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Hormone replacement therapy

Hormone replacement therapy: Who needs to take what?

We often hear both pros and cons to hormone replacement therapy for women. A new study in The Journal of the American Medical Association (JAMA) looks at estrogen-only use for women who have had a hysterectomy. Gynecologist Lynley Durrett, M.D., F.C.O.G., gives her perspective on the study and estrogen therapy overall.

“This particular study showed that a lot of the women who started on estrogen-only therapy in their early 50s, which is the main time menopausal symptoms set in, had a significant reduction in the number of heart attacks,” says Dr. Lynley Durrett, gynecologist at Piedmont Hospital. “The study also reported that this group of women had a reduction in breast cancer, which is a big concern for many women.” Women who have had a hysterectomy typically take estrogen only, but women who still have a uterus typically take estrogen plus progesterone. The added progesterone helps stop the overgrowth of the uterus’ lining and reduces the potential for cancerous changes.

So, if a woman does not have a uterus, she doesn’t require the addition of progesterone. A previous study done by the Women’s Health Initiative had differing results from the recent JAMA study; it showed that using combo hormone replacement (estrogen plus progesterone) showed a slight increase in risk for developing breast cancers and heart attacks. However, the women in the earlier Women’s Health Initiative study were 65 year of age and older. “Women who are 65 and over are not the typical population we are starting on hormone therapy because most of them have almost completed their menopausal transition,” says Dr. Durrett.

“So, the Women’s Health Initiative study doesn’t reflect how we really use the therapy in everyday practice.” If you’re 50 or older and have had a hysterectomy, Dr. Durrett says the first determination of whether you need estrogen therapy is the strength of your symptoms. If you need symptom relief, but your menopausal symptoms do not warrant such therapy, or if you’d rather avoid it, lifestyle changes can help manage symptoms.

Dr. Durrett suggests increasing exercise and hydration, as well as limiting consumption of spicy foods, caffeine and alcohol. Alternative treatments such as soy products and black cohosh can often help, as can anti-depressants to treat hot flashes. Choice of treatment often depends on the main symptoms.

The question of whether any woman should consider hormone replacement therapy for menopausal symptoms is a complex one best solved by the woman and her doctor as it often involves knowing how severe her symptoms are and whether the woman has any risk factors for heart diseases or even certain cancers. But, we do know that for any woman - keeping physically fit with a good body weight and eating a healthy diet are keys to helping her obtain optimum health.

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