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Hormone Replacement Therapy

What Are The Benefits Of HRT?

Last modified: 
10/04/2012 - 12:00

Contributing Author: Guy Slowik FRCS

Women today can expect to live 30 or 40 years after menopause. The lower amount of estrogen during these decades can affect their bodies in two general ways:

  • It can cause physical changes and uncomfortable symptoms that are associated with menopause. However, not every woman experiences bothersome symptoms of menopause.
  • It puts women at greater risk for certain dangerous diseases, like osteoporosis, which can lead to fractures.

The benefits of hormone replacement therapy include:

  • Controlling menopause symptoms
  • Preventing heart disease
  • Preventing osteoporosis
  • Preventing some hard-to-detect female cancers
  • Other good reasons
  • What if you've had a hysterectomy?

Controlling Menopause Symptoms

As a woman approaches menopause and her body slows its production of estrogen, she may experience certain symptoms:

  • Hot flashes - These may occur at any time and usually last from a few moments to several minutes. The face and neck may be flushed and blotches may appear for a short time on the upper body.
  • Night sweats - These are hot flashes that occur at night and can cause excessive perspiration.
  • Vaginal dryness, which can result in painful intercourse - Without estrogen, the vaginal walls become thinner, less moist, and less elastic.
  • A tendency to develop hair on the face - This occurs because all women have some of the male hormone testosterone. As estrogen levels in a woman diminish, the male hormone's effects may become more dominant.
  • A loss of muscle tone in the bladder and urethra - This can lead to frequent urination or leakage when a woman sneezes, coughs, laughs, or lifts something heavy.
  • Skin changes - The skin can become thinner and dry after menopause, and can lose its elasticity. Some women also notice that their hair becomes dry and their nails more brittle.
  • Sleep disruption - This can result from night sweats or psychological stress associated with "the change of life."
  • Mood swings - Some women experience an increase in anxiety or irritability. Some find they are more forgetful than usual and have trouble concentrating. These symptoms can be the result of hormonal changes, but they also can be unrelated to menopause.

Hormone replacement therapy can ease these symptoms.

Nice To Know:

Hot flashes are commonly associated with menopause. They are a sensation of sudden warmth in the face, neck, or chest, sometimes radiating up or down the entire body. They occur because reduced levels of estrogen can cause blood vessels in the skin to open wide.

Nice To Know:

The unpleasant symptoms that can result from a decrease in estrogen production have been well recognized for centuries. One hundred years ago, doctors recognized that these were cause by a loss of ovarian function and tried to relieve the problems by prescribing sheep's ovaries in a sandwich of unleavened bread. It is most unlikely that this remedy would have been effective or popular!

Preventing Heart Disease

In the U.S., heart disease is the number-one killer of men - and it is the number-one killer of women as well. Before menopause, a woman has a much lesser risk for heart disease than a man does. But after menopause, a woman's risk begins to increase toward that of a man's.

Changes in estrogen levels after menopause are accompanied by changes in the fat (lipid) levels in the blood, especially the different types of cholesterol. These changes are considered to be major factors in the increased incidence of heart attacks and atherosclerosis, also called "hardening of the arteries."

Hormone replacement therapy can correct these unfavorable lipid changes.

Among estrogen's positive effects on the heart are:

  • Reducing the LDL ("bad") cholesterol in the blood.
  • Increasing the HDL ("good") cholesterol in the blood.
  • Helping to keep blood vessels open.
  • Lowering blood pressure at night.
  • Reducing blood viscosity (how sticky the blood is), a property that may cause blood clots which could result in a heart attack or stroke. Estrogen's effects on clotting are complicated, however, since there also is an increased risk for thromboembolism (a blood clot that blocks a vessel) in women taking estrogen.
  • Possibly enhancing fibrinolysis, which is the body's natural process for breaking down blood clots.

However, estrogen increases a blood inflammatory protein (C-reactive protein) which has been shown to be a predictor of heart attacks. Thus many blood proteins change with estrogen use. It is unclear whether estrogen can prevent cardiovascular disease, including heart attacks and strokes in normal women.

How To Information:

Some research has indicated that estrogen might do more harm than good in women who already have heart disease.

Today, most experts recommend that:

  • Women with heart disease should not begin HRT

Preventing Osteoporosis

Hormone replacement therapy can help protect women against osteoporosis, a disease that causes bones to become more porous, which gradually makes them weaker and more brittle. Major studies have reported that women who take estrogen after menopause experience fewer bone fractures than women who do not.

The bones of both men and women are at their strongest and most dense around age 30 or 40. After this, there is a gradual thinning of bones. Bones affected by osteoporosis break more easily, particularly the spine, hip, and forearm. Unfortunately, these are the bones that allow people to remain active.

About 80% of the 24 million Americans who have osteoporosis are women. After menopause, bone loss accelerates to an average of 1 to 2 percent a year. This is because estrogen protects the skeleton by helping the body's bone-forming cells to keep working. After menopause, when the level of estrogen in a woman's body sharply decreases, some of this protection is lost.

Osteoporosis has been called "the silent epidemic" because it usually does not cause any symptoms until a fracture occurs. The human and economic costs of osteoporosis are significant:

  • As many as 20 percent of the people who break their hip because of osteoporosis die within a year.
  • Another 20 percent may be unable to walk for a year afterwards.
  • Up to 50 percent cannot walk as well as they did before the fracture.

Calcium and vitamin D are important companions to hormone replacement therapy for prevention and treatment of osteoporosis. HRT must be taken for many years to sustain protection against bone fractures.

Need To Know:

Women at higher risk for osteoporosis if they:

  • Are tall and/or thin
  • Have a poor diet that is low in calcium
  • Are Caucasian or Asian
  • Are smokers
  • Abuse alcohol
  • Are physically inactive
  • Take thyroid medication or corticosteriod medicines (prescribed for arthritis or other inflammatory diseases)
  • Had an early menopause (either naturally or through hysterectomy)
  • Have never given birth

Nice To Know:

Some studies have shown that hormone replacement therapy may even be protective against osteoarthritis   A form of arthritis in which the a joint degenerates, usually due to wear and tear, causing pain and restricting movement., also known as degenerative joint disease, which accounts for most of the hip and knee replacement operations in the elderly. As with osteoporosis prevention, HRT must be taken for many years to continue this protective effect.

Preventing Some Hard-To-Detect Female Cancers

When women first started taking hormone replacement therapy, it consisted of estrogen alone. Studies later showed that estrogen alone increased a woman's risk of cancer of the uterus, called endometrial cancer.

To prevent this, a second hormone (progesterone) is added to HRT if the woman still has her uterus. Some studies have indicated that women who take both of these hormone replacements may have a lower incidence of endometrial cancer.

Other Good Reasons

Extensive research has shown hormone replacement therapy may have additional benefits for women after menopause.

  • Memory loss and mental function. Studies have shown estrogen can protect against some memory loss and improve learning, even in some Alzheimer's disease patients.
  • Colorectal cancer. Various studies have pointed to a decreased risk in colorectal cancer in women who take HRT.
  • Diabetes. HRT may help women with diabetes control their blood sugar levels better after menopause.
  • Incontinence. A decline in estrogen levels may contribute toincontinence. HRT can help restore the lining of the urethra help support the bladder.
  • Migraine. Many postmenopausal women report a decreased incidence of migraines after take HRT. However, women who had experienced migraines related to their menstrual period may report flare-ups of the headaches.
  • Urinary tract infections. Some women experience an increase inurinary tract infections during menopause. Researchers believe that the use of estrogen may help the body resist infection.
  • Teeth. Women who take estrogen are less likely to lose their teeth, because the same properties that help prevent bone loss apply to preventing bone loss in the mouth.
  • Vision. Evidence exists that HRT may help prevent glaucoma and macular degeneration, two common causes of blindness.

Because reports of the true value of estrogen in these areas are conflicting, women should not choose hormone replacement therapy solely for these other reasons. But they can be considered as part of the larger picture in the decision of whether to begin HRT.

Need To Know:

The early effects of estrogen deficiency in menopause can include:

  • Hot flashes
  • Night sweats

Psychological effects of menopause can include:

  • Lethargy
  • Anxiety
  • Irritability
  • Depression
  • Forgetfulness
  • Difficulty in concentrating
  • Lower self-esteem (considering yourself to be "old")
  • Fast heartbeat
  • Headaches

Physical changes in the body from menopause can include:

  • Vaginal dryness
  • Painful intercourse
  • Discomfort when urinating
  • Dry skin and hair
  • Brittle nails

Later effects from estrogen deficiency include:

  • Osteoporosis
  • Fractures

What If You've Had A Hysterectomy?

A woman who has had a hysterectomy, but whose ovaries were left intact, most often will have a normal menopause. She may have the same symptoms as other women, except that her menstrual periods will have stopped immediately after the surgery. In a woman whose ovaries are removed as part of the hysterectomy, menopause will begin immediately.

When women first started taking hormone replacement therapy, it consisted of estrogen alone. Studies later showed that estrogen alone increased a woman's risk of cancer of the uterus, called emdometrial cancer. To prevent this, a second hormone (progesterone) was added to HRT for women who still have a uterus. But a woman who has had a hysterectomy does not have a uterus and is therefore not at risk for developing endometrail cancer. Therefore, women with hysterectomies can take estrogen alone, without progesterone.

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From Andrew Maynard - Chair of the University of Michigan Department of Environmental Health Sciences, with help from David Faulkner - 2013 Master of Public Health graduate.