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What Is Hormone (Replacement) Therapy?

Hormone therapy is a general term used to describe an attempt to substitute synthetic hormones for the hormones lost naturally during a woman's life cycle leading up to and following menopause. It is available only by prescription. Hormone therapy was formerly known as "hormone replacement therapy (HRT)" because it was believed possible to use synthetic hormones as a true substitute for natural ones. However, with the development of scientific research, the medical and legal community now know that there is no true substitute for natural hormones. Hence, the term referring to use of hormone medications is now known as ‘hormone therapy'. There is the pill or tablet form (PREMPRO), vaginal creams, vaginal ring insert, implants, or shots. There are also patches that stick to the skin. The body absorbs estrogen from the patch through the skin. Progestin usually is taken in pill form, sometimes in the same pill as the estrogen. It is also available as an IUD (intrauterine device), a vaginal gel, and shots.

There are basically two types of hormone therapy:

Estrogen Therapy (e.g. Premarin), for relief of surgically-induced (hysterectomy)
menopausal symptoms.
Combination Hormone Therapy (estrogen and progestin) (e.g. Prempro or Premphase), for relief of natural menopausal symptoms.

Estrogen works to regulate a woman’s monthly menstrual cycle and secondary sexual characteristics (such as breast development and function), and also prepares the body for fertilization and reproduction. Progesterone is released each month during menstruation to prepare the uterus for possible pregnancy and to prepare the breasts for lactation (milk production). As a woman reaches menopause, typically around 50 years old, her body produces less and less estrogen and progesterone.

Hormone replacement therapy (HRT) is synthetic estrogen and progesterone (called progestin) designed to "replace" a woman's depleting hormone levels. Decreased levels of estrogen may cause hot flashes, vaginal dryness, sleep disturbances, or other bothersome side effects. HRT can help to relieve these and other menopausal symptoms. HRT may also help prevent osteoporosis and heart disease. It is estimated that 40 million women will reach menopause in the next 20 years.

Benefits of HRT

Hormone Therapy can be very effective in combating hot flashes, vaginal dryness, sleep disturbances, or other bothersome side effects related to menopause. The dryness of tissue surrounding the vagina and urethra may cause pain during sexual intercourse or urination. These symptoms can also be relieved. Less clear is whether or not Hormone Therapy can alleviate other problems it was long believed to be able to reduce, such as heart disease.

HRT and Heart Disease

Heart disease is the leading cause of death in post-menopausal women. Several prior studies have shown that HRT can help reduce heart disease in some women. HRT may reduce the chance of a second heart attack by 84%. Estrogen/progestin combinations may also help decrease heart disease by working to lower LDL ("bad") cholesterol levels and increasing HDL ("good") cholesterol levels.

However, recent studies have dismissed claims that HRT can help reduce heart disease.

HRT and Osteoporosis

Hormone Therapy is also commonly prescribed to help prevent osteoporosis in post-menopausal women. Osteoporosis is a degenerative bone disease that affects approximately one third of women over age 50. It may be particularly effective against osteoporosis if taken during the first five years after menopause begins. It is estimated that HRT can lead to a 50% to 80% decrease in vertebral fractures and a 25% decrease in non-vertebral fractures with five years of use.

This therapy may also prevent osteoarthritis, a degenerative joint disease. As with osteoporosis, protection against osteoarthritis ends after HRT has been stopped.

HRT and Alzheimer’s Disease

Alzheimer's disease is a degenerative brain disease that leads to confusion and memory loss. There is no cure for Alzheimer's disease. However, some studies suggest that estrogen or various combinations of Hormone Therapy may delay the development of Alzheimer's.

Dangerous Side Effects of HRT

As with most prescription medications Hormone (Replacement) Therapy can carry with it certain side effects. These vary from person to person. But, the most frequent of these include: bloating, breast tenderness, depression, nausea, vaginal bleeding, fluid retention, weight gain and a possible increase in migraine headaches.

Risk of Endometrial Cancer

However, there are more significant potential side effects to be concerned about. Prolonged estrogen only therapy has been linked to an increased risk of uterine (endometrial) cancer. As a result, many physicians prescribe progestin with estrogen to counteract the risk of endometrial cancer.

Risk of Breast Cancer

A recent study done by the Women’s Health Initiative indicates that estrogen/progestin therapy resulted in a 26% increase in breast cancer, which caused the study to be stopped.

Risk of Ovarian Cancer

There has also been some research to suggest that long-term use of HRT (10 years or more) increases the risk of ovarian cancer. In a study of more than 200,000 women, researchers from the American Cancer Society found that using estrogen replacement therapy (estrogen without progestin) for 10 or more years increases the risk of death from ovarian cancer. Researchers are not certain why estrogen therapy increases the risk of ovarian cancer, they do know that estrogen causes ovarian cells to produce at faster than normal rates. The more times a cell divides, the higher the chances that it will replicate an abnormal copy, which could result in cancer if the abnormal copy controls cell growth.

Risks for Other Cancers

There is also research which suggests that hormone (replacement) therapy may present an increased risk for lobular cancer (found in the fatty tissue of the breast), ductal cancer (found in the ducts of the breast) and gallbladder cancer.

Risks for Strokes, Heart Attacks, Blood Clots and Heart Disease

The recent study of the Women’s Health Initiative has indicated that estrogen/progestin therapy has led to an increased risk in the following manner:

Strokes - 41% Increase
Heart Attacks - 29% Increase
Blood Clots - 105% Increase
Heart Disease - 22% Increase

Conclusions

The following summarizes the possible benefits and risks of ERT (estrogen without progestin). The benefits and risks may differ when estrogen is combined with progestin. For example, the increased risk of endometrial cancer is not associated with combination hormone therapy.

Possible Benefits
of Estrogen Therapy

Relieves menopausal symptoms—hot flashes, vaginal dryness, etc.
Prevents and treats osteoporosis
May improve mood
May protect against heart disease (research contradictory)
May provide some protective effect/benefit with Alzheimer’s disease and diabetes

Possible Risks
of Estrogen Therapy

May increase risk of heart attack and stroke
May increase risk of blood clots
May increase risk of breast cancer
Increases risk of endometrial cancer—cancer of the uterine lining (risk counteracted if estrogen is combined with progestin)
Increases risk of ovarian cancer
May be associated with side effects, such as bloating, nausea, etc.

The combined estrogen/progestin arm of the Women's Health Initiative, a large clinical trial that was studying HRT, heart disease, osteoporosis, breast cancer, and colon cancer in 63,000 American women between the ages of 50 and 79-was halted in by the National Institutes of Health (NIH) in 2002. Researchers felt that the elevated risk of breast cancer, as well as higher than normal rates of heart attack, stroke, and blood clots, outweighed the benefits that HRT may provide against hip fractures and colon cancer. The arm of the WHI that studied estrogen alone (without progestin) is continuing its study.

If you or a loved one took Prempro, Premarin or another hormone replacement therapy and have breast cancer, blood clots, stroke, heart disease or other complications, click here to have an attorney evaluate your case for free, with no obligation. Or, call toll free, 877.786.1LAW (1529). Any information you submit is kept private and confidential and is used for the sole purpose of evaluating your potential case.