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Postmenopausal Hormone Replacement Therapy FAQ

Choosing whether or not to use postmenopausal hormone replacement therapy (HRT) is an important health decision all women face as they approach menopause. As with taking any treatment the decision involves carefully balancing the possible risks and benefits.

We now have information from large studies including healthy women and those with established coronary artery disease (previous heart attack or angina). These studies have shed considerable light on many issues, particular with respect to heart disease and strokes, and have sparked serious concerns and questions regarding the indications and safety of HRT for postmenopausal women.

1. Is HRT dangerous?
HRT is not dangerous. There are certain risks now well recognized with its use however and these risks need to be considered in every women taking HRT or thinking about starting HRT. The Women’s Health Initiative looked at health risks and benefits in a large group of healthy postmenopausal women taking HRT compared to a similar group of women taking placebo. It was stopped early as the risks with taking combination HRT outweighed the benefits after four years of use. The results indicated that women on combined HRT had an increased number cardiac events, strokes, breast cancer and blood clots. There was no difference in death rates between the users and nonusers.

2. Are there any benefits to HRT?
The answer is yes. Women taking HRT do have fewer fractures associated with osteoporosis and less colon cancer. Other studies have demonstrated the HRT is very effective in relieving symptoms associated with menopause such as flashes, night sweats and mood.

3. Who should take HRT?
The only reason to take HRT is for the relief of menopausal symptoms. Estrogen continues to be the most effective way to control these symptoms. The risks and benefits need to be addressed individually in all women prior to initiating HRT. Women who chose HRT to control menopausal symptoms should take the lowest possible dose to control symptoms for the shortest period of time possible. Attempts should be made to wean HRT but stopping abruptly is not recommended as it will often result in a rebound of symptoms.

4. What if I am already on HRT?
Many women were started on HRT for prevention of disease including osteoporosis and heart disease rather than symptoms alone. We now know that HRT does not prevent heart disease. Women on HRT for this reasons should stop. Although HRT does decrease osteoporosis related fractures, we now have other treatment for osteoporosis which does not carry the same health risks as HRT. Women on HRT for symptoms, if their symptoms are now well controlled we would recommend a trial of weaning off the HRT by gradually decreasing the dose over a 3 – 6month period. Most women find that if the HRT is stopped abruptly they have a rebound of symptoms.

5. What if I have Coronary Artery Disease?
HRT should be avoided in patients with heart disease if possible. Women who are on HRT should be weaned off. If patients have refractory menopausal symptoms, HRT may be chosen to improve quality of life but should be used at the lowest possible does and for the shortest period of time.

Women need to be aware of the risk associated with HRT in order to make informed choices regarding the use of HRT. Each women needs to make her own decision about the amount of risk she is willing to take in order to gain the possible benefit of HRT. Even non-hormonal therapies and herbal remedies carry some risk, in many cases the risk are unknown. Although HRT does result in increased risk of heart attack, stroke, breast cancer and blood clots, the absolute risk to each individual women is actually quite small but varies due other underlying heath concerns. Women should discuss the balance of risks and benefits with her physician if she is on HRT currently or contemplating HRT for control of menopausal symptoms.

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