Quitting Hormone Replacement Therapy
Studies show about half of women who take HRT stop treatment within a year, and up to 75% within two years. Most dont have any problems while they stop, however, stopping suddenly does increase the risk of menopausal symptoms returning, so you should not stop taking your HRT without consulting your doctor.
Doctors may differ in how they taper their patients off HRT. Some gradually decrease estrogen and progesterone doses over time. Others decrease the number of times a week patients take the HRT, along with lower doses. Depending on what type of HRT you are taking and how high the dose, it can take from 3 to 6 months to completely taper off. It can be as long as a year, particularly if your menopause symptoms reappear during the process.
If you stop taking HRT and your symptoms, like hot flashes return, your doctor may first recommend you try nonhormonal treatments before putting you back on HRT. For women with vaginal symptoms, keep in mind that low-dose estrogen in the vagina does not increase the risk of breast cancer, or . Continuing vaginal estrogen does not pose a health risk according to studies.
Who Can Use It
You can begin hormone replacement therapy as soon as you start experiencing menopausal symptoms.
The average age for women to experience the menopause in the UK is 51. However, some women have the menopause when they are in their 30s, 40s or 60s. There is no way of predicting exactly when the menopause will happen.
Some women have menopausal symptoms, such as hot flushes and vaginal dryness, in the 3 to 4 years before the menopause. This is known as the peri-menopause.
The peri-menopause occurs because levels of the female sex hormones, oestrogen and progesterone, fall when the number of remaining eggs drops below a certain level. This means you may experience menopausal symptoms even when you are still having periods.
In most cases, HRT can be used without taking a test to confirm you are starting the menopause. A test for the menopause is usually only necessary if you are under 40 years old or have unusual bleeding patterns during your period.
Testing can help rule out other conditions that may cause similar symptoms, such as having an overactive thyroid gland . You should have regular smear tests for cervical cancer.
Guideline Recommendations For Hrt After Menopause
The American College of Obstetricians and Gynecologists, the North American Menopause Society , and the Endocrine Society publish HRT guidelines based on scientific evidence.
Women who may be good candidates for HRT, starting with the lowest dose appropriate for each individual, include those who:
Are younger than 60 years old
Have not been menopausal for more than 10 years
Have symptoms severe enough to have an impact on their life, such as painful sex from dry vagina, during hot flashes, or poor sleep due to nighttime
Have no history of heart disease
Have no history of blood clots
Have no history of breast
Women who have a risk of and/or blood clots may have another option though. Rather than the traditional oral HRT in pill form, they may be candidates for a patch. Studies have shown patches dont have as strong an effect on blood pressure or cholesterol, both of which are risk factors for heart disease.
For women experiencing or those related to urination, its possible neither pills nor patches are necessary. Many women do well with vaginal estrogen in the form of creams, suppositories and rings.
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What Are The Other Benefits And Risks Of Taking Hormone Replacement Therapy
In 2002, the Women’s Health Initiative , which was initiated by the National Institutes of Health, a randomized controlled trial with 16,608 postmenopausal women to evaluate the benefits and risks of HRT in the US. Participants either took estrogens and progestin or a placebo. After around five years of taking HRT, here’s what they found:
- There was a risk of bone fractures and colon cancer.
- There was a slight increased risk of breast cancer, coronary heart disease, stroke, and venous thromboembolic events .
Then, in 2016, a team of researchers reanalyzed the WHI data and walked away with several key guidelines for prescribing HRT:
- Patient age and the number of years since menopause largely impact benefits and risks.
- For postmenopausal people with symptoms who are under 60 years old or within 10 years of menopause, the benefits of HRT outweigh the risks.
- Early initiation of HRT can decrease the risk of cardiovascular disease and mortality, as well as possibly provide protection against cognitive decline.
- Since combined HRT increases the risk of breast cancer after five years, keeping the therapy to under five years is ideal.
Today, healthcare providers use the above guidelines when suggesting or prescribing HRT to their patients.
Added Benefits Of Hrt
HRT reduces the risk of various chronic conditions that can affect postmenopausal women, including:
- diabetes taking HRT around the time of menopause reduces a womans risk of developing diabetes
- osteoporosis HRT prevents further bone density loss, preserving bone integrity and reducing the risk of fractures, but it is not usually recommended as the first choice of treatment for osteoporosis, except in younger postmenopausal women
- bowel cancer HRT slightly reduces the risk of colorectal cancer
- cardiovascular disease HRT has been shown to reduce cardiovascular disease markers when used around the time of menopause.
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Hrt Does Not Cause Weight Gain
Weight gain at the menopause is related to age and lifestyle factors. An increase in body fat, especially around the abdomen, can occur during menopause because of hormonal changes, although exactly why this happens is not clear. Normal age-related decrease in muscle tissue, and a decrease in exercise levels, can also contribute to weight gain.
Most studies do not show a link between weight gain and HRT use. If a woman is prone to weight gain during her middle years, she will put on weight whether or not she uses HRT.
Some women may experience symptoms at the start of treatment, including bloating, fluid retention and breast fullness, which may be misinterpreted as weight gain. These symptoms usually disappear once the therapy doses are changed to suit the individual.
Herbs And Supplements During Menopause
Many over-the-counter natural products are promoted in stores and online as helpful with menopausal symptoms. These include vitamins and soy-based and herbal products . There are also endless arrays of special blends of herbs and vitamins that claim to reduce the discomforts of menopause.
These products are considered dietary supplements . They have not been evaluated by the Food and Drug Administration to be sure that they work or even that they are safe. Some supplements have been tested in small clinical trials, but often the studies only looked at taking the substance for a short time , so it isnt clear how safe it would be if taken for a long time. Another concern has been applying the results of a study of a particular version and dose of a supplement to others that werent tested.
Most of the plain herbs that are touted for menopausal symptoms carry a low risk of harm for most women, but some can interact with other drugs and/or cause unexpected problems. You should discuss herbs or supplements with your doctor before taking them.
Well-controlled scientific studies are needed to help find out if these products work and if they are any safer than the hormone therapy drugs now in use.
You can learn more in Dietary Supplements: What Is Safe?
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Estrogen Therapy And Cancer Risk
In women who still have a uterus, using systemic ET has been shown to increase the risk of endometrial cancer . The risk remains higher than average even after ET is no longer used. Although most studies that showed an increased risk were of women taking estrogen as a pill, women using a patch or high-dose vaginal ring can also expect to have an increased risk of endometrial cancer.
Because of this increased cancer risk, women who have gone through menopause and who still have a uterus are given a progestin along with estrogen. Studies have shown that EPT does not increase the risk for endometrial cancer.
Long-term use of vaginal creams, rings, or tablets containing topical estrogen doses may also increase the levels of estrogen in the body. Its not clear if this leads to health risks, but the amounts of hormone are much smaller than systemic therapies.
ET is not linked to a higher risk of breast cancer. In fact, certain groups of women taking ET, such as women who had no family history of breast cancer and those who had no history of benign breast disease, had a slightly lower risk of breast cancer.
The WHI study of ET did not report any results about ovarian cancer.
To put the risk into numbers, if 1,000 women who were 50 years old took estrogen for menopause for 5 years, one extra ovarian cancer would be expected to develop.
ET does not seem to have any effect on the risk of lung cancer.
Lower Your Chances Of Problems
Talk to your doctor about things you can do to make HRT less likely to cause issues:
- Start HRT within 10 years of menopause or before age 60.
- Take the lowest dose that works for you for the shortest possible time.
- Take progesterone or progestin if you still have your uterus.
- Ask about other forms of HRT besides pills, like patches, gels, mists, vaginal creams, vaginal suppositories, or vaginal rings.
- Get regular mammograms and pelvic exams.
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Types Of Studies Of Hormone Therapy And Cancer Risk
Different types of studies can be used to look at cancer risk from menopausal hormone therapy .
Randomized controlled trials: In this kind of study, a group of patients get the drug being studied , and another group gets a placebo . Results from this kind of study are powerful because which group a patient is in is based on chance. This helps assure that the groups are similar in all ways, such as risk for cancer, except for the drug thats being studied. This is the best way to see the effects of a drug. These types of studies can also be double-blinded, which means neither the people in the study nor their doctors know which group they are in. This lowers the chance that thoughts or opinions about treatment could affect the study results. Unfortunately, these kinds of studies are costly, which limits the number of people in the study, how long the study can continue, and the number of studies done.
A major drawback of observational studies is that the people getting the treatment being studied may have different cancer risk factors than the people who arent. Plus, the treatment can differ between the people being studied. This makes it less clear that the differences seen are only due to the drug being studied and not other factors.
When observational studies and randomized controlled trials have different results, most experts give more weight to the results of the randomized controlled trial.
When To See A Doctor For Hormone Replacement Therapy
Menopause is a normal part of aging and most symptoms will pass on their own. Some people find them mildly uncomfortable and others find they interfere with normal living. When you begin to experience menopausal symptoms or find them unbearable, you can see a doctor to discuss how to proceed.
If you have symptoms related to other conditions, like early menopause before age 45, or chronic period problems, abnormal periods or bleeding, or infertility, you should see your doctor to determine the cause.
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Evaluation For Hormone Therapy
All candidates for HT should be thoroughly evaluated with a detailed history and complete physical examination for a proper diagnosis and identification of any contraindications.
Baseline laboratory and imaging studies before administering HT include the following:
Fasting lipid profile
Blood sugar levels
Serum estradiol levels: In women who will be prescribed an implant and in those whose symptoms persist despite use of an adequate dose of a patch or gel
Serum follicle-stimulating hormone levels: To monitor women taking oral preparations for symptomatic control, especially those with premature menopause
Ultrasonography: To measure endometrial thickness and ovarian volume
Mammography: Performed once every 2-3 years and annually after the age of 50 years
Endometrial sampling is not required in routine practice. However, the presence of abnormal bleeding before or during HT should prompt consideration of ultrasonography to check endometrial thickness , followed by outpatient Pipelle sampling and hysteroscopy. In women with a tight cervix, formal hysteroscopy and dilation and curettage under general anesthesia are advised.
What Are The Risks Of Mht/hrt
The main risk is that some types of MHT lead to a slightly increased risk of developing breast cancer or thrombosis . However, it can prevent other conditions such as osteoporosis, heart disease, fractures, diabetes and some types of cancers.
Current international recommendations say that the benefits outweigh the risks in women who are having significant symptoms from menopause, and that MHT is effective and safe for most healthy women.
Some women have side effects such as nausea, fluid retention, bloating, breast tenderness and swelling, and irregular bleeding. These often go away with time.
MHT may not be suitable for you if you have or have had:
- breast cancer, endometrial cancer or other cancers that are dependent on hormones
- coronary heart disease, stroke or dementia
- blood clots in the legs or lungs
- untreated high blood pressure
The risks of MHT depend on your age, the type and dose of hormone therapy you take, duration of treatment, and your medical history.
Talk to your doctor to find out which risks apply to you. If you are unable to take MHT, your doctor may suggest other medications that may be helpful.
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How Is Hormone Replacement Therapy For Menopause Different From Gender
While gender-affirming hormone replacement therapy for transgender women is in theory similar to hormone replacement therapy for menopause, there are large differences in the prescription protocol:
- Age at prescription: Gender-affirming hormone replacement therapy may be prescribed at much younger ages.
- The use of ther hormones: Hormones that block the production of “male” sex hormones may also be taken alongside estrogen therapy .
What Is Hormone Therapy
These are hormones that supplement or mimic hormones that your body is no longer making consistently. During perimenopause, as ovarian function wanes, hormone levels fluctuate. Physicians often prescribe estrogen and progestin: estrogen to help with symptoms of menopause and progestin to reduce risk of uterine cancer and osteoporosis.
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How Should This Medicine Be Used
Hormone replacement therapy comes as a tablet to take by mouth. It is usually taken once a day. To help you remember to take hormone replacement therapy, take it around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take this medication exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Do not stop taking this medication without talking to your doctor.
Activella, FemHrt, and Prempro come as tablets containing estrogen and progestin. Take one tablet every day.
Ortho-Prefest comes in a blister card containing 30 tablets. Take one pink tablet once daily for 3 days, then take one white tablet once daily for 3 days. Repeat this process until you finish all the tablets on the card. Begin a new blister card the day after you finish the last one.
Premphase comes in a dispenser containing 28 tablets. Take one maroon tablet once daily on days 1 to 14, and take one light-blue tablet once daily on days 15 to 28. Begin a new dispenser the day after you finish the last one.
Before taking hormone replacement therapy, ask your pharmacist or doctor for a copy of the manufacturer’s information for the patient and read it carefully.
What Are The Side Effects Of Hormone Therapy For Prostate Cancer
Because androgens affect many other organs besides the prostate, ADT can have a wide range of side effects , including:
- loss of interest in sex
Studer UE, Whelan P, Albrecht W, et al. Immediate or deferred androgen deprivation for patients with prostate cancer not suitable for local treatment with curative intent: European Organisation for Research and Treatment of Cancer Trial 30891. Journal of Clinical Oncology 2006 24:18681876.
Zelefsky MJ, Eastham JA, Sartor AO. Castration-Resistant Prostate Cancer. In: Vincent T. DeVita J, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles & Practice of Oncology, 9e. Philadelphia, PA: Lippincott Williams & Wilkins 2011.
Smith MR, Saad F, Chowdhury S, et al. Apalutamide and overall survival in prostate cancer. European Urology 2021 79:150158.
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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
- 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 .
How Much Hormone Therapy Costs
The cost of hormone therapy depends on:
- the types of hormone therapy you receive
- how long and how often you receive hormone therapy
- the part of the country where you live
Talk with your health insurance company about what services it will pay for. Most insurance plans pay for hormone therapy for their members. To learn more, talk with the business office where you go for treatment. You can also go to the National Cancer Institute database, Organizations that Offer Support Services and search “financial assistance.” Or call toll-free 1-800-4-CANCER to ask for help.
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