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                                When the Patient Asks
                                                        A D R I E N N E D. M I L L E R

        Q: Is hormone replacement therapy for me?
              hysicians started treating peri-    pareunia, and discharge. In a study of      bleeding, thromboembolic disease,

      P       menopause symptoms in women
              with short courses of hormone
      replacement therapy (HRT) in the
                                                  the efficacy of low-dose estradiol
                                                  vaginal tablets for the treatment of
                                                  atrophic vaginitis, doses of 10 mcg and
                                                                                              breast cancer, other estrogen-sensitive
                                                                                              cancers, or liver disease.4 The recom-
                                                                                              mended dosage is the lowest effective
      1940s. When HRT demonstrated that           25 mcg were found to improve atro-          dose for the shortest duration. If the
      it could protect women from osteo-          phy, relieve vaginal symptoms, decrease     uterus is still present, combination
      porosis, cardiovascular disease, and        vaginal pH, and increase maturation of      estrogen and progestin or progesterone
      other age-related ailments, physicians      the vaginal epithelium.6 Whereas            must be prescribed to prevent endome-
      started prescribing long-term HRT for       greater improvements were seen with         trial hyperplasia or cancer.4
      all women who were postmenopausal.1         25 mcg, both doses were effective for          The risk-to-benefit ratio increases
      By 1995, approximately 38% of post-         treating vaginal atrophy in postmeno-       after menopause; therefore, recommen-
      menopausal women in the United              pausal women.6                              dations are to discontinue HRT 2 to 3
      States were taking HRT to treat meno-          Osteoporosis The WHI studied             years after the onset of menopause. As
      pausal symptoms and decrease the risk       16,608 women aged 50 to 79 years to         long as the patient’s symptoms do not
      of chronic conditions.2                     determine if estrogen and progestin         return, dosage can be tapered by reduc-
         In 1993, the National Institutes of      HRT can reduce the risk of hip, verte-      ing the daily dose or decreasing the
      Health commenced the Women’s                bral, and wrist fractures. Bone mineral     number of doses per week.4 JAAPA
      Health Initiative (WHI). The study          density (BMD) of the hip and lumbar
      was halted in 2002 because the investi-     spine were measured at baseline, and at     Adrienne Miller is a student at Eastern Virginia
      gators found an increased risk of breast    1, 3, and 6 years.7 Study conclusions       Medical School, Norfolk, Virginia. She has indicat-
      cancer, heart attack, stroke, and blood     showed that HRT can significantly           ed no relationships to disclose relating to the con-
                                                                                              tent of this article.
      clots in women taking HRT and an            improve BMD and reduce fracture risk
      increased risk of ovarian cancer in         regardless of age, personal or family
                                                                                              Mary Hewett, MS, PA-C, department editor
      women taking estrogen therapy.1 How-        history, tobacco or alcohol use, or frac-
      ever, current research shows that when      ture risk rates.7
      administered with careful supervision,         Colorectal cancer As part of the          1. Canderelli R, Leccesse L, Miller NL, Unruh Davidson J. Benefits
      HRT can safely relieve many symp-           WHI, Chlebowski and colleagues ana-             of hormone replacement therapy in postmenopausal women.
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