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. 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.

2 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. 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. A surgicalprocedure, called a hysterectomy,removes the uterus.

3 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:BrandGenericCycrinmedroxyprogester one 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.

4 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 . 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.

5 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). (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. Forinstance, a patch may cause irrita-tion at the site where it s also are nonhormonalapproaches to easing the symp-toms of menopause.

6 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: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.

7 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.). Talk with yourdoctor or other health care provider About the best treatmentfor you for each moves you can make to feel better are related toadopting a healthy lifestyle don t smoke, eat a variety offoods low in saturated fat, transfat, and cholesterol and mod-erate in total fat. Include grains, especially whole grains and avariety of dark green leafy vegetables, deeply colored fruit, anddry beans and peas in your eating plan. Also, maintain ahealthy weight, and be physically active for at least 30 minutesmost days of the week, preferably daily.

8 Alternatives include:For Postmenopausal Conditions:Osteoporosis See Box 13 for lifestyle behaviors to protect bone density. Designer estrogen raloxifene (Evista), which preserves bonedensity and prevents fractures (although not hip fractures). Bisphosphonates Actonel or Fosamax, which preservebone density, prevent fractures, and can reverse bone loss Teraparatide (parathyroid Hormone ), which may reversebone loss Calcitonin (a nasal spray or injectable), used to treat womenwho have osteoporosis, which may prevent some fractures(This drug is not approved for preventing osteoporosis.). Note: Phytoestrogens (see hot flashes) have not been shownto prevent osteoporosis or reduce the risk of disease Lifestyle behaviors, including: Following a healthy eating plan that includes a variety offoods low in saturated fat,transfat, cholesterol andmoderate in total fat, and rich in fruits and vegetables Choosing and preparing foods with less salt Not smoking Maintaining a healthy weight Being physically active Preventing and controlling high blood pressure Preventing and controlling high blood cholesterol Managing diabetes Taking prescribed medication to control heart diseaseFor Menopausal Symptoms:Hot flashes Lifestyle changes.

9 These include dressing and eating to avoid being too warm, sleeping in a cool room, andreducing stress. Avoid spicy foods and caffeine. Try deepbreathing and stress reduction techniques, including medi-tation and other relaxation methods. Phytoestrogens. Soybeans and some soy-based foods contain phytoestrogens, which are estrogen-likecompounds. Soy phytoestrogens can be consumedthrough foods or supplements. Soy food products includetofu, tempeh, soy milk, and soy nuts. Other plant sources of phytoestrogens include such botanicals such as blackcohosh, wild yam, dong quai, red clover, and valerian , there is no solid evidence that the phytoestrogensin soybeans, soy-based foods, other plant sources, ordietary supplements really do relieve hot flashes. Further,the risks of taking the more concentrated forms of soy phytoestrogens, such as pills and powders, are not supplements with phytoestrogens do not have to meet the same quality standards as do drugs.

10 Little isknown About the safety or efficacy of these products. Antidepressants, such as Effexor, Paxil, and Prozac. These medications have been proved moderately effectivein clinical dryness Vaginal lubricants and moisturizers (available over thecounter). Products that release estrogen locally (such as vaginalcreams, a vaginal suppository, called Vagifem, and a plasticring, called an Estring) these are used for more severedryness. The ring, which must be changed every 3 months,contains a low dose of estrogen and may not protectagainst osteoporosis. Mood swings Lifestyle behaviors, including getting enough sleep andbeing physically active Relaxation exercises Antidepressant or anti-anxiety drugsInsomnia Over-the-counter sleep aids Milk products, such as a glass of milk or cup of yogurt choose low-fat or fat-free varieties consumed at bedtime Do physical activity in the morning or early afternoon exercising later in the day may increase wakefulness Hot shower or bath immediately before going to bedMemory problems Mental exercises Lifestyle behaviors, especially getting enough sleep andbeing physically activeAlternatives to Hormone Therapy To Help PreventPostmenopausal Conditions and Relieve Menopausal SymptomsPostmenopausal UseMenopause may cause otherchanges that produce no symp-toms yet affect your health.