Facts About Menopausal Hormone Therapy

1 Facts AboutMenopausal Hormone Therapy once seemed the answer for many of the conditionswomen face as they age. It was thought that Hormone Therapy could ward off heart disease, osteoporosis, and cancer, while improving women s quality of beginning in July 2002, findings emerged from clinical trials that showed this was notso. In fact, long-term use of Hormone Therapy poses serious risks and may increase the riskof heart attack and stroke. This fact sheet discusses those findings and gives an overview ofsuch topics as menopause , Hormone Therapy , and alternative treatments for the symptomsof menopause and the various health risks that come in its wake.

2 It also provides a list ofsources you can contact for more DEPARTMENT OF HEALTH AND HUMAN SERVICESN ational Institutes of HealthNational Heart, Lung, and Blood InstituteMenopausalHormone TherapyMenopause and HormoneTherapyAs you age, significant internalchanges take place that affect yourproduction of the two female hormones, estrogen and proges-terone. The hormones, which areimportant in regulating the men-strual cycle and having a successful pregnancy, are produced by theovaries, two small oval-shapedorgans found on either side of the the years just beforemenopause, known as peri- menopause , your ovaries begin to shrink.

3 Levels of estrogen and progesterone fluctuate as your ovaries try to keep up Hormone can have irregular menstrual cycles,along with unpredictable episodesof heavy bleeding during a usually lasts several , your periods marks the time of your last menstrual is not considered the last untilyou have been period-free for 1 year without being ill, pregnant,breast-feeding, or using certainmedicines, all of which also cancause menstrual cycles to should be no bleeding,even spotting, during that menopause usually hap-pens sometime between the agesof 45 and also can undergo menopauseas the result of surgery.

4 A surgicalprocedure, called a hysterectomy,removes the uterus. This surgeryputs an end to your menstrualcycle but does not affectmenopause, which still occurs go through menopauseimmediately if both of yourovaries are also removed at surgery. Whether you gothrough menopause naturally 2 Box 1 Estrogen pills:BrandGenericPremarinconjugated equine estrogensCenestinsynthethic conjugated estrogensEstratabesterified estrogensMenestesterified estrogensOrtho-Estestropipate (piperazine estrone sulfate)Ogenestropipate (piperazine estrone sulfate)Estracemicronized 17-beta-estradiolEstinylethinyl estradiolProgestin pills.

5 BrandGenericCycrinmedroxyprogesterone acetateProveramedroxyprogesterone acetateAygestinnorethindrone acetateNorlutatenorethindrone acetatePrometriumprogesterone USP (in peanut oil)Estrogen-plus-progestin pills:BrandGenericPremphaseconjugated equine estrogens and medroxyprogesterone acetatePremproconjugated equine estrogens and medroxyprogesterone acetateFemhrtethinylestradiol and norethindrone acetateActivella17-beta-estradiol and norethindrone acetateOrtho-Prefest17-beta-estradiol and norgestimateExamples of Oral Estrogen and Estrogen/Progestin Productsor surgically, symptoms can resultas your body adjusts to the drop in estrogen levels.

6 These symptomsvary greatly one woman may go through menopause with fewsymptoms, while another has difficulty. Symptoms may last for several months or years, or most common symptoms arehot flashes or flushes, night sweats,and sleep disturbances. (A hot flashis a feeling of heat in your faceand over the surface of your body,which may cause the skin toappear flushed or red as blood vessels expand. It can be followedby sweating and shivering. Hotflashes that occur during sleep arecalled night sweats.) But the dropin estrogen also can contribute tochanges in the vaginal and urinarytracts, which can cause painfulintercourse and urinary relieve the symptoms ofmenopause, doctors may prescribehormone Therapy .

7 This can involvethe use of either estrogen alone or with another Hormone calledprogesterone, or progestin in itssynthetic form (See Box 1.). Thetwo hormones normally help toregulate a woman s menstrual is added to estrogen toprevent the overgrowth (or hyper-plasia) of cells in the lining of theuterus. This overgrowth can lead to uterine cancer. If you haven thad a hysterectomy, you ll receiveestrogen plus progesterone or a progestin; if you have had a hysterectomy, you ll receive onlyestrogen. Hormones may be takendaily (continuous use) or on onlycertain days of the month (cyclicuse).

8 (See Box 3.)They also can be taken in severalways, including orally, through a patch on the skin, as a cream or gel, or with an IUD (intrauter-ine device) or vaginal ring (SeeBox 2.). How the Therapy is takencan depend on its purpose. Forinstance, a vaginal estrogen ring or cream can ease vaginal dryness,urinary leakage, or vaginal or uri-nary infections, but does notrelieve hot Therapy may cause sideeffects, such as bleeding, bloating,breast tenderness or enlargement,headaches, mood changes, andnausea. Further, side effects vary by how the Hormone is taken.

9 Forinstance, a patch may cause irrita-tion at the site where it s also are nonhormonalapproaches to easing the symp-toms of menopause . Box 4 offers a list of some of these About Menopausal Hormone Therapy3 Box 2 Estrogen products:TypeBrandGenericVaginal CreamEstracemicronized 17-beta-estradiolOrtho DienestroldienestrolOgenestropipate (piperazine estrone sulfate)Premarinconjugated equine estrogensVaginal TabletVagifemestradiol hemihydrateVaginal RingEstringmicronized 17-beta-estradiolFemringestradiol acetateSkin PatchAloramicronized 17-beta-estradiolClimaramicronized 17-beta-estradiolEsclimmicronized 17-beta-estradiolEstradermmicronized 17-beta-estradiolVivellemicronized 17-beta-estradiolVivelle-Dotmicronized 17-beta-estradiolSkin GelEstrogelestradiol gelSkin CreamEstrasorbestradiol topical emulsionProgestin products:Vaginal GelCrinoneprogesteroneIUDM irenalevonorgestrelEstrogen plus progestin products.

10 Skin PatchCombipatch17-beta-estradiol and norethindrone acetateOrtho-Prefest17-beta-estradiol and norgestimateExamples of Gels, Creams, Patches, and OtherHormone ProductsBox 3 Cyclic or sequential Estrogen every day Progesterone or progestin added for 10 14 days out of every 4 weeksContinuous-combined Estrogen and progestin daily without a breakHormone TherapySchedules4 Box 4 You may want to consider alternatives to Hormone Therapy to ease Menopausal symptoms. The list below includes some locally applied Hormone products, which might not carry the same risks as those that deliver medicationthroughout the aware that some of these remedies are regulated by theFederal Government as dietary supplements, and as such donot undergo premarket approval and may not have data show-ing them to be safe and effective (See Box 5.)