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Guide to Menopause
Effects of Menopause
Estrogen replacement therapy (ERT) is a form of hormone replacement therapy (HRT). Usually it involves a daily dose of estrogen, supplemented with progesterone (or just estrogen after a hysterectomy). Before menopause the female body naturally produces large quantities of estrogen which is secreted by the ovaries. As menopause approaches, this natural supply of estrogen declines, affecting the reproductive system, urinary tract, bones, skin, blood vessels, breasts and brain. Taking ERT at the time of menopause can help reduce some of these negative effects. In year 2000 nearly 40 percent of all postmenopause women in America were using ERT. Short-term hormone therapy seems to be safe and effective. It is not a high risk proposition for those who have discussed and agreed it as an option with their doctor. The pros and cons are outlined in more detail below.
When Should I Begin ERT?
Once a woman has decided to take ERT, the next big decision is when to start. This is best answered by questioning why she decided to take it in the first place. If it is to reduce menopause symptoms such as hot flashes and vaginal dryness, she may decide to start during perimenopause. Many women then stop treatment once symptoms subside. However, if she chooses it to reduce her osteoporosis risk factors, it is generally recommended to start treatment when menopause occurs (periods have stopped for 12 consecutive months) and continue for up to 5 years. Most experts agree that taking HRT (ERT) for 5 years or less poses little or no danger.
How Do I Take It?
The common forms of ERT in the United States involve mixtures of several forms of estrogen taken from the urine of pregnant horses (so-called conjugated estrogens sold under various brand names including Premarin. Natural estrogens are generally considered less effective). The estrogen is usually supplemented with progestin, a synthetic man made version of progesterone which helps to balance some of the side effects of the estrogen. ERT can be taken in the form of a pill or a transdermal hormone patch which is applied directly to the skin (such as Estraderm and Climara Pro). Patches are considered safer because the hormones are absorbed directly into the bloodstream, bypassing the digestive system and thus avoiding being immediately processed by the liver. Women who cannot or choose not to use these synthetic estrogens may try vaginal estrogen gels and creams instead. While these are good for helping to deal with dryness in the vaginal area, helping to prevent vaginitis and urinary tract infections, they are not generally considered a full-scale version of ERT.
What Are The Benefits?
Eases Menopause Symptoms
Eliminates hot flashes. 77 percent of women surveyed as part of the 2002 Womens Health Initiative (WHI) study reported hot flashes reduced considerably while using ERT. It may also help prevent hair loss during menopause.
ERT not only prevents vaginal dryness and thinning but can actually reverse it within weeks of beginning treatment. See also, Low libido in menopause.
Improves mood swings and menopause depression. The estrogen seems to influence the 'happy hormones' in the brain (serotonin and dopamine). It may even help prevent menopause skin problems.
Helps to firm up loose pelvic muscles (kegels exercise are an alternative).
ERT seems to slow down bone loss associated with osteoporosis in women. Estrogen only needs to be taken in low doses of 0.3 to 0.625 mg a day. However to be effective, it needs to be taken consistently for the first five years after menopause, when bone deterioration is greatest. The WHI study showed that women who took estrogen (plus progestin) had a 33 percent less chance of having a hip fracture.
May reduce the risks of developing type 2 diabetes.
May reduce the risk of colon cancer
The WHI study found that women who took ERT, combined with progestin were 33 percent less likely to develop colon or rectum cancer. Why this is, is not particularly understood.
What Are The Risks?
Associated with a slight increased risk of heart disease and stroke in women.
Increases the risks of blood clots (thrombosis). Blood clots in the leg can be painful and occasionally lead to long term problems with leg swelling. The real threat however is that the clot develops and travels to the lung where it is potentially life threatening. Blood clots appear up to 3 times more in women who take estrogen than those who do not. The overall risk is still relatively low however at about 1 in 3,000 to 5,000.
There appears to be no extra risk of developing endometrial cancer as long as estrogen is supplemented with progestins. This is the main reason why progestins are now a routine part of ERT, except in women who have undergone a hysterectomy (in which case endometrial/womb changes are impossible). However adding progestins has it own side effects including bloating, breast tenderness, depression and irritability. In other words, premenstrual syndrome (PMS).
Studies have tried to connect the use of ERT and breast cancer, but have not succeeded to date. See Breast cancer guide.
ERT seems to slightly increase a woman’s risk of developing gallstones.
Research is not yet conclusive in this area. While some women find migraines develop or become worse with ERT, others report a reprieve in symptoms. If you are experiencing problems it may be worth trying another brand of ERT before abandoning it altogether.
It may cause some women to retain fluid. See Weight gain in menopause. Additionally, you may find it useful to check out books on menopause for published personal experiences.
What Exactly Are The Risks Of Heart Disease With ERT?
The effect of ERT on heart disease in women has become controversial. There are discrepancies between older studies (Nurses' Health Study) and HERS study (Heart and Estrogen/Progestin Replacement Study) and more recent ones, specifically the WHI Study. After initial studies ERT was encouraged as a treatment for lowering heart attack rates in women due to its apparent positive effect on cholesterol levels and blood vessels. Later studies questioned this and implied the opposite: that ERT actually resulted in an increase in stroke and heart disease in women who took it. One possible reason for the discrepancies between the older and newer studies is that the newer studies included a larger proportion of older women (who are by default more at risk of heart disease). Whatever the reason, the American Heart Association has issued guidelines stating that hormone therapy should not be used to prevent heart disease, although women who take it for other reasons, should continue to do so.
Does It Affect Blood Pressure?
ERT or any hormone replacement therapy does not appear to have a negative effect on blood pressure. Higher does of estrogen in the form of the birth control pill do however sometimes increase blood pressure. Read more: birth control pills and high blood pressure, for further information.