The study was halted in 2002 because the investigators found an increased risk of breast cancer, heart attack, stroke, and blood clots in women taking HRT and an increased risk of ovarian cancer in women taking estrogen therapy.1 However, current research shows that when administered with careful supervision, HRT can safely relieve many symptoms of perimenopause.1-5 Most commonly, HRT is an effective treatment for hot flashes, atrophic vaginitis, and postmenopausal osteoporosis.5-8 ?BENEFITS OF TREATMENT Hot flashes A common vasomotor symptom, hot flashes improve within several months in 30% to 50% of women and usually resolve completely within 4 to 5 years after the onset of menopause.4 Conjugated equine estrogen and medroxyprogesterone acetate (Depo-Provera, Provera, generics) were shown to improve hot flashes and sleep disturbances in women aged 50 to 54 years.5 Atrophic vaginitis The decrease in estrogen during menopause causes atrophic vaginitis, which leads to dryness, irritation, itching, soreness, dyspareunia, and discharge.
WTPA0709.qxp 6/24/09 3:12 PM Page 57 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 REFERENCES 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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