mind & body CHECKLIST Four Key Questions to Consider
Deciding whether to take HT isn’t something you should treat lightly. Some careful reflection and a full assessment of your health status and your symptoms are in order so that you can decide what’s right for you. Ask yourself:
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What benefits are you looking for? Think about the symptoms that are bothering you most—whether it’s hot flashes, insomnia, or mood changes, for example—then consider whether you can obtain relief from other, nonhormonal treatments or whether HT is likely to make the biggest difference.
What are your specific risks of taking these hormones? To engage in a comprehensive risk-benefit discussion with your doctor, come to your appointment armed with your personal and family medical history, especially when it comes to heart disease, breast cancer, and deep vein thrombosis. Also, “have an idea of your breast density,” Santoro advises, “because if you have very dense breasts, your doctor might be reluctant to prescribe HT.” Some women with dense breasts have a higher risk of breast cancer.
How much relief are you looking for? “If you’re willing to tolerate partial relief from hot flashes or vaginal dryness, you may be able to take a lower dose of estrogen,” Santoro says. “You really want to try to get this right as quickly as possible.”
What route of administration would be best for you? If you decide to take HT, consider whether your symptoms are localized (as in vaginal dryness) or systemic (as in hot flashes), as well as how good you are at remembering to take pills (which may determine whether you’re a candidate for pills or the patch).
While both combined HT and
estrogen-only HT raise the risk of stroke, pulmonary embolism, and deep vein thrombosis, they both decrease the risk of developing osteoporosis, and combined HT also lowers the risk of colon cancer. The WHI study found that the risk of breast cancer was slightly elevated with the use of combined HT, but there was no increased risk found with estrogen-only HT. “There’s also some suggestion that earlier initiation of hormone therapy—around the time of menopause (defined as one year after a woman’s last period)—may be associated with some reduced risk for Alzheimer’s,” Peterson notes. Despite these promising findings, right now, major health organizations, including ACOG, do not recommend HT for the prevention of cardiovascular or most other chronic diseases. For many chronic diseases, “there
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are alternative strategies— such as exercise, nutrition, and medications—to prevent heart disease or osteoporosis, which may be why medical organizations are not revisiting the issue of hormone therapy and disease prevention,” says Peterson.
The Details Combined hormone and estrogen- alone treatments are forms of drug therapy that are given to compensate for the lower levels of estrogen that are produced by your ovaries after menopause. If you still have an intact uterus—meaning, you haven’t had a hysterectomy—you should be given a progesterone-like agent (synthetic forms are called progestins) to help lower your risk of uterine cancer; taking estrogen alone increases the risk of uterine cancer. Sometimes male hormones called androgens (such as testosterone) may be prescribed off-label for women who
have experienced a serious downturn in sexual desire, although research is still being done to assess the safety and effectiveness of going this route. As far as HT goes, numerous
formulations are available. Estrogen comes in the form of pills, patches, and gels, as well as vaginal creams, tablets, and a flexible vaginal ring for women who have vaginal dryness without other menopausal symptoms. Most forms of estrogen therapy come in a variety of strengths or dosages. For women who need to take progestin, too, there are progestin-only and combined estrogen-progestin pills and patches, a progesterone gel to be used vaginally, and an intrauterine device that includes progestin. About 10 percent of women who take HT experience side effects such as breast tenderness, fluid retention, and cramping, while those who take combined HT (progestin and estrogen) may also
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