Hormone replacement therapy for menopausal symptoms: benefits and risks

Hormone Replacement Therapy

Menopause and Its Consequences

Menopause is that inevitable and irreversible time when a woman's reproductive cycle and menstruation periods gradually end, as her ovaries cease to respond to male gonadotropins and her capacity to become pregnant stops (Mayeux, Jr. 1997). This spontaneously occurs between 45 and 55 in American women, with 51 as the median age.

A woman's ovaries at the menopause are nearly empty of primary follicles - which, in child-bearing age, are abundant, mature and can be fertilized by the male sperm cell, resulting in conception and pregnancy. At menopause, the ovaries' production of the hormone called estrogen becomes very minimal, and this altered condition of a lack of estrogen produces many unpleasant symptoms in approximately 70% of all postmenopausal women (Mayeux, Jr.). These symptoms include hot flushes and extreme warmth, profuse sweating, tremor, irritability, and depression. Physically, the female reproductive organs shrink and lose their fullness. The vaginal pH turns more alkaline and it becomes more prone to chronic vaginitis, which is accompanied by itching, discharge, and tenderness. Pelvic ligaments and muscles also loosen and often result in bladder prolapse and stress incontinence (Mayeux, Jr.). The breasts also shrink and sag. Furthermore, osteoporosis develops when there is severe depletion of estrogen.A number of women lose sexual interest and abandon usual activities as a result of a perceived loss of femininity and attractiveness.

Estrogen/Hormone Replacement Therapy (ERT/HRT)

Most of these symptoms can be eliminated, minimized or reversed by estrogen replacement therapy. Even low doses of.01 mg of ethinyl estradiol or.625 mg of Premarin daily are effective in relieving genital atrophy, vaginitis and dyspareunia, orally/systematically or locally in the form of creams.

By restoring the level of estrogen that the body ceases to produce, this therapy relieves the discomforts and frustrations of menopause, like hot flashes, sleep disturbance, vaginal dryness, mood swings, osteoporosis, and incontinence (American Medical Women's Association 1999). It has also been shown to prevent Alzheimer's disease and colon cancer. HRT also contains progestin or prescribed along with it in order to reduce the risk of endometrial cancer.

Last July, however, the National Institutes of Health (NIH) came out with a finding from the so-called Women's Health Initiative, which surveyed an estimated 14 million menopausal and post-menopausal women before that month. It doused what has been long held by obstetrician-gynecologists as menopausal women's provision for healthy hearts, bones and moods as well as effective relief from menopausal symptoms (McCullough 2002). It announced its finding that HRT causes just what it is supposed to prevent and in a span of only five years from the start of HRT. The announcement jolted concerned women out of HRT and led groups like the American College of Obstetricians and Gynecologists, the American Heart Association and the North American Menopause Society to come to a common prescription of the lowest possible dose of hormones and for the shortest possible period to treat symptoms. They warned that hormones should not be used to prevent or treat heart disease and other degenerative ailments (McCullough).

Taking Hormones

Menopausal women may take hormones by taking.625 mg Premarin each month as the standard method (Hempel). This will induce monthly menstrual periods in the last days of the cycle, but these simulated bleedings will gradually decrease. Bloating, headaches and breast tenderness happen to 5-10% of menopausal women who take estrogen only. These symptoms, though, disappear after a few months.

They may take the same dose of Premarin with progestin in a lower dose of 2.5 mg, which will produce temporary spotting. After six months, the spotting will stop in 95% of all menopausal women without increasing the risk of developing endometrial cancer (Hempel). Possible side effects are bloating, weight gain, irritability and depression, but they improve with time.

Or women may take estrogen alone if they want to avoid spotting but at the risk of developing endometrial cancer 8 times. Yearly biopsies can detect cancer at early and curable stages. Women taking only estrogen are likely to have bloating, headaches and breast tenderness.

Walking and weight bearing exercise will help prevent osteoporosis if performed regularly. Exercise will also help reduce the risk of heart attack by 40%. Likewise, calcium taken orally or an eight-ounce glass of skim milk taken daily can deliver 300 mg of calcium to handle osteoporosis.

Hormone patches, however, do not provide the same degree of beneficial effects as does oral estrogen (Hempel).

All in all, the decision to take hormones is an individual matter that every involved woman should discuss with her doctor.