Any number of female and male hormones can be used in Hormone Replacement Therapy including estrogen, progesterone, and testosterone. They are often used in combinations depending on the nature of individual symptoms and family history. Benefits of HRT Control of symptoms - hot flashes, night sweats, vaginal thinning, impaired concentration are all improved with the reduction of estrogen deficiency. Cardiovascular protection - almost three dozen studies over the past 25 years demonstrate that HRT shows extraordinary benefits for the heart and all aspects of the cardiovascular system, especially among high risk women. Osteoporosis prevention - calcium, weight-bearing exercise, vitamin D and other life-style measures all lessen osteoporosis, but the bone strength required to lessen fracture rates usually doesn't occur without estrogen. Newly approved by the FDA, Alendronate (Fosamax) both prevents and treats osteoporosis and is probably the best alternative to estrogen replacement therapy. Better brain function - Memory and thought processes are improved by adequate estrogen levels. Estrogen supplements in elderly women have been shown to decrease the incidence of Alzheimer's disease by 40-60%. Estrogen also removes cholesterol plaques from the blood vessels in the bran, allowing an increased blood flow to the brain cells. Vaginal dryness and thinning - HRT not only prevents the problem, it can reverse them. Cancer prevention - 1997 American Cancer Society studies show that estrogen use significantly reduces the incidence of colorectal cancer, the number three cancer risk in women. Better skin - estrogen contributes to collagen production and elastin in skin, making skin smooth and pliable. Risks with HRT Risk of endometrial cancer - use of estrogen alone increases the risk of endometrial cancer 5-8 times compared with non users. However, when paired with progesterone, the cancer risk is the same as for women not on HRT. Risk of breast cancer - current evidence strongly suggests that estrogen may worsen an existing cancer. Despite wide media attention to the contrary, there is no scientific data to link estrogen use with an increase in the incidence of beast cancer. The National Institute of Health Women's Health Initiative (WHI) is currently conducting the largest study of women's health ever undertaken. Among other things, the study is examining the relationship of estrogen to breast cancer. The results will be known in 2,005. Side Effects Bloating - some women retain water with HRT. Restrict salt intake, try vitamin B6 as a mild diuretic, lower the progesterone/progestin dose, or switch to another progestin or micronized progesterone which has fewer side effects than synthetic progestin. Weight gain - increase your body's metabolic rate by modifying your diet and exercising to burn calories and fat. Breast tenderness - restrict salt intake, lower the estrogen dose, change to another progestin or progesterone, cut down on caffeine. Headaches - restrict salt intake, reduce the dose of oral estrogen or change to an every-day continuous dosage, switch to the estrogen patch. Depression - restrict salt intake. Stop HRT to see if hormones are the cause or if other lifestyle changes -- children leaving home, retirement, relationships, etc.--are the contributing factors. Nausea - take estrogen tablets at bedtime, eat a few crackers before rising in the morning, switch to an estrogen patch. Considerations The risks associated with cardiovascular disease and osteoporosis are well-documented and occur in significant numbers of menopausal women. The use of estrogen creams can prevent or reverse changes in the vulva, vagina, and bladder. The cream is also an effective way to "jump start" vaginal rehabilitation since it works faster than pills. An estrogen-containing vaginal ring called Estring is used like a diaphragm and provides continuous-release estrogen for three months at a time. HRT is available via a pill or a patch. The oral estrogen pill is absorbed into the bloodstream from the intestine and then is metabolized through the liver. The patch bypasses the liver and goes to work immediately on tissue. Choose the pill if: the patch fails to deliver acceptable estrogen as measured by blood levels. your lipoprotein profile is unfavorable and you don't want to risk a 3-6 month delay in improvement of HDL and LDL levels. the patch won't stick because you live in a hot climate, or sweating is a problem. the patch causes intolerable skin irritation you are taking progesterone pills (no patch is available) and prefer to take both hormones at the same time. Choose the patch if: you have high triglycerides you took oral estrogen and it raised your blood pressure you have gallbladder disease or are at risk for it taking the pill causes nausea you have had abnormal clotting disease in the past such as a blood clot in a leg or in the lung. •taking the pill aggravates your migraine headaches. the pill does not maintain a steady enough estrogen level to relieve your estrogen deficiency symptoms, such as hot flashes, night sweats, and short-term memory loss. you are a poor pill-taker and often forget to take them Forms of HRT Although the Pill and the Patch are the most common forms of HRT, other options include: estrogen pellets - implanted under the skin, estrogen pellets provide steady estrogen levels for three months, when new ones must be added. They have the same advantages as the patch but the disadvantage is that the pellet is placed under the skin with a large-bore tube that requires local anesthesia and stitches afterward. estrogen shots - generally discouraged because they can cause up and down estrogen levels from one shot to the next, they are an option for women whose bodies don't absorb oral medications or who have reasons not to use the patch. The highs and lows can be reduced by more frequent, smaller injections, much like allergy shots. designer estrogens - newly approved Selective Estrogen Receptor Modulators (SERMs) mimic beneficial estrogen, but also act as estrogen blockers in organs where the hormone can be harmful. The SERM Raloxifene (Evista) was approved by the FDA in December, 1997.     ABOUT THIS PROGRAM | UNDERSTANDING MENOPAUSE | WEATHERING THE CHANGE | MORE INFORMATION | RETURN TO THE CHANGE MAIN PAGE © 1998 Prairie Public Broadcasting, Inc.