Understanding the Role of HRT in Treating Menopause
Symptoms of Menopause
For the most effective treatment, see your physician at the onset of menopausal symptoms, including:
- Hot flashes
- Mood swings
- Sleep disorders
- Vaginal dryness
- Painful intercourse
- Painful urination
July 2003 — Treating the symptoms of menopause — nature's rite of passage that typically affects women age 45 or older — is a topic of continued debate.
The Women's Health Initiative (WHI) launched a study in 1991 that followed the effects of hormone replacement therapy (HRT) in menopausal and post-menopausal women. Although the study was discontinued in 2002, researchers found an increasing trend in the risk for breast cancer, heart disease, blood clots and stroke. It also was reported that HRT may contribute to an increase in Alzheimer's disease.
However, this doesn't mean HRT should be dismissed as a treatment option. With the direction of your physician, you can determine if the benefits of HRT outweigh the risks — or if your menopausal symptoms are manageable without therapy.
Timing Is Everything
"The debate on HRT continues, and there are many questions still unanswered by the WHI study. Certain critical factors were not taken into account, and a more comprehensive study has yet to be developed," says Robert Siudmak, MD, obstetrician/gynecologist on the medical staff at Memorial Regional Hospital and Memorial Hospital West.
One of the key factors, according to Dr. Siudmak, is the timing of hormone replacement therapy. "The WHI study included only women age 50 or older — two-thirds of whom were 60 or older. However, the onset of menopause in the general population occurs anywhere from age 45 to 55. When HRT is admin-istered long after the onset of menopause, the body has already gone through an extended period of estrogen depletion. The effects of this depletion are complex and therefore, could play a role in the resulting conditions seen with HRT."
Consult Your Physician
Pre-menopausal women are encouraged to speak to their physician about the benefits and risks of hormone replacement therapy.
"While the risks of HRT are real, the absolute risk to the individual is actually small," says Dr. Siudmak. "Hormone replacement therapy is still the best method for treating the symptoms of menopause. Doctors and patients must discuss the risks of HRT, address lifestyle issues, screen for family history and make informed decisions based on the individual needs of the patient."
It is now recommended that hormone replacement therapy, once prescribed to prevent heart disease and osteoporosis, only be used to treat the symptoms of menopause. "There is no conclusive evidence that HRT prevents heart disease, and there are more suitable drugs to prevent osteoporosis," says Dr. Siudmak. "It is also recommended that patients use the smallest HRT dosage for the shortest time possible."
As the controversy over HRT continues, women must make their own individual decision regarding hormone replacement therapy. "More studies are needed to clarify the ongoing debate," says Dr. Siudmak. "In the meantime, speak to your physician to make an informed decision."
For referral to a physician, call the Memorial Healthcare System Physician Referral Service at (800) 944-DOCS.