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Menopause and HRT

Holistic-online.com

Treatment of Menopausal Problems
Modern Western Medicine

The treatment of choice in Western Medicine for menopausal problems is Hormone Replacement Therapy (HRT).

The primary goals of estrogen replacement therapy are:
bulletTo relieve symptoms such as hot flashes, vaginal dryness, and urinary problems
bulletTo help prevent osteoporosis
bulletTo help prevent atherosclerosis and coronary artery disease

These goals are accomplished by restoring the level of estrogen in the patient to the premenopause levels.

Estrogen is available in nonsynthetic (natural) or synthetic (laboratory-produced) forms. (Some people object to using the term 'natural' in this case. The hormone is processed from the urine of horses and is not from human beings. It contains hormones of horses also. Thus it is strictly is not natural.To learn more about how the estrogen hormone is produced, refer to our section on Estrogen and then look under Genesis.) Synthetic estrogens are a hundred times more potent than natural estrogens and therefore are not routinely recommended for women in menopause. Only very low doses of a natural estrogen are needed to prevent hot flashes and osteoporosis. High doses can cause problems, such as an increased tendency to have migraine headaches, increased probability of catching breast cancer etc. (Refer to our section on risks of hormone therapy for more information.)

Estrogen may be given in a number of ways. (Refer to our section How HRT Is Administered: Application of Estrogen for more information.) It can be taken orally in the form of a tablet or used as a skin patch (transdermal estrogen). It also may be applied to the vagina as a cream when the primary reasons for using it are to prevent thinning of the vaginal lining and to prevent painful intercourse. Some of the estrogen taken this way is absorbed into the bloodstream, particularly as the vaginal lining becomes healthier.

Estrogen is associated with several side effects. You should be aware of its long-term risks as well as benefits.

See: 

Side Effects of HRT and Suggested Solutions for a description of the various side effects encountered and how they can be managed.

Benefits of Hormone Replacement Therapy for a descrition of the known benefits of HRT

Risks/Dangers of HRT for a description of the risks of taking estrogen and HRT.

Discuss with your doctor the potential benefits and the the risks before deciding whether to use estrogen replacement therapy. Side effects of estrogen include nausea, breast discomfort, headache, and mood changes.

Postmenopausal women who take estrogen without progesterone have an increased risk of endometrial cancer (cancer of the lining of the uterus). The increased risk is related to the dose and duration of estrogen therapy. If a woman has abnormal bleeding from the vagina, a biopsy of the uterine lining may be performed to determine whether she has endometrial cancer. Taking progesterone in addition to estrogen can almost eliminate the risk of endometrial cancer. Progesterone doesn't appear to negate estrogen's beneficial effect on cardiovascular disease.

For more on progesterone, refer to our section Progesterone. This section has a thorugh description of progesterone and its effects.

Many women are fearful of starting ERT because of the fear of catching breast cancer. Indeed, it has been shown that people who take HRT has an increased chance of having breast cancer as compared to those you don't. (For a detailed description of this issue along with the results from clinical studies, refer to our section: Risks/Dangers of Estrogen Use (HRT) Estrogen therapy may not be appropriate for you if you have a high risk of developing breast cancer. However, for women who are prone to osteoporosis and heart disease and who are at low risk for developing breast cancer, the benefit gained from estrogen therapy outweighs the risk.

The risk of developing gallbladder disease is modestly increased during the first year of estrogen replacement therapy.

Generally, estrogen replacement therapy is not prescribed for women who have or have had breast cancer or advanced endometrial cancer or who have genital bleeding of unknown cause, acute liver disease, or a blood clotting disorder. Estrogen replacement therapy is not prescribed for women who have chronic liver disease or acute intermittent porphyria.

Women who can't take estrogen may be given anti-anxiety drugs, progesterone, or clonidine to reduce the discomfort of hot flashes. Antidepressants may also help some women by relieving depression, anxiety, irritability, and insomnia. For a description of the non-hormonal drug treatment of menopausal symptoms, please refer to our section: Nonhormonal Drug Therapies.

Nowadays, estrogen is hardly ever given individually. This is because taking estrogen alone increases your risk of endometrial or uterine cancer. Thus estrogen and progestin supplements are used together. They are usually given orally, as a cream, injection, suppository or through a skin patch. Progestin can cause side effects such as irregular bleeding, headaches, bloatedness, and breast swelling and pain. You may even develop an artificial monthly period, depending on the dosage regimen you're on.  For more information on administering HRT refer to:

How HRT Is Administered: Application of Estrogen

How HRT Is Administered: Application of Progesterone/Progestin

Ways of Taking HRT

Your doctor may recommend HRT to help prevent cardiovascular disease and osteoporosis, particularly if these diseases run in your family. Your doctor may prescribe a vaginal estrogen cream to help stop the thinning of vaginal tissues and improve lubrication. If you have had breast cancer, endometrial cancer, active liver disease or blood clots, there are increased risks associated with taking hormone replacement therapy.

We have covered Hormone Replacement Therapy in detail. It covers in depth the benefits, risks, how it is administered, the advantages and disadvantages of the various regimens used as well as the role played by the various hormones.

For people who do not want to take hormone supplements or who cannot take it for various reasons, there are non-hormone drug therapies available. See: Nonhormonal Drug Therapies.

See Also:     

Hormone Replacement Therapy (HRT)

Conditions Requiring Immediate Medical Attention (Call your doctor if..)

Common Sense Remedies

  Alternative and Natural Approaches to the treatment of Menopause

Next Topic: Nonhormonal Drug Therapies.

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