Guest Author - Dr. Denise Howard
Hormone replacement therapy (HRT) is the administration of an estrogen and progestin combination to treat symptoms related to hormone deficiency, which occurs after menopause. In women who have had their uterus surgically removed, there isnít any need for the progestin component, so estrogen replacement therapy (ERT) is prescribed. All medications and therapies have their potential risks and it is important to understand these before accepting any treatment.
HRT/ERT has undergone a pendulum like effect in its popularity. When it was first introduced, it was thought to be a wonder drug and then the association with endometrial cancer was recognized. The addition of progestin to the regimen minimized this risk and it was again very popular. Recent studies have shown an association with breast cancer and an increased risk of other conditions resulting in a more conservative approach to the prescribing of this treatment.
The absolute risk of HRT in women in their 50s with use for less than 5 years is low and those who have been menopausal for >10 years or in their 60s are at greater risk. The increased risks noted here involves the use of HRT for > 5years.
Breast cancer is the most common cancer in women and the news that HRT increased this risk was the most shocking revelation of recent large studies. The risk was increased by 6.8 additional cases per 1000 women after more than 5 years of use of combined estrogen and progestin therapy. This risk was not increased in those women using estrogen alone.
HRT also increases the risk of thromboembolic events, a fact known from the birth control pill experience. The overall risk of venous thromboembolism is 2-5 cases per 1000 women and 1-1.2 cases of stroke. Women taking combination therapy had an increased risk of coronary heart disease at 8 additional cases per 10,000 person years. The risk was not increased in those taking estrogen alone or in those less 59 years of age.
HRT also has an undesirable effect on the cholesterol and triglyceride levels. The increase in lipids most likely contributes to an increase risk of heart disease and thromboembolic events. This effect is much less with transdermal administration.
Hormone replacement therapy in certain combinations and preparations increases the risk of breast cancer, heart disease and venous thromboembolism.
No therapy is without its risks and it is therefore important to weigh the benefits against the risks when selecting any treatment. HRT has provided benefit to generations of women and even though there are some untoward effects, it is a viable option in women who are at low risk of related complications.
I hope this article has provided you with information that will help you make wise choices, so you may:
Live healthy, live well and live long!