Hormone Replacement Therapy

Are there different types of hormone replacement therapy?

Yes. There are different types of hormone replacement therapy. One type involves taking estrogen alone, but hormone replacement therapy with estrogen alone can increase the risk of cancer of the uterus (womb) and endometrium (lining of the uterus). Adding progestin, a synthetic form of progesterone, to your treatment seems to keep the risk of these two cancers down.

In the past, women taking these two hormones would take estrogen for the first part of the cycle and progestin during the latter part of the cycle. But this form of hormone replacement therapy may cause bleeding every month, much like having a menstrual period. Many women quit taking the hormones because of this monthly bleeding.

Taking both of the hormones every day throughout the month seems to fix this problem for many women - most women taking continuous estrogen and progestin therapy quit having bleeding after three to six months.

How is continuous hormone replacement therapy taken?

Your doctor will probably start you on the estrogen and progestin at the same time. He or she will probably start you on a low dose of progestin to see if you have bleeding on the lowest dose.

Take both pills every day. You don't have to stop on certain days of the months.

If you have bleeding, tell your doctor. The dose of progestin may need to be increased.

What are the benefits of hormone replacement therapy?

Hormone replacement therapy can be beneficial in many ways:

• It can reduce your risk of osteoporosis, a condition that causes the bones to become porous and thin and more likely to break.
• It can relieve symptoms of menopause, such as flushing, night sweats and vaginal dryness.
• It can decrease your risk of heart attacks.

What are the risks of hormone replacement therapy?

As mentioned before, estrogen taken alone can increase the risk of cancer of the uterus and endometrium.

Progestin can cause tender breasts, fluid retention, swelling, moodiness and cramps. These side effects seem to be less for some women who take continuous hormone replacement therapy. Progestin may also reduce how well estrogen works to protect against heart disease. Studies are still being done on the use of progestin.

Generally, women who have had endometrial cancer, breast cancer, blood clots, stroke, unexplained vaginal bleeding or liver disease shouldn't take hormone replacement therapy.

Are there any signs of problems I should look for?

Yes. If you bleed after you haven't had any periods for several months, call your doctor. Also call your doctor if you notice any breast lumps or pain, or if you have any questions.