Hormone Replacement Therapy
From Encyclopedia of Sex and Sexuality
Hormones are chemicals produced by glands in the body. Some regulate metabolism and others, the female hormones, regulate the menstrual cycle. In women, the two main hormones specifically for female functions are estrogen and progesterone. Estrogen also plays a key role in maintaining the health of a woman’s heart, blood vessels, and bones.
Menopause is the time in a mature woman’s life when her ovaries stop producing estrogen and progesterone and when she stops having menstrual periods. (Some women go through an “artificial” menopause if their ovaries are estrogen removed surgically or rendered inactive.) Estrogen is also produced in the fat cells of the body, so even at menopause the estrogen level never falls to zero. Nonetheless, it is at a very low level, insufficient to protect a woman from osteoporosis and heart disease.
When estrogen levels fall, almost all women experience symptoms of it. The hot flash is the most common. This is a sudden feeling of heat which spreads over the body, and the skin may flush and sweat. These sensations rarely last more than twenty minutes, but may occur many times over a twenty-four-hour period. Often hot flashes occur at night, interrupting sleep.
The lining of the vagina, the vaginal mucosa, also responds to decreased estrogen levels. The cells produce less lubrication and become thinner, and itching, burning, or painful intercourse may result.
Osteoporosis (accelerated loss of bone density) is another consequence of decreased estrogen levels. After menopause, some women are at greater risk of hip, wrist, or spinal bone fractures. This is due to an increased loss of calcium from the bone, making them more prone to fractures. Slender white women are at the greatest risk of getting osteoporosis, but all postmenopausal women are at risk. Smoking and lack of proper exercise aggravate the process, as does inadequate nutrition.
Heart attacks occur only rarely in women prior to menopause. Estrogen has a protective effect on the arteries of the heart and elsewhere. Estrogen helps maintain the HDL or “good” cholesterol level and decreases the LDL or “bad” cholesterol level. After menopause, and without estrogen replacement by pills, heart attacks are more common.
Menopause is usually preceded by irregular menstrual periods. A woman may skip one or two months or may stop menstruating suddenly, or the amount of flow may change. Hormone therapy is started at menopause or earlier if a woman develops the symptoms before menopause actually occurs. If a woman has her ovaries surgically removed, she would start hormone replacement therapy at that time.
Estrogen therapy alone can stimulate the lining of the uterus (the endometrium) and, in fact, it increases the incidence of cancer of this lining. To negate this effect, progesterone is added to the hormone therapy regimen.
There are a variety of methods employed to replace hormones. One can cycle the woman with estrogen twenty-five days of the month, add progesterone the last ten of these days, and then allow a period of five to six days without hormones. Most women will have a menstrual period during the time off hormones. This bleeding is regular and usually light. Another method is to give estrogen and progesterone daily, with no hormone-free interval. Using this method, some women will experience irregular spotting, and others will not have any bleeding. There are estrogen and progesterone pills, as well as a skin patch containing estrogen, or these hormones can be administered by injection.
Any time that a woman has irregular bleeding after menopause an endometrial sampling of the uterine lining should be performed either by endometrial biopsy or “D & C.” This is to ensure that the bleeding is not from abnormal cells or from cancer of the uterus (see uterine cancer).
With few exceptions, nearly all women can take hormones in the menopausal years. Estrogen replacement therapy after menopause eliminates hot flashes, helps retard development of osteoporosis, reduces the risk of cardiovascular disease, corrects thinning of vaginal tissue, and also helps to make the menopausal years a more enjoyable and satisfying time in a woman’s life.
There have been reports that women using hormone replacement therapy are at a slightly increased risk of breast cancer. However, the relationship has not been scientifically proven and any women who are concerned about this risk should consult their physicians.