Estrogen therapy, a form of hormone replacement therapy, is a useful way of combating the uncomfortable symptoms that often accompany menopause. Roughly 1.5 million women between the ages of 45 and 55 experience menopausal symptoms, which often involve hot flashes, flushing, and night sweats, also known as vasomotor symptoms. Estrogen therapy is a treatment for symptomatic menopausal women experiencing distressing symptoms. Without it, a third of women experience at least itching, irritation, dryness, and dyspareunia, leading to decreased quality of life.

Estrogen therapy useful in preventing age-related cognitive declines among women. Estrogen replacement therapy may prevent or slow cognitive declines in women by promoting cholinergic and serotonergic activity in specific brain regions, maintaining neural circuitry, altering lipoprotein levels, and preventing cerebral ischemia. Estrogen replacement therapy also has physiological benefits that may promote maintenance of physical functioning.

What are estrogen and progesterone?

Estrogen and progesterone are hormones that are produced by a woman’s ovaries.

Why does the body need estrogen?

Estrogen thickens the lining of the uterus, preparing it for the possible implantation of a fertilized egg. Estrogen also influences how the body uses calcium, an important mineral in the building of bones. In addition, estrogen helps maintain healthy levels of cholesterol in the blood. Estrogen is necessary for keeping the vagina healthy.

As menopause nears, the ovaries reduce most of their production of these hormones. Lowered or fluctuating estrogen levels may cause menopause symptoms such as hot flashes, and medical conditions such as osteoporosis.

What is hormone therapy (HT)?

Hormone therapy (HT) is a treatment that is used to supplement the body with either estrogen alone or estrogen and progesterone in combination. When the ovaries no longer produce adequate amounts of these hormones (as in menopause), HT can be given to supplement the body with adequate levels of estrogen and progesterone. HT helps to replenish the estrogen, relieving some of the symptoms of menopause and helping to prevent osteoporosis.

Why is progesterone taken?

Progesterone is used along with estrogen in women who still have their uterus. In these women, estrogen– if taken without progesterone–increases a woman’s risk for cancer of the endometrium (the lining of the uterus). During a woman’s reproductive years, cells from the endometrium are shed during menstruation. When the endometrium is no longer shed, estrogen can cause an overgrowth of cells in the uterus, a condition that can lead to cancer.

Progesterone reduces the risk of endometrial (uterine) cancer by making the endometrium thin. Women who take progesterone may have monthly bleeding, or no bleeding at all, depending on how the hormone therapy is taken. Monthly bleeding can be lessened and, in some cases, eliminated by taking progesterone and estrogen together continuously. Women who have had a hysterectomy (removal of the uterus through surgery) typically do not need to take progesterone. This is an important point because estrogen taken alone has fewer long-term risks than HT that uses a combination of estrogen and progesterone.

What are the types of hormone therapy (HT)?

There are two main types of HT:

• Estrogen Therapy (ET): Estrogen is taken alone. Doctors most often prescribe a low dose of estrogen to be taken as a pill or patch every day. Estrogen may also be prescribed as a cream, vaginal ring, gel, or spray. You should take the lowest dose of estrogen needed to relieve menopause symptoms and/or to prevent osteoporosis. This type of HT is used if a woman has had a hysterectomy
• Estrogen Progesterone/Progestin Hormone Therapy (EPT): Also called combination therapy, this form of HT combines doses of estrogen and progesterone (progestin is a synthetic form of progesterone). This type of HT is used if a woman still has her uterus

What are the benefits of taking hormone therapy (HT)?

HT is prescribed to relieve:

• Hot flashes
• Vaginal dryness that can result in painful intercourse
• Other problematic symptoms of menopause, such as night sweats and dry, itchy skin

Other benefits of taking HT include:

• Reduced risk of developing osteoporosis and reduced risk of bone breakage
• Improvement of mood and overall sense of mental well-being in some women
• Decreased tooth loss
• Lowered risk of colon cancer
• Lowered risk of diabetes
• Modest improvement in joint pains
• The lower death rate for women who take hormone therapy in their 50s.

How can I know if estrogen is right for me?

The balance of risks versus benefits of estrogen therapy can be very different for each woman, depending on her age, family history, and personal medical history. It is important to allow enough time to discuss the risks and benefits of hormone therapy. This is a question that should usually be addressed to your doctor.

How long should I take estrogen?

Since research on estrogen therapy is ongoing, women should reevaluate their treatment plans each year. Discontinue estrogen therapy (under your health care provider’s guidance) if you develop a medical condition that would make it less safe for you.

Medications

Estrogen is most commonly given in these forms:

• Pill or tablet
• Vaginal cream
• Vaginal ring insert
• Patch
• Skin gel

Progestin is available in these forms:

• Pill (can be combined with estrogen)
• Vaginal capsule
• Injection
• Implant
• Skin gel

What are the risks of taking hormone therapy (HT)?

While HT helps many women get through menopause, the treatment (like any prescription or even non-prescription medicines) is not risk-free. Known health risks include:

• Increased risk of blood clots and stroke. However, in women within 5 years of menopause, there was no statistically significant increase in stroke risk. Also, studies suggest that using estrogen delivered from the skin via a patch/cream might further lessen the risk of blood clots.
• Increased chance of gallbladder/gallstone problems.

What are the side effects of hormone therapy (HT)?

Like almost all medications, hormone therapy has side effects. The most common side effects are:

• Irregular spotting
• Breast tenderness

Less common side effects of hormone therapy include:

• Fluid retention
• Headaches (including migraine)
• Skin discoloration (brown or black spots)
• Increased breast density making mammogram interpretation more difficult
• Skin irritation under estrogen patch

How can I reduce these side effects?

Adjusting either the dosage or the form of the medication you are taking can often reduce the side effects of HT. However, you should never make changes in your medication or stop taking it without first consulting your doctor.

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