Hormone Replacement Therapy: Is It for You?
Hormone replacement therapy, either using estrogen alone or estrogen with progesterone, supplements the body’s natural hormone levels and is used to ease the symptoms of menopause. Estrogen and progestin come in the form of pills, patches, sprays, gels, a vaginal ring, and creams.
It was initially believed that hormone replacement therapy might lower a woman’s risk of heart disease and other medical conditions. But researchers uncovered surprising findings during the massive Women’s Health Initiative study, which ended abruptly in 2002 when higher rates of heart attack, stroke, and breast cancer were recorded among postmenopausal women who were taking the drugs.
According to the Endocrine Society, the latest research indicates that the level of risk depends on a woman’s health history, age, and other factors. Cynthia Stuenkel, MD, an internist, endocrinologist, and clinical professor of medicine at the University of California–San Diego, says that for most healthy women with bothersome menopausal symptoms, the benefits of limited hormone therapy may exceed the risks.
For women with diabetes, who already face a heightened risk for heart disease, the recommendations are less clear. “We worry about the risk of coronary heart disease, and we probably want to be a little more careful,” she says. “The picture is a little less black and white.”
Some experts recommend through-the-skin, or transdermal, options for hormone replacement, such as patches, gels, or sprays. These may be “metabolically friendlier” than oral choices for women with diabetes who do not have heart disease, Stuenkel says. A number of nonhormonal prescription therapies, such as low doses of the antidepressant paroxetine (sold as Paxil, Pexeva, and Brisdelle), can also be helpful in treating hot flash symptoms, she says.
If a woman chooses not to go on hormone replacement therapy, she should discuss with her doctor other options for treating her symptoms.