Why is hormone replacement therapy (HRT) used?

When a woman goes through menopause, she has fewer and fewer periods. After a few months or years, her periods stop altogether. After this, her ovaries no longer release eggs, and she makes less of the hormones estrogen and progesterone.

Menopause is part of getting older. Women may also go through menopause if their ovaries had to be taken out. For many women, the changes that come with menopause are not a problem. However, some women have a hard time because the body makes too little hormones. If you are one of these women, it may help you to take the hormones lost when your periods stop. This is called hormone replacement therapy or HRT.

HRT can be used before, during, and after menopause. You can take the hormones in tablets, creams, skin patches, shots, or vaginal suppositories. You may take estrogen with or without progesterone.

How can HRT help?

HRT can help prevent and treat bone loss caused by osteoporosis.
Osteoporosis makes you more likely to have bone fractures. Bone loss starts at around age 35 and gets worse quickly around the time your periods stop. HRT can slow down bone loss. Taking calcium can also help. You are most at risk if you are thin and white, or if you smoke, or if your mother had bone loss.

HRT can lower your chances of coronary heart disease.
Women who have gone through menopause have a higher chance of heart disease. Estrogen helps lower that risk. HRT can be especially important if you have high blood pressure, diabetes, too much cholesterol, or a family history of heart disease before age 55.

HRT can help you get through menopause.
It helps take care of:

• Hot flashes.

• Sleep problems.

• Dryness in the vagina.

HRT may also be a good idea if you stop having your periods for any reason before the age of 40.

Are there risks of taking HRT?

It is important to know the risks of HRT:

• Cancer of the uterus. When estrogen is given with no progesterone, there is a higher chance of cancer of the uterus. Ask your health care provider about what you should be taking if your uterus has not been removed.

• Breast cancer. Studies are being done to find out if there is a higher chance of getting breast cancer after taking HRT. Talk to your health care provider. It may be a good idea to be checked and to have a mammogram before you start HRT. It is also important to have a mammogram as often as your provider recommends, and for you to check your breasts every month. Tell your health care provider if you have a family history of breast cancer.

• Gallstones. If you take HRT by mouth, you may have a higher chance of gallstones.

What are the side effects of HRT?

HRT can cause side effects. You may notice that:

• You have bleeding or vaginal discharge.

• You feel bloated, retain fluid, or gain weight.

• Your breasts are tender and larger.

• You have nausea.

• You have headaches and mood swings.

If you are taking both estrogen and progesterone, you may need to stop taking the hormones for a few days each month. Most of the time you will then have some vaginal bleeding. This bleeding lasts 2 or 3 days, most often without cramps or bloating. This is not a period. Tell your health care provider if you have bleeding any other time.

Who should not take HRT?

If you have any of these health problems, you should not take HRT:

• Vaginal bleeding that cannot be explained.

• Liver disease.

• History of blood clots or strokes.

• Breast cancer.

If you have any of the health problems listed below, HRT may make them worse. Make sure you tell your health care provider if you have had:

• Problems with your uterus.

• Breast disease of any kind.

• Migraine headaches.

• Gallbladder disease.

Also, if you smoke, it may not be a good idea to take HRT.

What can I do to take care of myself?

The problems some women have because of menopause can be helped by HRT.

If you are thinking about taking HRT:

• Talk to your health care provider about how it could help and what problems it could cause.

If you are already taking HRT:

• Do not change your hormone dose without checking with your health care provider first.

• Talk with your provider if you have any problems.