Hormone Replacement Therapy (HRT)
Estrogen and progestin combinations (pills or tablets)
Transdermal combination preparations (a patch placed on the skin that continuously releases estrogen and progestin)
Oral progestin (pills or tablets; used along with an estrogen-only preparation)
Progestin intrauterine device (IUD; used along with an estrogen-only preparation)
Estrogen-progestin hormone therapy, or HRT, is recommended for all women with a uterus who choose to take estrogen. Using estrogen without progestin greatly increases your risk of endometrial cancer. Taking progestin with estrogen eliminates this increased risk.5
How It Works
HRT increases the estrogen and progestin levels in your body. There are several standard hormone replacement therapy schedules, including continuous and cyclic along with higher-dose and low-dose.
Combining progestin with estrogen:
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
The estrogen in hormone therapy is used by some postmenopausal women to increase estrogen levels. This helps prevent osteoporosis and perimenopausal symptoms, such as hot flashes and sleep problems.
But HRT slightly increases risks of some serious health problems. In a small number of women, HRT may increase the risk of blood clots, stroke, heart disease, breast cancer, ovarian cancer, or dementia.2, 1 In women who are 10 or more years past menopause, using HRT slightly raises the risk of heart disease.6
Because of the risks of HRT, many experts recommend that HRT be used for:
Who should not use HRT
You should not use HRT if you:
How Well It Works
HRT increases estrogen levels, which may:
Risks of hormone replacement therapy
Hormone replacement therapy (HRT) 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 HRT is started.2 Talk with your doctor about these risks. Using HRT may increase your risk of:
Experts do not yet know whether lower-dose, shorter-term HRT reduces or eliminates these risks.
Estrogen side effects
Side effects that can occur with all forms of estrogen but are more frequent with oral estrogen include:
In addition, the estrogen patch (transdermal estrogen) may cause skin irritation.
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.
Progestin side effects
The side effects of progestin often cause women to stop using hormone replacement therapy (HRT). Adjusting the progestin dose, changing the dosing schedule, or changing the type of progestin may reduce side effects. The progestin intrauterine device (IUD) reduces or eliminates side effects that are common with oral progestin.5
Progestin side effects include:
Cyclic progestin (taken 10 to 14 days a month) is more likely to cause:
The combination transdermal patch may cause skin irritation.
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
What To Think About
If you have been taking HRT, talk with your doctor about your reasons for taking it. Are you taking it to help with perimenopausal symptoms or for long-term health reasons? Consider changing to another treatment, depending on the problem you are using HRT to treat. If HRT seems like the best choice for you, plan to use the lowest possible effective dose.
If you are unable to tolerate the side effects of progestin in hormone replacement therapy and you have not had a hysterectomy, try nonhormonal treatment options.
The British Million Women Study has confirmed the Women's Health Initiative findings and has provided more information about estrogen, progestin, and breast and endometrial cancers.3 This is important information for women deciding whether to take estrogen without progestin, as described above.
When given with a skin patch, estrogen-progestin enters the bloodstream directly, without passing through the liver. The estrogen and progestin in pills must be processed by the liver before entering the bloodstream. This is why women with liver or gallbladder disease can usually use a patch form of HRT.
eMedicineHealth Medical Reference from Healthwise
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