Home Am I at Risk? Hormone Therapy - Taking HT

Hormone Therapy - Taking HT

How do I decide whether or not to take hormone therapy?

To decide whether hormone therapy is right for you, first talk to your doctor about your menopausal symptoms and how much they bother you. Your choice will ultimately be guided by how bothersome your symptoms are, your age, your other risk factors, what your treatment options are, and your personal preferences.

Although large studies like the Women’s Health Initiative have taught us a lot about the risks and benefits of hormone therapy, there is still much we don’t know. Each woman is unique, and in the end the decision on whether or not to take hormone therapy should be reached together with your doctor after weighing the possible risks and benefits. Although taking hormones for short periods at low doses is considered safer than longer-term hormone therapy, there is no amount that is considered completely safe.

Who should not take hormone therapy?

You should not take hormone therapy if you have:

  • History of heart disease or stroke
  • A history of blood clots
  • Unusual vaginal bleeding
  • A history of hormone-sensitive cancer (such as breast or uterine)
  • Liver disease
  • Or if you are pregnant or may become pregnant

How should I choose which type of hormone therapy to take?

Your choice of hormone therapy will depend on what your symptoms are, how severe they are, and personal preference. For example, in women whose main complaint is vaginal dryness, vaginal creams, gels or tablets may be the best choice because these products deliver the minimum amount of hormone where it’s needed most. Women taking hormones to control hot flashes need a systemic hormone (one that is delivered to the whole body), so a pill may be better.

Research all your options and discuss them with your doctor to decide which type of hormone therapy is right for you. Regardless of what you decide, you should take the lowest dose that controls your symptoms for the shortest amount of time possible. With a doctor’s guidance most women can try to wean off treatment within the first year. Women whose symptoms return can try to taper off again in 6 months.

What are the alternatives to hormone therapy?

For information on non-hormonal ways to cope with your menopausal symptoms and prevent osteoporosis, see the NHLBI’s booklet Facts About Menopausal Hormone Therapy.

For more information:

http://www.nhlbi.nih.gov/health/women/pht_facts.pdf
National Heart Lung and Blood Institute Facts about menopausal hormone therapy

http://www.fda.gov/womens/menopause/
FDA Menopause & Hormones Information

http://www.menopause.org/edumaterials/htcharts.pdf
List of Hormone Products for Postmenopausal Use in the United States and Canada
The North American Menopause Society

References

1. Grady D, Rubin SM, Petitti DB, et al. Hormone therapy to prevent disease and prolong life in postmenopausal women. Ann Intern Med. Dec 15 1992;117(12):1016-1037.
2. Effects of estrogen or estrogen/ progestin regimens on heart disease risk factors in postmenopausal women. The Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial. The Writing Group for the PEPI Trial. JAMA. Jan 18 1995;273(3):199-208.
3. Cushman M, Kuller LH, Prentice R, et al. Estrogen plus progestin and risk of venous thrombosis. JAMA. Oct 6 2004;292(13):1573-1580.
4. Collins P, Rosano GM, Sarrel PM, et al. 17 beta-Estradiol attenuates acetylcholine-induced coronary arterial constriction in women but not men with coronary heart disease. Circulation. Jul 1 1995;92(1):24-30.
5. Reis SE, Gloth ST, Blumenthal RS, et al. Ethinyl estradiol acutely attenuates abnormal coronary vasomotor responses to acetylcholine in postmenopausal women. Circulation. Jan 1994;89(1):52-60.
6. Mendelsohn ME, Karas RH. The Protective Effects of Estrogen on the Cardiovascular System. N Engl J Med. June 10, 1999 1999;340(23):1801-1811.
7. Manson JE, Hsia J, Johnson KC, et al. Estrogen plus progestin and the risk of coronary heart disease. N Engl J Med. Aug 7 2003;349(6):523-534.
8. Wathen CN, Feig DS, Feightner JW, Abramson BL, Cheung AM. Hormone replacement therapy for the primary prevention of chronic diseases: recommendation statement from the Canadian Task Force on Preventive Health Care. CMAJ. May 11, 2004 2004;170(10):1535-1537.
9. Mosca L, Banka CL, Benjamin EJ, Berra K, Bushnell C, Dolor RJ. Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women: 2007 Update. Circulation. 2007;115:0000-0000.
10. Grodstein F, Stampfer M. The epidemiology of coronary heart disease and estrogen replacement in postmenopausal women. Prog Cardiovasc Dis. Nov-Dec 1995;38(3):199-210.
11. Heckbert SR, Weiss NS, Koepsell TD, et al. Duration of estrogen replacement therapy in relation to the risk of incident myocardial infarction in postmenopausal women. Arch Intern Med. Jun 23 1997;157(12):1330-1336.
12. Writing Group for the Women's Health Initiative Investigators. Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women: Principal Results From the Women's Health Initiative Randomized Controlled Trial. JAMA. July 17, 2002 2002;288(3):321-333.
13. Anderson GL, Limacher M, Assaf AR, et al. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women's Health Initiative randomized controlled trial. JAMA. Apr 14 2004;291(14):1701-1712.
14. Matthews KA, Kuller LH, Wing RR, Meilahn EN, Plantinga P. Prior to use of estrogen replacement therapy, are users healthier than nonusers? Am J Epidemiol. May 15 1996;143(10):971-978.
15. Barrett-Connor EL, Cohn BA, Wingard DL, Edelstein SL. Why is diabetes mellitus a stronger risk factor for fatal ischemic heart disease in women than in men? The Rancho Bernardo Study. JAMA. Feb 6 1991;265(5):627-631.
16. Rossouw JE, Prentice RL, Manson JE, et al. Postmenopausal hormone therapy and risk of cardiovascular disease by age and years since menopause. JAMA. Apr 4 2007;297(13):1465-1477.
17. Manson JE, Allison MA, Rossouw JE, et al. Estrogen therapy and coronary-artery calcification. N Engl J Med. Jun 21 2007;356(25):2591-2602.
18. Clarke SC, Kelleher J, Lloyd-Jones H, Slack M, Schofiel PM. A study of hormone replacement therapy in postmenopausal women with ischaemic heart disease: the Papworth HRT atherosclerosis study. Bjog. Sep 2002;109(9):1056-1062.
19. Alexander KP, Newby LK, Hellkamp AS, et al. Initiation of hormone replacement therapy after acute myocardial infarction is associated with more cardiac events during follow-up. J Am Coll Cardiol. July 1, 2001 2001;38(1):1-7.
20. Hulley S, Grady D, Bush T, et al. Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. Heart and Estrogen/progestin Replacement Study (HERS) Research Group. JAMA. Aug 19 1998;280(7):605-613.
21. Grady D, Herrington D, Bittner V, et al. Cardiovascular disease outcomes during 6.8 years of hormone therapy: Heart and Estrogen/progestin Replacement Study follow-up (HERS II). JAMA. Jul 3 2002;288(1):49-57.
22. Executive summary. Hormone therapy. Obstet Gynecol. Oct 2004;104(4 Suppl):1S-4S.
23. Barrett-Connor E, Mosca L, Collins P, et al. Effects of raloxifene on cardiovascular events and breast cancer in postmenopausal women. N Engl J Med. Jul 13 2006;355(2):125-137.
24. Col NF, Weber G, Stiggelbout A, Chuo J, D'Agostino R, Corso P. Short-term Menopausal Hormone Therapy for Symptom Relief: An Updated Decision Model. Arch Intern Med. August 9, 2004 2004;164(15):1634-1640.
25. Facts About Menopausal Hormone Therapy. National Heart Lung and Blood Institute. June 2005. Available at: http://www.nhlbi.nih.gov/health/women/pht_facts.pdf. Accessed August 8, 2007.
26. Zizic TM. Pharmacologic prevention of osteoporotic fractures. Am Fam Physician. Oct 1 2004;70(7):1293-1300.
27. Ewer MS, Vooletich MT, Durand JB, et al. Reversibility of trastuzumab-related cardiotoxicity: new insights based on clinical course and response to medical treatment. J Clin Oncol. Nov 1 2005;23(31):7820-7826.
28. Almeida OP, Flicker L. Association between hormone replacement therapy and dementia: is it time to forget? Int Psychogeriatr. Jun 2005;17(2):155-164.
29. Craig MC, Maki PM, Murphy DG. The Women's Health Initiative Memory Study: findings and implications for treatment. Lancet Neurol. Mar 2005;4(3):190-194.


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