Patient Education

Hormone Therapy

A woman’s body produces different amounts of hormones at certain important times in her life. During puberty, her body’s hormones began to produce more and more to allow her menstrual cycle to begin. During pregnancy, they change to cause the healthy growth of a baby. During menopause, hormone levels decrease to cause her to stop having her menstrual cycle. All these changes are very natural. However, menopause can cause some undesirable side effects from the estrogen depletion. These side effects can be anywhere from mild to very severe, and their manifestation is different in every woman. For women with more severe side effects, hormone therapy (HT) is an option to help restore estrogen levels in order to reduce symptoms. This page covers the basics about hormone therapy.

WHAT HORMONES AFFECT MENOPAUSE?

Although several things affect the onset of menopause, the hormone estrogen is the key factor. Estrogen is a female hormone that is produced in the ovaries that is produced from puberty to menopause. Estrogen is very important because it influences the whole reproductive system, the menstrual cycle, as well as bone density. The levels of estrogen in the body determine what happens to the reproductive organs and what stage the menstrual cycle is currently in.

During the menstrual cycle, the levels of estrogen cause the endometrial lining to thicken in order to prepare for pregnancy. On day 14 of the cycle, the estrogen signals the ovaries to produce a ripe egg for fertilization. However, if the egg is not fertilized, by day 28 of the cycle, estrogen levels drop significantly, triggering the endometrial lining to shed completely- a process which results in your monthly period. 
As a woman ages, the amount of estrogen she is able to produce lessons greatly. Eventually, the amount of estrogen produced is too small to allow the endometrial lining to thicken, and periods to stop. The average age that this occurs is around 50 years old, but can be anywhere from 40-55 years. This drop in estrogen can cause unwanted side effects, and women may choose to go on hormone therapy to relieve these problems.

WHAT ARE THE BENEFITS OF HORMONE THERAPY?

When a woman’s estrogen decreases dramatically, it can cause several unwanted side effects for her. Hormone therapy can greatly reduce these side effects and the risk of developing the bone condition osteoporosis. Several negative side effects that are reduced include:

  • Hot Flashes: Hot flashes are very sudden feelings of heat that can spread over the entire body, causing discomfort, flushing, and sweating for anywhere from several seconds to several minutes. Around 75% of all menopausal women experience hot flashes. They can occur at any time of the day or night, and can oftentimes disrupt your sleep. Sometimes, they may occur several times a day or just a few times a month. Hormone therapy can greatly relieve hot flashes. 
  • Vaginal Dryness: Menopause can cause vaginal dryness, making the lining become very dry and thin. This can oftentimes cause pain during intercourse and the body may be more prone to vaginal infection. Sometimes a woman may experience itching and burning. Menopausal women also may need to urinate more frequently, and may be prone more prone to bladder infections. Hormone therapy can help reduce these problems.
  • Protection from Osteoporosis: Low estrogen levels can contribute to osteoporosis, a condition that results in bone loss. Overtime, the bones become more and more fragile and brittle, increasing the risk that they will break- most commonly the wrist, spine, and hip. Although all women can get osteoporosis, it most commonly runs in families and in women with low body weight. Other risk factors include lack of weight bearing exercise, poor calcium and vitamin D intake, smoking, and use of certain steroids. The use of hormone therapy can help to slow bone loss.
  • Mood/ Insomnia: Hormone therapy has also been shown to improve the moods of menopausal women and to improve sleep problems.

ARE THERE ANY CONCERNS OR RISKS FROM HORMONE THERAPY?

The greatest risk of hormone therapy is an increased risk of blood clots, stroke and heart attack. Your practitioner will asses your risk factors such as your heath, history, family history, obesity and smoking can determine if you are a good candidate for therapy. The hormone estrogen causes the endometrium to grow to be very thick (endometrial hyperplasia), which could lead to endometrial cancer. In order to prevent this, your practitioner will prescribe small doses of a progestin which will help keep the growth of the endometrium in check. Initially hormone therapy may cause some bleeding for a short period of time which may last 3 or 4 months.

Although all women are at risk of developing breast cancer, some women who take estrogen and progestin hormone therapy may have an increased risk of developing this disease.

WHAT IS THE TREATMENT LIKE?

There are many types of treatments including pills, patches, rings, gels, and creams. There is something to fit everyone’s lifestyle and needs. It is important to consider your medical history, age, symptoms and whether or not you have a Uterus. Additionally, hormone therapy can be administered in several ways:

  • Continuous Cyclic Therapy: Estrogen is administered every day in monthly cycles, and progestin is added only during the first two weeks. 
  • Continuous-Combined Therapy: Both estrogen and progestin are taken every day. 
  • Cyclic Therapy: Estrogen is taken continuously and progestin is added at varying times along with the estrogen. Times without progestin may cause bleeding.

WILL I NEED FOLLOW-UP APPOINTMENTS WITH MY HEALTH CARE PRACTITIONER?

Once hormone therapy is started, a 3-4 month follow up visit is suggested to ensure therapy goals have been reached and that side effects are being experienced. You may also need an ultrasound and/or endometrial biopsy to check your endometrial growth, blood tests, pelvic exams and breast exams may be necessary. However, if you have abnormal bleeding, you should tell your health care provider as soon as possible.

IN CONCLUSION

Hormone therapy is a safe, effective way to reduce the symptoms of menopause and to prevent osteoporosis. If you are experiencing any of the symptoms described, talk to your health care provider about hormone therapy and whether or not it would be a good option for you.