HOME > Menopause Resource Center > Postmenopausal Hormone Therapy

Menopause Resource Center

Facts About Postmenopausal Hormone Therapy
article syndicated from NHLBI

NOTE: Since this fact sheet was written in October 2002, a development has occurred that may affect your health decisions. The National Institutes of Health stopped the estrogen-alone study of the Women's Health Initiative (WHI).

Choosing whether or not to use postmenopausal hormone therapy can be one of the most important health decisions women face as they age. As with taking any treatment, the decision involves carefully weighing the risks and benefits involved.

But, until recently, the picture of those risks and benefits has been unclear. Studies gave conflicting results about the therapy's effects on breast cancer, heart disease, and other conditions.

Box 1
Oral Estrogen and Estrogen/Progestin Products*

Estrogen pills:

Premarin

conjugated equine estrogens

Cenestin

synthetic conjugated estrogens

Estratab

esterified estrogens

Menest

esterified estrogens

Ortho-Est

estropipate (piperazine estrone sulfate)

Ogen

estropipate (piperazine estrone sulfate)

Estrace

micronized 17-beta-estradiol

Progestin pills:

Amen

medroxyprogesterone acetate

Cycrin

medroxyprogesterone acetate

Provera

medroxyprogesterone acetate

Micronor

norethindrone

Nor-QD

norethindrone

Aygestin

norethindrone acetate

Ovrette

norgestrel

Norplant

levonorgestrel

Prometrium

progesterone USP (in peanut oil)

Megace

megestrol acetate (not for uterine protection)

Estrogen plus progestin pills:

Premphase

conjugated equine estrogens and medroxyprogesterone acetate

Prempro

conjugated equine estrogens and medroxyprogesterone acetate

Femhrt

ethinylestradiol and norethindrone acetate

Activella

17-beta-estradiol and norethindrone ecetate

Ortho-Prefest

17-beta-estradiol and norgestimate


* As of Fall 2000

Back to Top

In the summer of 2002, new findings emerged that have finally begun to fill in some of the picture's details. While much more remains to be learned, the findings offer women some guidance about the risks and benefits of using postmenopausal hormone therapy.

This fact sheet discusses those findings and gives you an overview of such topics as menopause, hormone therapy, and alternative treatments to the symptoms of menopause and various health risks that come in its wake. It also provides a list of sources you can contact for more information.

If you're on hormone therapy–whether short- or long-term use–you're bound to have a lot of concerns. This fact sheet will provide some information, but it's important to talk with your doctor or other health care provider about your health profile. Being informed is one of the best ways you can protect your health.

Box 2
Gels, Creams, Patches, and Other Hormone Products*

Estrogen products:

Cream

Estrace

micronized 17-beta-estradiol
 

Ortho Dienestrol

dienestrol
 

Premarin

conjugated equine estrogens

Vaginal Tablet

Vagifem

estradiol hemihydrate

Vaginal Ring

Estring

micronized 17-beta-estradiol

Skin Patch

Alora

micronized 17-beta-estradiol

 

Climara

micronized 17-beta-estradiol

 

Esclim

micronized 17-beta-estradiol
 

Estraderm

micronized 17-beta-estradiol
 

Vivelle

micronized 17-beta-estradiol
 

Vivelle-Dot

micronized 17-beta-estradiol

Progestin products:

Vaginal Gel

Crinone

progesterone

Injection

Depo-Provera

medroxyprogesterone acetate (not for uterine protection)

IUD

Mirena

levonorgestrel
 

Progestasert

progesterone

Estrogen plus progestin products:

Skin Patch

Combipatch

17-beta-estradiol and norethindrone acetate

Ortho-Prefest

17-beta-estradiol and norgestimate

Injection

Depo-Testadiol

testosterone and estradiol cypionate


* As of Fall 2000

Back to Top

Menopause and Hormone Therapy

As you age, significant internal changes take place that affect your production of the two female hormones, estrogen and progesterone. The hormones, which are important in regulating the menstrual cycle and having a successful pregnancy, are produced by the ovaries, two small, oval-shaped organs.

During the years just before menopause, known as perimenopause, your ovaries begin to shrink. Levels of estrogen and progesterone fluctuate as your ovaries try to keep up production of the hormones. You can have irregular menstrual cycles, along with unpredictable episodes of heavy bleeding during a period. Perimenopause usually lasts several years.

Eventually, your periods stop. Menopause marks the time of your last menstrual period. It is not considered the last until you have been period-free for 1 year without being ill, pregnant, breast-feeding, or using certain medicines, all of which also can cause menstrual cycles to cease. There should be no bleeding, even spotting, during that year. Natural menopause usually happens sometime between the ages of 45 and 54.

You also can undergo menopause as the result of surgery. A surgical procedure, called a hysterectomy, removes the uterus and sometimes the ovaries and fallopian tubes as well. You go through menopause if both of your ovaries are removed. Otherwise, the surgery does not affect menopause, which still occurs naturally.

Whether you go through menopause naturally or surgically, symptoms can result as your body tries to adjust to the drop in estrogen levels. These symptoms vary greatly–one woman may breeze through menopause with few symptoms, while another has difficulty. Symptoms may last for several months or years, or persist. The most common symptoms are hot flashes or flushes, sweats, and sleep disturbances. (A hot flash is a feeling of heat in your face and upper body, which may cause the skin to appear flushed or red as blood vessels expand. Hot flashes that occur with severe sweating during sleep are called night sweats.) But the drop in estrogen also can contribute to other symptoms, such as changes in the vaginal and urinary tracts, which can cause painful intercourse, urinary infections, and the need to urinate more often.

Box 3
Hormone Therapy Schedules
  • Cyclic or sequential–Estrogen for 25 or 30 days a month, with progestin added for 10-14 days
  • Continuous-combined–Estrogen and progestin daily

To relieve the symptoms of menopause, doctors may prescribe postmenopausal hormone therapy. This can involve the use of either estrogen alone or with another hormone called progesterone, or progestin in its synthetic form. The two hormones normally help to regulate a woman's menstrual cycle. Progestin is added to estrogen to prevent the overgrowth (or hyperplasia) of cells in the lining of the uterus. This overgrowth can lead to uterine cancer. If you haven't had a hysterectomy, you'll receive estrogen plus progestin therapy; if you have had a hysterectomy, you'll receive estrogen-only therapy. Hormones may be taken daily (continuous use) or on only certain days of the month (cyclic use).

They also can be taken in several ways, including orally, through a patch on the skin, as a cream or gel, or with an intrauterine device (IUD) or vaginal ring. How the therapy is taken can depend on its purpose. For instance, a vaginal estrogen ring or cream can ease vaginal dryness, urinary leakage, or vaginal or urinary infections, but does not relieve hot flashes.

Hormone therapy may cause side effects, such as bleeding, bloating, breast tenderness or enlargement, headaches, mood changes, and nausea. Further, side effects vary by how the hormone is taken. For instance, a patch may cause irritation at the site where it's applied.

Box 1, Box 2, and Box 3 list products and schedules for various hormone therapies. There also are nonhormonal approaches to easing the symptoms of menopause. Box 4 offers a list of some of these alternatives.

Back to Top

Box 4
Alternatives to Hormone Therapy to Help Prevent Postmenopausal Conditions and Relieve Menopausal Symptoms

You may want to consider alternatives to hormone therapy to ease menopausal symptoms. The list below includes some locally applied hormone products (which may not carry the same risks as those that deliver medication throughout the body), dietary supplements, and lifestyle measures. Talk with your doctor or other health care provider about the best treatment for you for each symptom.

Be aware that, unlike drugs, the U.S. Food and Drug Administration (FDA) does not have the authority to approve dietary supplements before they are sold. The dietary supplement manufacturer is responsible for insuring that the product is safe and that any representations or claims made about it are adequately substantiated and not false or misleading (see Box 5).

One positive move you can make to feel better is to adopt a healthy lifestyle–don't smoke, eat a variety of foods low in saturated fat and cholesterol and moderate in total fat, maintain a healthy weight, and be physically active.

For postmenopausal conditions:

Osteoporosis

  • See Box 20 for lifestyle behaviors to protect bone density
  • Designer estrogen Raloxifene (Evista), which preserves bone density
  • Bisphosphonates Actonel or Fosamax, which reverse bone loss and prevent fractures
  • Calcitonin (a nasal spray), which may prevent fractures
  • Note: Phytoestrogens (see "Hot flashes" below) have not been shown to reduce fractures

Heart disease

  • Lifestyle behaviors, including:
    • Following a healthy eating plan
    • Limiting consumption of alcoholic beverages
    • Not smoking
    • Maintaining a healthy weight
    • Being physically active
  • Preventing and controlling high blood pressure
  • Preventing and controlling high blood cholesterol
  • Managing diabetes
  • Taking prescribed medication to control heart disease

For menopausal symptoms:

Hot flashes

  • Lifestyle changes. These include dressing and eating to avoid being too warm, sleeping in a cool room, and reducing stress. Avoid spicy foods and caffeine. Try deep breathing and stress reduction techniques, including meditation and other relaxation methods.
  • Soy. This contains phytoestrogens. (Phytoestrogens are estrogen-like substances derived from a plant source.) However, there is no solid evidence that soy–or other sources of phytoestrogens–really do relieve hot flashes. Further, the risks of taking soy, especially the more concentrated forms of soy, such as pills and powders, are not known. Phytoestrogens from soy can be consumed through foods or supplements. Soy food products include tofu, tempeh, soy milk, and soy nuts. These soy products are more likely to work on mild hot flashes.
  • Other sources of phytoestrogens. These include such herbs as black cohosh, a member of the buttercup family, wild yam, dong quai, and valerian root.
  • Antidepressants, such as Effexor, Paxil, and Prozac have been proved moderately effective in clinical trials; however, they have not been approved for this use.

Vaginal dryness

  • Vaginal lubricants and moisturizers (available over the counter).
  • Products that release estrogen locally (such as vaginal creams, a vaginal suppository, called Vagifem, and a plastic ring, called an Estring)–these are used for more severe dryness. The ring contains a low dose of estrogen and may not protect against osteoporosis. It also must be changed every 3 months.

Mood swings

  • Lifestyle behaviors, including getting enough sleep and being physically active
  • Relaxation exercises
  • Antidepressant or anti-anxiety drugs

Insomnia

  • Over-the-counter sleep aids
  • Milk products, such as a glass of milk or cup of yogurt–choose low- or fat-free varieties
  • Do physical activity in the morning or early afternoon– exercising later in the day may increase wakefulness
  • Hot shower or bath immediately before going to bed

Memory problems

  • Mental exercises
  • Lifestyle behaviors, especially getting enough sleep and being physically active

Back to Top

Postmenopausal Use

Menopause may cause other changes that produce no symptoms yet affect your health. For instance, a woman's risk of developing heart disease begins to rise around menopause. After menopause, women's rate of bone loss increases. The increased rate can lead to osteoporosis, which may in turn increase the risk of bone fractures, usually after age 70.

Through the years, studies were finding evidence that estrogen might help with some of these postmenopausal health risks– especially heart disease and osteoporosis. With more than 40 million American women over age 50, the promise seemed great.

Although erroneously thought of in the past as a "man's disease," heart disease is the leading killer of American women. Women typically develop it about 10 years later than men.

Similarly, menopause is a time of increased bone loss. Bone is living tissue. Old bone is continuously being broken down and new bone formed in its place. With menopause, bone loss is greater and, if not enough new bone is made, the result can be weakened bones and osteoporosis, which increases the risk of breaks. One of every two women over age 50 will have an osteoporosis-related fracture during her life.

Many scientists believed these increased health risks were linked to the postmenopausal drop in estrogen produced by the ovaries and that replacing estrogen would help protect against the diseases.