Perimenopause Treatment

Should you take HRT (hormone replacement therapy)? Many women take HRT to get relief from troublesome symptoms such as mood swings or hot flashes. There’s no question that short-term estrogen therapy alleviates these symptoms. Other women may have started on HRT after discussing health risks with their family physician.

If you are taking HRT, you may be wondering if you should continue. Today many women are confused about hormones in light of news reports that the risks of combined HRT (estrogen plus progestin) outweigh the benefits. In July 2002, the Women’s Health Initiative (WHI) study on combined HRT was abruptly halted. Sponsored by the National Institutes of Health, WHI followed more than 27,000 healthy women, aged 50 to 79, taking either combined HRT or estrogen only. The goal was to determine whether HRT protected from heart disease and osteoporosis, as well as the increased risk for cancer and blood clots.

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After a little more than five years of study, the results revealed that women taking combined HRT were at increased risk for heart disease, blood clots, stroke and breast cancer. Although the risks were small, it was enough to stop the investigation of combined HRT. The hormone regimen did protect from hip fracture and colon cancer, but more women suffered a serious health event than a positive one. Women in the study taking estrogen only were told to continue taking their pills as before, because it remained uncertain whether the benefits outweigh the risks. At the time of writing, no further data had been reported.

This new knowledge about HRT has led the American College of Obstetrics and Gynecologists and the North American Menopause Society to revise guidelines on the appropriate use of combined HRT:

• The number one indication for combined HRT is to treat menopausal symptoms such as hot flashes, night sweats and mood swings in women with a uterus.

• The use of combined HRT and estrogen-only therapy should be used for the shortest duration possible and at lower-than-standard doses. It remains unknown whether patches and creams are any safer than pills.

• Women who have been on HRT for five years or more should talk with their physicians about whether to continue.

• If you decide to discontinue HRT, ask your doctor the best way to do so.

• Combined HRT should not be used to treat heart disease. Your doctor should discuss other options with you.

If you are considering HRT, review with your doctor why you want to take the drug, your personal benefits without HRT and your increased health risks with HRT use.

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