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Hormone Therapy & Heart Disease

What is hormone therapy?

Hormone therapy (HT), also called menopausal hormone therapy, is a treatment for women who are going through or have gone through menopause. The female hormone estrogen is the most common type of hormone therapy. Because taking estrogen alone may increase the risk of uterine cancer, it is usually combined with another type of hormone called a progestogen.1 Estrogen alone is only given to women who have had a hysterectomy (had their uterus surgically removed).2 See also: Age & Menopause

What is hormone therapy used for?

Hormone therapy is used to treat menopausal symptoms such as hot flashes, night sweats, sleep disturbances, and vaginal dryness.

Hormone therapy has also been investigated as a way to prevent or treat many diseases that become common after menopause, from heart disease and cancer to Alzheimer’s disease and osteoporosis, but results have generally been disappointing so far.

What are the different kinds of hormone therapy?

There are three main types of hormone therapy:

  • Estrogen-only therapy (ET)
  • Progestogen-only therapy
  • Combined estrogen-progestogen therapy (EPT)

There are many variations on these main themes: hormone therapies come in different combinations of estrogens and progestogens, with different dosing strengths and schedules. It is generally recommended that you use the lowest dose that controls your symptoms.

Hormone therapy can be applied in many ways. It is usually given as a pill, but can also be given as an injection, or absorbed through the skin as a patch, gel, cream, or spray, or as a vaginal cream, ring, or tablet. For a list of the different hormone therapy formulations available in the U.S. and Canada, visit http://www.menopause.org/edumaterials/htcharts.pdf.

What are custom-compounded hormones?

While there are a wide variety of doses and preparations of hormone therapy, not every possible combination is commercially available. To fill this gap, a type of pharmacist called a compounding pharmacist will mix custom hormone formulations according to a doctor’s prescription.

Advocates of custom-compounded hormones say that some women can benefit by finding the exact dose or combination that works best for them. However, commercial hormone therapy preparations are approved and regulated by the FDA. This means that their safety and effectiveness has been scientifically proven in clinical trials, and that the FDA supervises their production to make sure that dosages are accurate and consistent and the ingredients are pure. Custom-compounded hormone preparations are not FDA-approved. Since none of them have been tested in clinical trials there is no way of knowing whether they are effective or even if they are safe. In addition, because a pharmacist mixes them individually, the doses of hormones may not be the same every time.

What are bioidentical hormones?

The term "bioidentical hormones" refers to hormones that occur naturally in the body. In terms of hormone therapy, this usually refers to preparations containing the natural estrogens 17beta-estradiol, estrone, or estriol, and the natural progestogen progesterone.

Most hormone preparations advertised as "bioidentical" are available from compounding pharmacies only and are not FDA-regulated. Purveyors of bioidentical hormones often claim that because they are closer to the hormones found in a woman’s body before menopause they are safer and more effective than other kinds of hormone therapy. However, there is no scientific evidence to support these claims. Being truly "bioidentical" is not as simple as using a few naturally-occurring hormones, either: the body naturally produces more than 25 kinds of estrogen, and no pill can deliver hormones to different areas exactly like the body does. "Bioidentical" compounded hormones have the same problems as other compounded hormones—there is no way of knowing if they work or even if they’re safe.
If you are interested in bioidentical hormones, there are a few FDA-approved hormone therapy preparations available at retail pharmacies that contain only naturally occurring hormones. The risks and benefits of these preparations are thought to be the same as other types of hormone therapy.

Next: Hormone Therapy & Your Heart


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