# Menopausal symptoms can be very uncomfortable leading to loss of sleep, mood swings, hot flashes and diminished sexual satisfaction. For some women, menopause causes little or no symptoms; while other women have severe symptoms that interfere with their daily lives. Although symptoms can be very uncomfortable, they are not dangerous or life threatening. Hormone replacement therapy (estrogen with or without progesterone) has traditionally been prescribed to relieve these symptoms.

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# It was originally thought that estrogen therapy could also prevent heart disease and protect against osteoporosis. However, the early studies some limitations. In an effort to provide more definitive answers on hormone replacement therapy (HRT) the National Institutes of Health funded a very large study. Recently, results from this study, named the Women's Health Initiative Study, were released. This study provides information that will help patients and their healthcare providers make decisions about HRT. Below are answers to several questions that have been asked by women concerned about HRT. 

**[Do I need to stop my hormone replacement therapy
today?]{.underline}** No. Although recent studies show a slight increase
in risk of heart disease and breast cancer -- overall the risk for each
individual woman is still low. It is best to discuss YOUR own risks and
benefits with your healthcare provider before deciding whether to
continue or start HRT.

**[What are the risks and benefits of HRT?]{.underline}** The Women's
Health Initiative (WHI) study included more than 16,000 women with an
intact uterus who received either Prempro^^ or a placebo (a sugar
pill). Prempro^^ is a combination tablet that contains congugated
estrogen (Premarin^^ 0.625 mg) plus medroxyprogesterone 2.5 mg.

*In each year, if 10,000 women were to take a placebo and 10,000 women
were to take HRT, the following events would occur:*

+----------------+----------------+---------------+------------------+
|                | **Placebo**    | **HRT**       | **HRT**          |
|                |                |               |                  |
|                | **(sugar       | **(Prem       | **Risks &        |
|                | pill)**        | pro**^^**)** | Benefits**       |
+----------------+----------------+---------------+------------------+
| **Heart        | 30 cases       | 37 cases      | -   7 *more*     |
| attacks**      |                |               |     cases        |
|                | 30 cases       | 38 cases      |                  |
| **Breast       |                |               | -   8 *more*     |
| cancer**       | 20 cases       | 29 cases      |     cases        |
|                |                |               |                  |
| **Strokes**    | 16 cases       | 34 cases      | -   9 *more*     |
|                |                |               |     cases        |
| **Blood        | 15 cases       | 10 cases      |                  |
| clots**        |                |               | -   18 *more*    |
|                | 16 cases       | 10 cases      |     cases        |
| **Hip          |                |               |                  |
| fractures**    |                |               | -   5 *less*     |
|                |                |               |     cases        |
| **Colon        |                |               |                  |
| cancer**       |                |               | ```{=html}       |
|                |                |               | <!-- -->         |
|                |                |               | ```              |
|                |                |               | -   6 *less*     |
|                |                |               |     cases        |
+----------------+----------------+---------------+------------------+

The five-year study found no difference in the number of deaths between
women taking HRT and placebo.

# **I have had a hysterectomy. How do these studies apply to me?** The recently published studies did NOT include women who had a hysterectomy and are only taking estrogen. The WHI study did include a group of women who had undergone hysterectomy, however this part of the study is still underway. The results of this part of the study are not expected to be available until 2005.

Some researchers have theorized that it is the progesterone and not the
estrogen that increases a woman's risk of heart disease and possibly
other problems. If this is true, than women taking estrogen following
hysterectomy may not be at increased risk. However, until the results of
this part of the WHI are published this remains controversial.

**[I started HRT to prevent heart disease. Should I continue
it?]{.underline}** Surprising to physicians and researchers, in recent
placebo controlled studies, HRT did not protect against heart disease.
There is now data to suggest that if you currently have heart disease
you should not begin taking HRT. Also, it does not appear that HRT
prevents heart disease. Although there may be other reasons to begin HRT
(e.g., for bothersome menopausal symptoms), prevention of heart disease
is no longer the sole reason women should decide to take HRT.

# 

# **I heard that HRT protects my bones; is this still true?** HRT has been shown to help prevent bone loss and prevent hip fractures. This is mainly true if you started it when your menopausal symptoms first began. If you are concerned about osteoporosis, discuss ALL of your options with your healthcare provider before deciding if HRT is a good choice for you. All women should consider regular weight-bearing exercise and calcium and vitamin D every day to prevent osteoporosis.

**[Does HRT really increase my risk of breast cancer?]{.underline}**
There is some evidence that your risk for breast cancer can increase
slightly with HRT. The WHI studies showed that if 10,000 postmenopausal
women with a uterus took estrogen plus progestin for one year, 8 more
will develop breast cancer compared to women not taking HRT. Regardless
of whether you are taking HRT or not, all women should keep up with
their regular schedule breast self-examinations and mammograms.

**[What about blood clots in my veins?]{.underline}** Taking HRT does
increase your risk of developing a blood clot in your lower leg veins
that can sometimes travel to your lungs. This increased risk does not go
away with time. Risk of blood clots is typically higher for women who
smoke cigarettes or who remain in one position for long periods of time
(e.g., during airplane flights or car trips longer than 4 hours).

**[Are there other types of estrogen that I should consider taking? What
about "natural" estrogen products?]{.underline}** The most common
estrogen taken in America is Premarin^^, otherwise known as a
congugated estrogen. Prempro^^ (which combines Premarin^^ with
medroxyprogesterone) was the product studied in the WHI.

There are other prescription hormones available, as well as
over-the-counter products that have or claim estrogen properties.
Unfortunately there is scarce information available about the risks and
the benefits of these other types of estrogens. It is tempting to feel
"safe" by taking a hormone other than the medications studied in the WHI
(Premarin^^ or Prempro^^). However there is no information to show
that these products are as effective or safer than Prempro^^.

![](media/image2.wmf){width="2.8in" height="2.2in"}**[Would a lower dose
of estrogen be better for me?]{.underline}** Since a lower dose of
estrogen was not studied, it is difficult to know exactly how taking a
lower dose would affect the risks and benefits of taking estrogen.
Certainly if you are taking estrogen to prevent menopausal symptoms, it
is prudent to take the lowest dose that keeps your symptoms under
adequate control. Whether lower doses of estrogen provide the same bone
protection is uncertain. Discuss the option of lowering your estrogen
dose with your healthcare provider.