The Doctor's Corner: Understand the facts about Hormone Replacement Therapy The Doctor's Corner: Understand the facts about Hormone Replacement Therapy (January 14, 2004)

By Carolyn Mannon, M.D.

Last year, the media frenzy that followed the publication of the Women's Health Initiative study left women confused about whether or not they should be taking hormone replacement therapy to benefit their health. It is very important to discuss this decision with your health care provider. Understand the facts. Do not be persuaded by sensationalized news report. In this article, I will attempt to simplify this very complicated issue.

First of all, what is hormone replacement therapy (HRT)? The term refers to medications that can be taken to "replace" hormones no longer produced by the body, in attempt to prevent menopausal symptoms and associated health risks. These medicines can be in the form of pills or patches. Typically they contain both estrogen and progesterone. Women who have previously undergone hysterectomy are candidates to take estrogen replacement alone.

Menopause refers to the time in a woman's life when the ovaries stop making estrogen, causing several changes in her body. Vasomotor symptoms such as hot flashes and night sweats are perhaps the most bothersome. Other common irritating symptoms include mood swings, irritability, difficulty concentrating and vaginal dryness and painful intercourse. Lack of estrogen over time is also a major contributor to osteoporosis and bone fractures.

To take or not to take HRT -- that is the question. Women need to understand all the risks and benefits as well as know the alternatives. HRT remains the gold standard for relief of vasomotor symptoms, such as hot flashes. If you suffer from hot flashes, irritability, night sweats or vaginal dryness, HRT would likely relieve these problems. There are alternative treatments as well (see below).

HRT is also helpful for decreasing the risk of osteoporosis and bone fracture, but there are also alternative choices (below). HRT is not a good choice for prevention of heart disease.

Women who have had breast cancer or those who have had blood clots in the legs or lungs may not take HRT. The choice of using HRT should be discussed with your physician on an annual basis. This decision may change as new data becomes available.

Short term use may be appropriate in certain cases. If you chose to discontinue HRT, there are no specific recommendations.
Non-hormonal remedies

Hot flashes : ** Anti-depressant medications have been found to relieve hot flashes, including Effexor, Zoloft, Paxil and Prozac. ** Clonidine is a blood pressure medicine that reduces hot flashes. ** Gabapentin is an anti-seizure medicine that has been shown to decrease hot flashes. ** Many herbal and soy products have been tested with varying results. Black cohash is the only herbal remedy with data to support its use. Caution should be used because it remains unclear if this herb stimulates estrogen receptors and is therefore not recommended for breast cancer patients.

Vaginal atrophy:

** Vaginal creams and "rings" (Estring and Femring, which is absorbed with doses like oral estrogen) are excellent choices to relieve dryness and prevent urinary and vaginal infections. They do not interfere with intercourse. Their action is local; minuscule amounts may be systemically absorbed. ** I recommend using over-the-counter lubricants (Replens, Astroglide, KY Jelly) during intercourse for all postmenopausal women.

Osteoporosis :

** Take calcium (1500mg/day) and vitamin D (400mg/day) supplements. ** Do weight-bearing exercise (20 minutes/day). ** Medications called bisphosphonates are a first-line choice to decrease bone fractures. ** SERMs (selective estrogen receptor modulators, such as Evista) increase bone density, with possible decreased risk of breast cancer (studies ongoing).

Dr. Carolyn Mannon is a board-certified obstetrician and gynecologist. She completed her training at UCSF and her practice is at the Menlo Medical Clinic.
Health column

The Doctor's Corner is a regular feature of the Almanac's monthly Health & Fitness section. If you have a question regarding a particular health issue you'd like to see addressed in a future column by a doctor from the Menlo Medical Clinic, write to the clinic at mmcweb@stanfordmed.org or call 497-8022.

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