Pros and Cons of Hormone Therapy:
Making an Informed Decision
WHY MIGHT HORMONE THERAPY BE PRESCRIBED?
Hormone therapy is very effective in relieving menopausal discomforts such as hot flashes, night sweats and vaginal dryness. For symptom relief, HT is generally prescribed for 1-5 years.
More recently, hormone therapy has been prescribed with the goal of reducing the risk of heart disease, osteoporosis, a condition of thinning, fragile bones, which affects women as they age and which can be debilitating. For risk reduction, doctors usually suggest that a woman take HT for 10 to 20 years or even throughout her lifetime.
When taking hormones, women who have a uterus are almost always prescribed estrogen and progesterone, since estrogen alone greatly increases a woman's risk of uterine cancer and adding progesterone prevents this. A woman who has had her uterus removed can use estrogen alone, often called "estrogen replacement therapy" (ERT).
Hormone or estrogen therapy is particularly important to consider for women who experience menopause before the age of 40, whether naturally or as a result of surgery to remove the ovaries, radiation or chemotherapy, to counter the effects of a premature drop in estrogen levels on a woman's body.
WHY HORMONE THERAPY MIGHT NOT BE AN OPTION?
Many women prefer non-hormonal approaches for menopausal discomforts and to maintain good health as they age. Good nutrition, regular physical exercise and stopping smoking are some known ways to reduce the risks of heart disease, osteoporosis and breast cancer and are beneficial if a woman is using hormones or not. Some of the long-term studies now underway will allow us to compare the benefits of HT to healthy lifestyle patterns.
Current research studies show an increased risk of breast cancer in women using HT. This increase appears to be in the neigbourhood of 26% on women using this.
Some women experience unpleasant side effects on HT such as irregular bleeding, bloating, headaches, breast tenderness and irritability. These may be temporary or can be helped by altering the dose and kind of hormones prescribed. However, side effects may lead some women to avoid or discontinue hormone use. Hormone therapy also increases a woman's risk of gallbladder disease two or three-fold.
Women with certain conditions should not take hormone therapy. These include:
- women with breast cancer,
- active liver disease,
- a history of blood clots
- or unexplained vaginal bleeding.
Other conditions require careful evaluation before considering hormones. Among these are:
- migraine headaches;
- high triglycerides;
- gallbladder or chronic liver disease;
- history of cancer of the uterus or ovaries;
- fibroids;
- history of endometriosis;
- history of exposure to the estrogen DES.
