
Published in JAMA: August 21, 2002
The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be reproduced noncommercially by physicians and other health care professionals to share with patients. Any other reproduction is subject to AMA approval. To purchase bulk reprints, call (718) 946-7424.