MEDICATIONS: HORMONE THERAPY: INTRODUCTION

The two major female hormones estrogen and progesterone control the female reproductive system and have an effect on many systems and tissues throughout the body. For example, they play a role in building and maintaining bone strength, keeping the skin and hair healthy, maintaining healthy blood cholesterol levels, and they can influence behavior and brain function. As hormone production declines at menopause, bones begin to thin, especially during the first 5 to 10 years after menopause. Also at menopause, women begin to lose their natural resistance to heart disease; by age 65, their risk of heart attack equals that of men.

Hormone therapy (HT) is treatment with prescription hormonal medications to restore a woman's declining hormone levels. Doctors used to advise women who were taking HT to relieve symptoms of menopause such as hot flashes, to continue taking the hormones on a long-term basis to help reduce their chances of developing osteoporosis and heart disease. But with the results of recent studies that indicate a possible increased risk of heart attack, stroke and breast cancer from HT, doctors now recommend that women take HT primarily for the relief of menopausal symptoms and to take the lowest dose of the hormones for the shortest time possible.

The History of Hormone Therapy

Estrogen has been used to treat the symptoms of menopause for years, beginning in the 1950s and 1960s. By 1975, estrogen had become one of the top prescription drugs in the United States.

In the mid-1970s, medical studies found that postmenopausal women who used estrogen therapy alone had a significantly increased risk of uterine cancer. Then researchers found that adding progestin, a synthetic form of progesterone (which counterbalances the effects of estrogen) to estrogen therapy provided protection against uterine cancer. As a result, progestin was added to the hormone replacement regimen for women who still had their uterus. This became the treatment that is now called HT.

HT quickly became a very popular treatment, recommended not only for treating menopausal symptoms but also for long-term protection against osteoporosis and fractures, heart disease and even Alzheimer's disease. However, in 2002, a large-scale study by the National Institutes of Health, called the Women's Health Initiative, was stopped early because of evidence linking HT to a slightly increased risk of stroke, heart disease and breast cancer.

Since then, doctors have been recommending that the therapy be used primarily for the relief of menopausal symptoms, especially in women who could benefit from estrogen in other ways such as increased bone density. Doctors now prescribe lower doses of estrogen and progestin, which are usually less than what the body produces naturally before menopause. How much estrogen to prescribe, with or without progestin and in what form, is determined on an individual basis, depending on each woman's symptoms, health history and health risks.

If you are considering HT, talk to your doctor, who can help you weigh the potential risks of therapy against the potential benefits so you can make an informed decision.

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