Health Conditions

The decision to take ERT, HRT, or neither must be based on an individual's personal risk profile. Women without short-term symptoms of reduced estrogen levels and women whose symptoms are mild may decide not to use prescription drug therapy. Mild symptoms may respond well to lifestyle modifications such as avoiding caffeine and spicy foods. Some women find relief with alternative therapies such as acupuncture.

Estrogen Replacement Therapy (ERT)

ERT is commonly used to decrease short-term discomfort from menopause-related symptoms, such as hot flashes, insomnia, and mood swings. Estrogen also plays a significant role in preventing osteoporosis by building and maintaining bone. ERT can prevent the decline of bone density and may reduce the incidence of fractures. While calcium, vitamin D, diet and exercise are important first steps for maintaining healthy bone, the loss of estrogen after menopause speeds up the rate of bone loss for all women.

Some women should not take estrogen. Women who have not had a hysterectomy (the surgical removal of the uterus) are considered to have an ?intact? uterus. When estrogen is taken alone, the risk of uterine cancer increases for a woman with an intact uterus; therefore taking estrogen alone is not advisable for those women. The risk increases with long-term use (5 years or longer). Others who should avoid ERT are women who have or ever have had:

• Abnormal vaginal bleeding
• Blood clots or clotting disorders
• Breast cancer
• High triglyceride levels
• Liver disease

Potential side effects of ERT include:

• Bloating
• Breast tenderness
• Headaches
• Nausea
• Vaginal bleeding

Some of estrogen?s side effects may be eliminated by reducing the dose or changing the way the estrogen is delivered to the body. Lower-dose oral estrogen products that have become available in the last 20 years are often an option for women who experience side effects with higher estrogen doses. Lower-dose estrogens have been shown to reduce menopausal symptoms and reduce bone loss about as well as higher doses.

Although estrogen traditionally has been given as oral tablets, alternative dosage forms, including gels, lotions, and patches that are applied to the skin, have been developed. Vaginal rings containing hormones have also become available in the last few years. While some women find these topically-applied or vaginally-inserted forms easier to use, estrogen side effects may still be associated with all of them. The side effects may be lessened, however, because not as much estrogen may enter the blood. Irritation on the skin where gels, lotions, or patches have been applied is common. Some women experience abdominal pain or vaginal irritation from using the estrogen ring.

Hormone Replacement Therapy (HRT)

HRT usually refers to a combination of estrogen and progesterone. Taking progesterone in combination with estrogen not only adds to the control of menopausal symptoms, it also offsets or ?opposes? the possibility that estrogen will increase the risk of uterine cancer for women who have not had a hysterectomy (surgical removal of the uterus).

Benefits

Either ERT or HRT decreases:

• Bone loss
• Colon cancer risk
• Hot flashes
• Pain associated with intercourse
• Vaginal dryness and thinning of the vaginal walls

Either ERT or HRT may possibly:

• Decrease the risk of fractures
• Decrease urinary incontinence (the inability to control urine flow)
• Improve skin texture, collagen content, and skin thickness
• Improve mood
• Relieve insomnia and other sleep disturbances

Risks

Both ERT and HRT should be avoided by women who have or ever have had:

• Blood clots or clotting disorders
• Breast cancer
• Gall stones or gallbladder disease
• Liver disease
• Other estrogen-dependent cancer (such as endometrial or ovarian cancer)

HRT may increase the risk of:

• Breast tenderness
• Mood changes

Either ERT or HRT may increase the risk of:

• Breast cancer (slightly) - especially when taken for 5 years or longer
• Gallbladder disease
• Heart attacks for women who already have heart disease
• Vaginal bleeding

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Note: The above information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist, or other healthcare professional. It is not intended to diagnose a health condition, but it can be used as a guide to help you decide if you should seek professional treatment or to help you learn more about your condition once it has been diagnosed.