Estrogen Replacement Therapy (ERT)
Oral (pills or tablets)
Enjuvia contains plant-based, rather than animal-based, estrogen. Risks and benefits are thought to be the same for both types of estrogen.
Transdermal (patch placed on the skin that releases estrogen continuously)
Vaginal ring (inserted high into the vagina; releases estrogen continuously for 3 months)
Skin cream (applied daily to the legs, thighs, or calves)
Skin gel (applied daily to an arm from wrist to shoulder)
How It Works
Estrogen replacement therapy (ERT) increases the estrogen level in your body. Estrogen impacts multiple systems of the body.
When given through an estrogen patch, vaginal ring, or skin cream or gel (transdermal estrogen), estrogen enters the bloodstream directly, without passing through the liver. The estrogen in pills must be processed by the liver before entering the bloodstream, which puts stress on an impaired liver.
Low-dose vaginal estrogen affects only the urinary and genital area. For more information, see Low-Dose Vaginal Estrogen for Dryness and Atrophy.
Patch warning. Direct sunlight or high heat can increase, then decrease, the amount of hormone released from a patch. This can give you a big dose at the time and leave less hormone for the patch to release later in the week. Avoid direct sunlight on the hormone patch. Also avoid using a tanning bed, heating pad, electric blanket, hot tub, or sauna while you are using a hormone patch.
Why It Is Used
Estrogen replacement therapy (ERT) is used to increase estrogen levels in postmenopausal women who have no uterus. This treatment may help prevent perimenopausal symptoms, osteoporosis, and colon cancer.
Women in their 20s, 30s, and 40s who experience early menopause after having their ovaries removed (oophorectomy) or because of other medical reasons typically take ERT to reduce their risk of early bone loss and osteoporosis. Historically, women have continued using ERT for years beyond menopause. Some women now discontinue ERT around the age of menopause.
Women with a uterus who take estrogen also need the hormone progestin to prevent the estrogen from overgrowing the uterine lining, which can lead to endometrial (uterine) cancer. Estrogen-progestin is called hormone replacement therapy (HRT).
Do not use estrogen treatment if you:
How Well It Works
Systemic estrogen replacement therapy (ERT) affects your entire body and reverses the effect of low estrogen. Systemic ERT may:
Low-dose estrogen. Researchers are studying the effects of low-dose estrogen therapy. Low-dose estrogen may keep bones strong and may relieve hot flash symptoms.5 But the long-term risks of taking low-dose estrogen are not yet known.
Risks of estrogen replacement therapy
Estrogen replacement therapy (ERT) may increase the risk of health problems in a small number of women. This increase in risk depends on your age, your personal risk, and when ERT is started.1 Talk with your doctor about these risks. Using ERT may increase your risk of:
Side effects that can occur with all forms of estrogen but are more common with oral estrogen (and less common with a patch, cream, gel, or vaginal ring) include:
Some of these side effects, such as headaches, nausea, fluid retention, weight gain, and breast tenderness, may go away after a few weeks of use.
The estrogen patch (transdermal estrogen) may cause skin irritation.
An estrogen ring must be replaced every 3 months. If the ring falls out at any time during the 3-month treatment period, you may rinse it with lukewarm water and reinsert it.
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
What To Think About
In the Million Women Study of British women ages 50 to 64, taking any form of estrogen for 10 years increased breast cancer risk. The Women's Health Initiative study did not show this increased risk for women taking estrogen alone (ERT) for 7 years.3 So taking long-term ERT probably slightly increases breast cancer risk, and taking it with progestin (HRT) further increases breast cancer risk.2 But only women who have had a hysterectomy can take estrogen alone without also worrying about endometrial (uterine) cancer risk.2
ERT use slightly increases the risk of stroke. For this reason, the Women's Health Initiative ERT trial was stopped sooner than originally planned. In this large trial, women using ERT had no change in heart disease risk, had fewer hip fractures (a sign of estrogen's bone-protecting effect), and (unlike the larger Million Women Study) had no increase in breast cancer risk during the study's nearly 7 years of ERT treatment.3
If you are taking ERT after early menopause caused by a surgical hysterectomy, talk with your doctor about long-term ERT risks and benefits.
eMedicineHealth Medical Reference from Healthwise
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