McKesson Clinical Reference Systems: Women's Health Advisor 2002.2
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Why is hormone replacement therapy (HRT) used?

When you go through menopause, you have fewer and fewer periods. After a few months or years, you stop having periods. Your ovaries no longer release eggs. Your body makes less of the hormones estrogen and progesterone.

Menopause is part of getting older. You also go through menopause if your ovaries are taken out. For many women, the changes that come with menopause are not a problem. However, some women have a hard time because of the drop in hormones. If you are one of these women, it may help to take hormone medicine. This is called hormone replacement therapy, or HRT.

HRT can be used before, during, and after menopause. You can take the hormones in many different forms, including pills. If your uterus has been removed, you may take estrogen alone. If you still have your uterus, you need to take both estrogen and progesterone.

How can HRT help?

HRT can help prevent and treat bone loss caused by osteoporosis.
Osteoporosis makes you more likely to have bone fractures. Bone loss starts at around age 35. It can get worse quickly around the time your periods stop. HRT can slow down bone loss. Taking a different kind of medicine or calcium with vitamin D can also help.

HRT can help you get through menopause.
It may help take care of some of the symptoms of menopause, such as:

• Hot flashes.
• Sleep problems.
• Dryness in the vagina.
• Irritability.
• Headaches.
• Fatigue.
• Depression.
• Less desire for sex.

Are there risks of taking HRT?

It is important to know the risks of HRT:

• Cancer of the uterus. When estrogen is taken without progesterone, there is a higher chance of cancer of the uterus. If you still have your uterus, you should take both hormones.
• Breast cancer. Taking estrogen and progesterone together may increase your chance of having breast cancer. Talk to your health care provider about this. Tell your health care provider if you have a family history of breast cancer.
• Heart attacks, strokes, and blood clots in the legs and lungs

  Taking estrogen and progesterone together may increase your chance of having a heart attack, stroke, or blood clots.

What are the side effects of HRT?

HRT can cause side effects. You may notice that:

• You have bleeding or vaginal discharge.
• You feel bloated, retain fluid, or gain weight.
• Your breasts are tender and larger.
• You have nausea.
• You have headaches and mood swings (if you take progesterone with the estrogen).

If you are taking both estrogen and progesterone, you may need to stop taking the hormones for a few days each month. Most of the time you will then have some vaginal bleeding. This bleeding lasts 2 or 3 days, most often without cramps or bloating. This is not a period. Tell your health care provider if you have bleeding any other time. If you take both estrogen and progesterone every day in low doses, you should not have bleeding. (You may have a little bit of spotting for just the first 2 or 3 months.)

Who should not take HRT?

If you have had or have now any of these health problems, you should not take HRT:

• Heart attack.
• Uncontrolled high blood pressure.
• Stroke.
• Blood clots in your blood vessels or strokes.
• Vaginal bleeding that cannot be explained.
• Liver disease.
• Cancer of the breast or uterus.

You should also not take HRT if you are pregnant or think you may be pregnant.

If you have any of the health problems listed below, HRT may make them worse. Make sure you tell your health care provider if you have had:

• Problems with fibroid tumors or other problems in your uterus.
• Breast disease of any kind.
• Migraine headaches.
• Gallbladder disease.

Also, if you smoke, it may not be a good idea to take HRT.

What can I do to take care of myself?

If you are thinking about taking HRT:

• Talk to your health care provider about how HRT might help and what problems it could cause.
• Get a mammogram before you begin HRT.

If you are already taking HRT:

• Do not change your hormone dose without checking with your health care provider first.
• Have a mammogram every year. You should also check your breasts every month.
• Have a complete physical exam as often as your health care provider recommends.
• Talk with your provider if you have any problems.

This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.