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When a woman approaches the big 'five zero' or an age approximately around there, her body undergoes some drastic changes, both physically and mentally. Most of these changes are attributed to the declining estrogen levels. The ovaries gradually decrease the production of estrogen, the hormone responsible for not only controlling the menstrual cycle in a woman, but which also protected her from heart diseases and bone related disorders, especially osteoporosis.
The ovaries gradually cease to produce any estrogen and progesterone. The woman is then said to have attained menopause. Due to the fluctuating levels of these hormones during and after menopause, women experience uncomfortable symptoms like hot flashes, sweats, insomnia, vaginal dryness, mood swings, etc. For some women these can drive them towards a dire need for therapy. In such situations comes the role of Hormone Replacement Therapy (HRT).
What is HRT?
Hormone Replacement Therapy (HRT) involves use of medications containing one or more synthetic female hormones, commonly estrogen and progestin, to help the body make up for the loss. Women who have had their uterus removed generally receive Estrogen-only therapy. This is termed as Estrogen Replacement therapy (ERT). The combination therapy is referred to as HRT.
Benefits of HRT
HRT not only helps alleviate the menopausal symptoms, but also protects women against cardiac and bone related disorders. It also helps improve the quality of life in a woman by providing relief from hot flashes, sleep difficulties and vaginal dryness. Besides these benefits, HRT has also been proved to help prevent Alzheimer's disease, colon cancer, and macular degeneration. But there is a negative side to the coin too as there are side effects.
Risks of HRT
As the percentage of women taking HRT increased, they started reporting side effects such as unusual vaginal discharge and bleeding, nausea, headaches, fluid retention and swollen breasts. Gradually more serious side effects were also revealed. On long term use, HRT has been proved to increase the risk of strokes, breast cancer, and endometrial cancer. With growing awareness of these side effects, the US Government began a large study, called the Women’s Health Initiative (WHI), to help answer some of the questions associated with hormone-replacement therapy. The results of this study and many others that followed compelled the doctors to reconsider their recommendations about HRT.
HRT and Benefits vs Risks
The benefits of HRT considerably improved the quality of life for women. HRT therefore, became the ‘most prescribed therapy’ in the US with over 10 million women taking HRT. But with more and more reports of its side effects, choosing to use HRT or not to, has become one of the most important health decsions for women. Short term use of HRT, for e.g, 2 to 4 years still appears to be safe. But the long term studies have provided conflicting results.
On one hand, the reports of a WHI study claim a 41% increase in strokes among women taking estrogen and progestin in combination. The study also proved an increase in the number of blood clots in such women. But on the other hand, there are positive reports as far as bone related disorders are concerned. Since estrogen is responsible for maintaining the bone strength, women on HRT after menopause benefitted with 34% fewer hip fractures compared to those not receiving hormones.
But the WHI estrogen/progestin trial which had begun in the year 1993 was finally stopped in 2 phases. One, in the year 2002, because of a 26% increased risk of breast cancer found in women taking hormone therapy and the other in 2004 because of an increase in the risk of strokes.
Yet another study, published by the National Cancer Institute in 2002, claimed that women using estrogen therapy alone have an increased risk of developing ovarian cancer. The longer you use the therapy, the higher the risk. In women who used ERT for 20 or more years, the risk of ovarian cancer was three times that of women who did not use any estrogen.
Considering the benefits and risks ratio of HRT, the Committee on Safety of Medicines no longer recommends HRT as safe to use for a long-term treatment.
But the short-term use of HRT does provide appreciable benefits. Hence, women can consider this therapy for short-term treatment of menopausal symptoms. Before making a decision to adopt or reject HRT, it is always advisable to weigh the risks and benefits in each individual’s case as the risk of heart disease or osteoporosis with and without taking HRT may vary on the basis of a number of factors including family history.
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—About our writer:
Sona Chawla, a sociable, fun-loving person who enjoys spending time with family and friends. I love to write and consider it the most favorite pastime for me besides cooking a variety of cuisines.
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