Hormone Replacement Therapy

Hormone replacement therapy (HRT), or simply hormone therapy, refers to the administration of estrogen replacement and sometimes progestin (a form of progesterone) to supplement when the body reduces or stops its own hormone production. One of the most common indications for hormone replacement is menopausal women suffering from hot flashes.

Candidates for Hormone Therapy

Hormone therapy or estrogen replacement may be beneficial for women who are experiencing:

• Moderate to severe symptoms associated with menopause (hot flashes)
• Early menopause
• Premature ovarian failure
• Severe loss of bone density when other treatments have been ineffective

Hormone Replacement Therapy Options

Two options for hormone therapy are:

• Combined hormone therapy uses both estrogen and progestin, which reduces the risk of endometrial cancer.
• Estrogen-only therapy does not include progestin.  It’s generally used in women who have had a hysterectomy, since there is no risk of endometrial cancer. It may be given systemically through pills, gels, sprays or skin patches. It can also be administered locally through vaginal rings, vaginal tablets or vaginal creams to reduce dryness or thinning of the vaginal lining.

Progestin is sometimes given in combination with estrogen or separately in the form of a pill, patch, gel or intrauterine device.

Risks of Hormone Therapy

It is important to ensure the benefits of hormone therapy outweigh the risks. Combination therapy may increase the risk of:

• Stroke
• Breast cancer
• Deep vein thrombosis
• Gallbladder disease
• Urinary incontinence

Estrogen-only therapy carries the same risks as combination therapy, except for breast cancer, which appears to be reduced with the therapy. Women who still have their uterus may be at increased risk of endometrial cancer with estrogen-only therapy.

Who Should Avoid Hormone Therapy

Women with a history of the following should avoid hormone replacement therapy:

• Breast, ovarian, or endometrial cancer
• Blood clots
• Liver disease

Women taking hormone therapy should continue yearly gynecological visits and any new side effects or health changes should be reported right away.