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Hormone replacement therapy
Hormone replacement therapy is estrogen or combination estrogen/progestin medication,
available by prescription, to relieve menopausal symptoms (such as hot flashes,
sleep disturbance, vaginal dryness, mood swings, and urinary symptoms), reduce
risk of osteoporosis, and reduce risk of cardiovascular disease. There is some
evidence that it may also be useful in preventing Alzheimer's disease and colon
cancer. Medical opinion about the risks of hormone replacement therapy is divided.
When estrogen is given alone, it stimulates the lining of the uterus and increases
risk for endometrial cancer (cancer of the uterus), so it is prescribed with
progestin in order to prevent this from happening, except in cases where women
have had a hysterectomy. Women traditionally use hormone replacement therapy
to reduce symptoms associated with menopause, as well as to reduce risks of
many diseases, from heart disease to colon cancer.
The benefits of hormone replacement therapy outweigh the risks for most women,
and continuing research indicates that the use of long-term hormone replacement
therapy assists in the prevention of diseases such as osteoporosis and heart
disease.
Heart disease is the major cause of death in women over the age of 65, and
women who take hormones, even those with high risk factors for heart disease,
are found to have a 50% reduction in risk of fatal heart attacks. Hormone replacement
therapy is believed to work in reducing the risk of heart disease by lowering
cholesterol levels, and by enabling blood vessels to dilate and increase blood
flow to the heart.
Hormone replacement therapy also prevents bone loss associated with menopause
and reduces risk of fracture, especially when therapy is begun within three
years of menopause and continued for ten years or more. Hormone replacement
therapy must be used long-term in order to have positive effects on bone and
unfortunately unless hormone replacement therapy is continued, it’s positive
effects will stop once therapy is discontinued. Hormone replacement therapy
cannot reverse bone loss, nor can it cure osteoporosis, however, hormone replacement
therapy does slow bone loss and preserves existing bone.
Other benefits of hormone replacement therapy include a decrease in risk of
colon cancer as well as a decrease in menopausal symptoms. For many women, hot
flashes are a very uncomfortable symptom of menopause that can be relieved by
hormone replacement therapy. Hot flashes generally subside 1-2 weeks after starting
hormone replacement therapy, however, hot flashes will likely return if hormone
replacement therapy is discontinued. Often, the symptoms associated with menopause
may cause emotional distress and fortunately hormone replacement therapy can
help restore a sense of well-being by treating the symptoms of menopause, including
hot flashes, night sweats, fatigue, nervousness, and irritability.
Hormone replacement therapy may cause nausea, bloating, breast tenderness,
headaches, water retention, irritability, mood swings, anxiety, and “withdrawal
periods,” irregular bleeding that tends to be of concern to most women. Other
side effects of hormone replacement therapy may include premenstrual syndrome
(PMS) symptoms, skin irritations such as itching, redness, and acne, headaches,
facial hair, and voice deepening.
Women who suffer from breast cancer may not be able to use hormone replacement
therapy as it is unclear the effect that hormones have on breast cancer. Though
previously thought that hormone replacement therapy might increase the risk
of endometrial cancer, it is now understood that by combining estrogen and progestin
in the hormone replacement therapy, the risk of this type of cancer is actually
decreased and is lower for women using hormone replacement therapy as for those
who are not.
Hormone replacement therapy is available in oral formulations, injections,
vaginal creams, and skin patches. Hormone replacement therapy can be prescribed
as a continuous therapy or a sequential therapy in which the progestin is taken
at cyclic intervals.
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