By Keith Brown, DO

Hormone replacement therapy (HRT), now often referred to as hormone therapy, has become one hot topic in women's healthcare. The terms refer to medication containing one or more female hormones, commonly estrogen plus progestin (synthetic progesterone).

HRT most often is used to treat symptoms of menopause such as "hot flashes," vaginal dryness, mood swings, sleep disorders and decreased sexual desire. This medication may be taken in the form of a pill, a patch, vaginal cream or gel. Based on early studies, many physicians once believed that HRT might be beneficial in reducing the risk for heart disease and bone fractures caused by osteoporosis (thinning of the bones) in addition to treating menopausal symptoms. However, the results of a recent study, the Women's Health Initiative (WHI), has led physicians to revise their recommendations regarding HRT.

With a huge number of participants -- more than 161,809 women 50 to 79 years of age in 40 different medical centers -- the WHI examined health benefits and risks of HRT. One component of the WHI that studied the use of estrogen and progestin in women who had a uterus was stopped early, in 2002, because health risks exceeded health benefits. These risks were primarily because of a 26 percent increase in breast cancer (actually an increase of only eight in 10,000 women). A second component of the WHI investigating estrogen-only therapy in women who no longer had a uterus was halted early, in 2004, because of increased stroke risk.

During menopause, the amount of estrogen produced by a woman's ovaries drops. These naturally occurring low estrogen levels may cause symptoms that include hot flashes, sleep problems, mood swings and vaginal dryness. Most women experience relief from symptoms within a few weeks of taking HRT. Short-term HRT use (two to four years) to treat menopause symptoms still appears to be safe. Usually, hot flashes and night sweats are less severe after a couple of years -- especially if HRT is tapered gradually.

WHI researchers concluded that because of slightly increased cardiac, stroke, blood clot and breast cancer risk, HRT should not be given strictly for the prevention of high cholesterol or heart disease.

While estrogen has been shown to contribute to bone strength, women who are considering taking HRT to prevent osteoporosis should discuss with their physician their individual risk for coronary heart disease, stroke, blood clots and breast cancer.

The WHI study found a lower risk for colon cancer in women who took estrogen/ progestin than in women not on HRT. Hormone therapy was found to have no effect on incontinence or uterine/endometrial cancer after menopause.

Women who suffer from common symptoms of menopause, mood swings and sleep problems benefit from HRT in overall quality of life. However, no scientific evidence exists that HRT is helpful in the treatment of major depression. Studies have not shown that HRT slows down the symptoms of Alzheimer's disease. Research is ongoing as to whether HRT provides any benefits with regard to other memory loss.

The WHI study shows relatively small increases in the risks for heart disease, breast cancer, blood clots and stroke to an individual woman. However, when the entire population of postmenopausal women and the number of years a woman may be on HRT are considered, the number of strokes, heart attacks, breast cancer cases and blood clots appears to outweigh the protective effect of HRT on bones.

Some women may still wish to consider HRT for short-term treatment of menopausal symptoms. The key is to weigh the risks associated with taking HRT against individual risk for heart disease or osteoporosis without taking HRT. Every woman is different. Therefore, your medical history should be evaluated individually when considering HRT.

Keith Brown, DO

Keith Brown, DO, recently opened his gynecology-only practice with MedSchool Associates on the campus of Northern Nevada Medical Center in Suite 211, Vista Medical Terrace, 2345 E. Prater Way, Sparks. For more information or an appointment, please call 784-7500.

Northern Nevada Medical Center 2375 E. Prater Way, Sparks, NV 89434 775-331-7000