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Diseases & Conditions > Menopause

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What is HRT and Can It Help Me During Menopause?

Sheryl Kraft

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HRT: Three letters that can bring a lot of menopausal women RELIEF.

What it is: Treatment using female hormones (estrogen and progesterone) to relieve moderate-to-severe symptoms of menopause like hot flashes, vaginal dryness and osteoporosis.

Hormone replacement therapy comes in many forms including oral tablets, skin patches, vaginal creams, sprays, gels and rings.

HRT At A Glance

  • Estrogen therapy (ET). This is estrogen taken alone. Because estrogen may increase the risk of endometrial cancer (cancer of the uterus), it’s only advised for those women who don’t have a uterus (for example, if you’ve had a hysterectomy).
  • Combined Estrogen and Progestogen.  Also known as EPT, this combines doses of estrogen and progesterone or progestin (a synthetic form of progesterone). It’s use for women who still have a uterus since taking these medicines together can help lower the risk of endometrial cancer.
  • Vaginal Estrogen. Rather than estrogen taken as a pill that circulates estrogen throughout your body, this deposits a small amount of estrogen directly to the vagina via cream, tablet, suppository or ring to help with itching and dryness by restoring vaginal blood flow to reverse the thinning and dryness of your vaginal tissues. It can help with urinary problems, too. Because it’s applied directly to the vaginal area, it does not cause any significant rise in your blood levels of estrogen.

You may have heard conflicting stories about HRT, which has a long history dating back to 1942 when Premarin (estrogen made from the urine of a pregnant mare) was approved by the FDA to treat hot flashes. In the years that followed, researchers began combining estrogen with a progestogen to reduce the risk of endometrial cancer that may have arisen from the use of estrogen alone.

But then in 2002, studies linked HRT to breast cancer, strokes, heart disease, and blood clots. The Women’s Health Initiative said that hormone replacement therapy had more risks than benefits, which caused lots of women to abandon treatment out of fear, confusion, and concern.

Fast forward to today, when the guidelines and knowledge have (again) changed since many experts found those studies to be flawed and inconclusive. Now, The North American Menopause Society and others agree that HRT is the gold standard for treating moderate to severe hot flashes and vaginal dryness and is helpful in preventing or slowing osteoporosis.

Most healthy women can use HRT for relief from hot flashes and vaginal dryness, but what it can’t do prevent heart disease or dementia. In fact, a study published in the Journal of the American Medical Association Internal Medicine found that the use of HRT could actually increase postmenopausal women’s risk of heart disease.

The general consensus?

  • While HRT can be extremely helpful for many women to treat hot flashes, vaginal dryness and osteoporosis, it’s not advised for those who have a history of breast or uterine cancer, stroke, heart or liver disease or untreated high blood pressure.
  • HRT is best used by women aged 60 or younger who are within 10 years of menopause and have no risk factors or contraindications.
  • Because experts recognize that every woman’s symptoms and personal health history is different, there’s no longer a “one-size-fits-all” way to use HRT.
  • Compared with the way HRT was prescribed years ago, today it’s used in much lower doses for much shorter periods of time.
  • The most important consideration of all?  Have an open and honest discussion with your health care provider, who can guide you and help steer you toward making the best decision for HRT use.Sources

    http://www.menopause.org/for-women/menopauseflashes/menopause-symptoms-and-treatments/hormone-therapy-benefits-risks

    https://www.ourbodiesourselves.org/book-excerpts/health-article/history-hormone-treatment-menopause/

    https://www.nhlbi.nih.gov/files/docs/pht_facts.pdf

    https://www.health.harvard.edu/womens-health/by_the_way_doctor_is_vaginal_estrogen_safe

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