What Hormones Are Used To Treat The Symptoms Of Menopause
The hormones most commonly used to treat symptoms of menopause are estrogen and progesterone. . Often, these 2 hormones are used together, but some women are given estrogen alone. Its important to know which hormones you are talking about when looking at the risks.
Common estrogen preparations used to treat menopausal symptoms include conjugated equine estrogens and estradiol, but several forms or types of estrogen are available.
There are also many progestins available, but medroxyprogesterone acetate , is often used with an estrogen to treat menopausal symptoms. Some preparations contain both an estrogen and a progestin.
Androgens are also sometimes used to treat menopausal symptoms. This is not common, though, and because only a few studies have looked at this practice, it isnt clear how safe it is in the long run.
Tibolone is a synthetic hormone drug that can act like estrogen, progesterone, and testosterone in different tissues of the body. Because this drug isnt available in the US, its not discussed here.
Does Having Or Not Having A Uterus Make A Difference In Deciding What Type Of Hormone Therapy I Should Take
Yes, it does.
If you still have your uterus:
Progesterone is used along with estrogen. Taking estrogen without progesterone increases your risk for cancer of the endometrium . During your reproductive years, cells from your endometrium are shed during menstruation. When the endometrium is no longer shed, estrogen can cause an overgrowth of cells in your uterus, a condition that can lead to cancer.
Progesterone reduces the risk of endometrial cancer by making the endometrium thin. If you take progesterone, you may have monthly bleeding, or no bleeding at all, depending on how the hormone therapy is taken. Monthly bleeding can be lessened and, in some cases, eliminated by taking progesterone and estrogen together continuously.
If you no longer have your uterus :
You typically won’t need to take progesterone. This is an important point because estrogen taken alone has fewer long-term risks than HT that uses a combination of estrogen and progesterone.
A Higher Risk Of Certain Cancers
A 2020 study found that past use of HRT was linked to a higher risk of breast cancer. This elevated risk was associated with both estrogen-only and combined therapies.
There is some debate about the risk of ovarian cancer. Some studies suggest that both estrogen-only and combined therapies raise your risk of ovarian cancer. Other say ovarian cancer is only a risk with estrogen-only therapy, but not with combination therapies.
Estrogen-only HRT may also increase the risk of endometrial cancer . A of 28 studies concluded that the following HRT regimens may all increase the risk of endometrial cancer:
- estrogen-only, sequential combination therapy
- micronized progesterone
Because of the risk, these therapies are generally recommended for women who no longer have a uterus.
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Risks Of Hormone Replacement Therapy
Many medical experts agree that hormone replacement therapy is an option worth considering for healthy adults under 60 seeking to manage certain menopausal symptoms. But it’s important to point out that research has highlighted several potentially serious risks of using HRT.
In particular, research that began in 2002 raised significant concerns, including that some participants on HRT had a higher risk of breast cancer, heart disease, stroke, blood clots, urinary incontinence, gallbladder disease, and dementia. The affected participants were mostly over the age of 60 and past the menopausal stage.
Since then, researchers have continued to analyze these findings as they explore the long-term safety of HRT. Experts have clarified that the potential risks may be more likely in people who:
- Begin HRT at age 60 or older
- Begin HRT more than 10 years after the start of menopause
- Have a personal or family history of conditions like cancer and heart disease
Anyone with these risk factors will not be considered a candidate for hormone replacement therapy.
To help avoid further risks in people who are prescribed HRT, the U.S. Food and Drug Administration recommends using HRT at the lowest working dose for the shortest period of time possible, which is typically no longer than five years.
Can Increase The Risk Of Blood Clots
Studies have shown that HRT may raise your risk of blood clots and stroke. This risk may be highest for people over 60 or who started menopause over a decade ago. The longer you take HRT, the greater the increase in your risk.
Because of this risk, health experts recommend the lowest possible HRT dose for the shortest period of time for people over 60 or who are 10 years past the onset of menopause.
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The Health Risks And Benefits Of Hrt
In 1991, the U.S. National Institutes of Health launched the Women’s Health Initiative , a set of studies involving healthy post-menopausal women that was carried out in 40 U.S. centres. The WHI included a clinical trial to evaluate the risks and benefits of the two types of HRT and to see how they affected the incidence of heart disease, breast cancer, colorectal cancer and fractures in post-menopausal women. The trial was divided into two arms:
- One arm involved more than 16,000 post-menopausal women aged 50 to 79 who had not had a hysterectomy. They took pills daily that were either a combination of estrogen and progestin , or a placebo .
- The second arm involved more than 10,000 women who had received a hysterectomy and who took estrogen pills alone or a placebo.
In July 2002, after an average 5.2 years of regular follow-up, the NIH prematurely ended the combined HRT arm of the WHI trial. An independent monitoring board, which regularly reviewed the findings, concluded that there were more risks than benefits among the group using combined HRT, compared with the placebo group. The study found that changes in the incidence of disease per 10,000 women on combined HRT in one year were:
- Seven more cases of coronary heart disease
- Eight more cases of strokes
- Eighteen more cases and a twofold greater rate of total blood clots in the lungs and legs
- Eight more cases of invasive breast cancer
- Six fewer cases of colorectal cancer
- Five fewer cases of hip fractures
A Note From Cleveland Clinic
The decision to take hormone therapy needs to be a very personalized one. Hormone therapy is not for everyone. Discuss the risks and benefits of hormone therapy with your healthcare provider at an office visit specifically dedicated for this conversation. Youll need the time to address all the issues and answer questions in order to arrive at a decision that is best for you. Factors considered should be your age, family history, personal medical history and the severity of your menopausal symptoms.
Be sure to talk about the pros and cons of the different types and forms of HT as well as non-hormonal options such as dietary changes, exercise and weight management, meditation and alternative options.
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Estrogen/progestin Combination Hormone Therapy Causes Breast Cancer
On July 9, 2002, officials from the National Institutes of Health announced that one form of hormone therapy , Prempro, was found to cause breast cancer in previously healthy women. These women were volunteer participants in the Women’s Health Initiative, the largest and longest trial ever of estrogen therapy and HT. The WHI began in 1991 as the first randomized clinical trial to look at the long-term health effects of post menopausal hormone therapy. Just over 16,000 women participated in this section of the trial. Half of the trail participants were given an estrogen/progestin combination in the form of Prempro, and the other half was given a look-alike placebo with no active ingredients. Prempro is a combination of a synthetic estrogen with a progestin .
By the time the trial was stopped, women had been taking their pills for an average of 5.2 years each. During that time, 166 women taking the hormone combination developed invasive breast cancer, compared to 124 women on placebo, an overall increase of 26 percent. Another way of expressing the increased risk caused by Prempro is that each year, among 10,000 postmenopausal women taking estrogen/progestin, eight more will have invasive breast cancer. This increased risk of breast cancer does not appear until the hormones have been taken for at least two years. It also appears that the risk continues to increase with longer use.
Offers Protection Against Cardiovascular Disease
Numerous studies have confirmed that when HRT is started early, within 10 years of menopause, it can help protect your heart and vascular system from disease.
Before starting HRT, its important to undergo a physical exam to be sure you dont already have signs of cardiovascular disease. Your doctor will likely want you to have a check-up every year while youre on HRT to be sure youre maintaining good heart health.
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Side Effects And Risks Of Bhrt
While the FDA has approved some preparations of bioidentical estradiol and progesterone, it hasnt approved any compounded bioidentical hormones. There are claims that bioidentical hormones are safer and more effective than traditional HRT because theyre identical in structure to those produced in the body. But these claims have not been confirmed by large-scale, reputable studies. The FDA urges caution when using compounded products.
Research has shown that hormone replacement therapy in general may increase the risk for certain conditions and diseases including:
Talk to your doctor about which form may be best for you and your lifestyle. Youll likely need to be monitored regularly once you begin BHRT to evaluate your bodys response. However, the FDA cautions against monitoring hormone levels via blood and saliva tests. These only tell you your hormone levels at a moment in time and can vary widely throughout the day.
The FDA recommends that if you do choose any form of hormone therapy that you use the lowest dose that produces results. The FDA also says you should use it for the shortest length of time possible.
About Estradiol And Premarin
Estradiol is the most potent natural estrogen made in the body during the reproductive years. Symptoms of menopause may be caused by a natural decrease in these estrogen levels. Medical formulations of estradiol can help relieve symptoms of menopause. Estradiol may be prescribed for:
- hot flashes
- vaginal dryness
- vaginal burning
Estradiol is also used for comfort care in serious cases of breast cancer or prostate cancer.
Premarin, on the other hand, is the brand name of a conjugated estrogen. Conjugated estrogen is also a medical formulation. Its a mixture of several types of estrogens.
Premarin, like estradiol, is used to provide comfort to patients with serious forms of breast cancer or prostate cancer. Its also used to treat the same symptoms of menopause that estradiol does. Further, its also sometimes prescribed for abnormal uterine bleeding.
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Making Sense Of Hormone Replacement Therapy
With all of the contradictory messages, it’s hard for a woman to know what to do. There’s also a lot of lingering anger about what happened in the wake of the Women’s Health Initiative results.
“I lost a lot of faith in my doctors after that,” says April Dawson, a 63-year-old Connecticut woman who used hormone replacement therapy for about a year. “And all of the women I know feel the same way.
“In the first place, I didn’t like the idea of going on medication when I didn’t have any symptoms,” Dawson tells WebMD. “But I feel like my doctors ganged up on me and pushed me to take it.”
Today, doctors are far more likely to tell women that they must make the decision themselves, weighing the pros and cons of hormone replacement therapy, considering their symptoms, family history, lifestyle, and risk of disease.
If you take HRT, keep in mind that the absolute risks are low. But you should still regularly check in with your doctor. Ask if there is any new information that might cause you to rethink your decision.
“Hormone therapy is a field that continues to change rapidly,” says Shuster. “Treatment has to be more individualized than ever. Women are seeking the one right answer, but for now, we just don’t have one.”
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Does Hrt Cause Weight Gain
Contrary to popular belief, HRT does not cause weight gain. Changes in weight are typically from menopause and other lifestyle factors. Any noticeable weight gain is usually just bloating and swelling.15
For some women, the benefits may outweigh these side effects. Talk to your doctor to see whats right for you. As always, dont be afraid to express any concerns or hesitations.
References
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How To Get Started On Hrt
Speak to a GP if you’re interested in starting HRT.
You can usually begin HRT as soon as you start experiencing menopausal symptoms and will not usually need to have any tests first.
A GP can explain the different types of HRT available and help you choose one that’s suitable for you.
You’ll usually start with a low dose, which may be increased at a later stage. It may take a few weeks to feel the effects of treatment and there may be some side effects at first.
A GP will usually recommend trying treatment for 3 months to see if it helps. If it does not, they may suggest changing your dose, or changing the type of HRT you’re taking.
Estrogen Replacement Therapy: Are There Any Risks
Almost every form of medication comes with potential risks and estrogen replacement therapy is no different. There have been many research studies into menopause and HRT and its often shown that the benefits of taking HRT can be greater than the risks for lots of women, Welsh says. However, there are risks of HRT and depending on your medical and family history, you may be at a higher risk than others.
Some of the risks include endometrial cancer , breast cancer, blood clots, and strokes, according to Welsh. Its important to talk with your doctor about your individual risk, the benefits versus the risks, and which form of HRT would be best suited to you, she says.
Research from 2019 by the Womens Health Initiative actually found that estrogen-only replacement therapy can lower the risk of breast cancer, while combination hormone therapy increases the risk.
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Hormone Replacement Therapy May Cause Side Effects Tell Your Doctor If Any Of These Symptoms Are Severe Or Do Not Go Away:
- changes in sex drive or ability
- nervousness
- brown or black skin patches
- swelling of hands, feet, or lower legs
- bleeding or spotting between menstrual periods
- changes in menstrual flow
- dark-colored urine
- light-colored stool
Hormone replacement therapy may increase the risk of developing endometrial cancer and gallbladder disease. Talk to your doctor about the risks of taking this medication.
Hormone replacement therapy may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s MedWatch Adverse Event Reporting program online or by phone .
Coverage And Cost Comparison Of Estrace Vs Premarin
Insurance and Medicare prescription plans typically cover Estrace and Premarin.
A typical generic Estrace prescription is for a tube of cream and costs about $36 if you pay out of pocket, but using a free SingleCare coupon can bring the price down to as little as $6.
A typical prescription for a tube Premarin costs about $250 out-of-pocket. A SingleCare card can bring the price down to as low as $198.
As plans vary, contact your insurance provider for coverage details.
| $198+ |
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What Is The Best Alternative To Premarin
Estrace is a similar alternative to Premarin. Other medications containing estrogen include the Vivelle Dot Patch, Climara Patch, or vaginal estrogen in the form of Vagifem vaginal tablets or Estring Vaginal Ring. Talk to your healthcare provider to see if one of these medications is appropriate for you.
Does Premarin Cause Dementia
Premarin has a boxed warning about dementia. The WHI Memory Study mentioned above found an increased risk of developing dementia in postmenopausal women who took estrogen alone or estrogen with a progestin. Therefore, the prescribing information recommends that estrogen, whether taken alone or with progestin, should be prescribed at the lowest dose and for the shortest time.
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Choosing The Best Type Of Estrogen Therapy
When deciding what type of estrogen therapy to get, work closely with your doctor. While oral estrogen has been around for a long time and is well studied, some modes of taking hormone therapy are not. They may have lower risks or different risks that we don’t know about yet. Your doctor should be up to date on the latest research.
Right now, the full risks of hormone therapy are unclear. So if you do decide to get ERT, experts generally recommend that you get it at the lowest dose for the shortest time possible. Talk to your doctor about how long you should expect to take ERT and how you can limit your risks.
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Why Is This Medication Prescribed
Combinations of estrogen and progestin are used to treat certain symptoms of menopause. Estrogen and progestin are two female sex hormones. Hormone replacement therapy works by replacing estrogen hormone that is no longer being made by the body. Estrogen reduces feelings of warmth in the upper body and periods of sweating and heat , vaginal symptoms and difficulty with urination, but it does not relieve other symptoms of menopause such as nervousness or depression. Estrogen also prevents thinning of the bones in menopausal women. Progestin is added to estrogen in hormone replacement therapy to reduce the risk of uterine cancer in women who still have their uterus.
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