I.
INTRODUCTION
II.
HORMONE
REPLACEMENT THERAPIES
III.
TYPES OF
THERAPIES
a. Pill
b. Patch
IV.
HRT
SIDE-EFFECTS
e. Osteoporosis
VII.
CONCLUSION
VIII.
BIBLIOGRAPHY
In today’s society, healthcare is a primary concern for many women. They are questioning the physicians that they
are seeing, the facilities that they are seen in, and even the types of
medications they should take. How can
female patients be sure that there are no long term or adverse side effects to
any of the medications that they are given?
Trusting the physician is a foremost concern. So, what happens when their emotions are
uncontrollable due to changing hormones, or their body is not responding the
same way as in the past? Hormone replacement therapy is a method that has been
used in the past to control hot flashes during menopause, osteoporosis, and
sexual desire in both men and women. But
what do we really know about these forms of therapy? In the past few years, new research has come
out regarding adverse side effects of hormone therapy and how dangerous it can
become. With the development of breast
cancer and heart disease in many women taking hormone replacement, the question
of safety has become even more important.
What are the reasons for using hormone replacement therapy and do the
benefits outweigh the costs in every situation?
It is inevitable that women will eventually go through menopause. They will experience numerous symptoms
including hot flashes, night sweats, vaginal dryness, reduced sex drive, hair loss,
vaginal and bladder infections, and many more.
While not all women will experience these symptoms, there are many that
will. All these symptoms are due to that
fact that women, at a certain age, stop ovulating. Although the ovaries usually still have many
eggs which are viable, the ovaries are no longer producing estrogen which is
the female sex hormone that drives the menstruation cycle. What this means for women is that they are no
longer able to produce children. When a
woman begins experiencing these symptoms she wants relief, but what are her
options? Women will more than likely
experience side effects due to their changing hormone levels, but the
consequences of the estrogen and progesterone cocktails in the various
medications on the market far outweigh the benefits that they provide.
Hormone replacement therapy, also known as HRT, is an approach to treating
women with one or more female hormones produced in insufficient amounts in
their body. Most commonly the hormones
are estrogen and progestin, a synthetic form of progesterone. HRT is most often used to treat the most
severe symptoms that women experience which, again, include mood swings, sleep
disorders, vaginal dryness, decreased sexual desire, and hot flashes (Menopause-
Hormone Replacement Therapy, 2007).
Hormone replacement therapy has greatly impacted the medical field and
bridged gaps in our healthcare, but the positive and negative consequences of
these advances are not fully known.
Early on in the discovery of HRT, studies showed that it was a
significant leap in treating the symptoms of menopause, but it also could prove
beneficial for reducing the risk of heart disease and osteoporosis induced bone
fractures. The function of estrogen in
the body is to increase the “good” cholesterol in the bloodstream while
decreasing the levels or “bad” cholesterol.
The good cholesterol is the high-density lipoprotein (HDL) and the bad
cholesterol is officially known as low-density lipoprotein (LDL). Therefore estrogen, one of the main
components of HRT, would seem to be a beneficial component in the makeup of
beneficial drugs for menopausal symptoms.
However, there are far too many consequences that outweigh the positive
benefits associated with conventional allopathic medicines to provide suitable
relief from the grips of menopausal symptoms.
There are four main types of hormone
replacement therapies which are delivered using three different methods,
including pills, patches, and vaginal creams.
The first is cyclic hormone therapy.
This is the most commonly recommended form of HRT. This is the pill form in which the individual
takes estrogen for 25 days and then progestin is added into the regimen around
day 10-14. There are then no pills taken
days 3-5 to allow for monthly bleeding.
This is usually not a period since most women on HRT have ended their
natural cycles with the onset of menopause (UCLA
Health System, 2007).
The second form of therapy is also in pill form. It is continuous therapy with estrogen and
progestin taken together on a daily basis.
This is indicated for irregular bleeding for up to one year of use and
does not have a built in three day period for monthly bleeding (UCLA
Health System, 2007).
The third is a patch which is applied to the abdomen or thigh. This form of delivery absorbs the estrogen
through the skin and into the bloodstream, which for some women is far more
convenient, but it does lack the benefits of the progestin supplement (UCLA
Health System, 2007).
The final method is vaginal cream which also contains estrogen only and
has been known to have vaginal dryness as a major side effect. This form of hormone replacement therapy is
not usually used alone. It is used in
conjunction with the other forms of HRT because it has not been linked to the
beneficial effects of HRT such as prevention of bone disease like the other
forms of HRT. (UCLA
Health System, 2007)This is important to note because higher levels
of HDL and lower levels of LDL are crucial factors when assessing an
individual’s risk factor for developing cardiovascular disease.
By having higher levels of HDL and lower levels of LDL, many researchers
believed that it would thus lower the levels of cardiovascular disease in
menopausal women. However, when the
Women’s Health Initiative (WHI)
conducted the research on this hopeful method of treatment, they obtained very
different results. With the introduction
of estrogen and progestin into the bloodstream, they found that the number of
heart attacks increased by 29%. Also,
the risk of developing cardiovascular disease is increased when a woman reaches
the age of 60, but that is not the only reason a women at 60 taking HRT could
develop cardiovascular disease. Another
study published in 2002 by The Heart Estrogen/progestin Replacement Study
(HERS) showed that there were essentially no benefits to taking HRT after
following women for nearly 7 years (UCLA
Health System, 2007). There
is also a study currently underway called Kronos Early Estrogen Prevention
Study (KEEPS). This study is trying to better understand younger women and
postmenopausal drug therapy.
Specifically, researchers in this study are trying to find the link, if
any, between estrogen and heart disease in younger menopausal women. (KEEPS, 2006)
Studies have showed for many years that women that take certain types of
contraceptives with increased dosages of estrogen have increased risk of
developing blood clots or thromboembolic disease. Thrombosis occurs when blood clots form
inside the veins in your body. The risk
for many women is at its highest in the first one to two years of therapy and
generally affects women who have a high risk of blood clots regardless of the
medication. Another way that women have
shown to increase their chances of developing this type of health problem has
been through cigarette use. A study by
the Women’s Health Initiative (WHI)
stated that there is a significant increase in the risk of strokes when taking
estrogen-only therapy. Further, their
study also stated that the incidence of strokes among women taking both
estrogen and progestin increased almost 41% compared to women not taking any
form of hormones. (UCLA
Health System, 2007)
Cancer has also been a primary concern in relation to hormone
replacement therapy. Breast cancer is
already one of the most common and most talked about forms of cancer in the
Uterine and endometrial cancer is also a concern of those that are taking
HRT drugs. It has been shown that women
taking estrogen alone have an increased tendency for abnormal growth of the
uterine lining. The risk for endometrial
cancer is 6-8 times greater for those women who are taking HRT medications (Menopause-
Hormone Replacement Therapy, 2007).
Likewise, women who are taking only progestin find that they have a
decrease in uterine lining. In order to
keep these effects under control, many physicians prescribe progestin to reduce
the adverse effects of the estrogen. The
Women’s Health Initiative has found in various studies that there was little
difference between women who are taking HRT drugs and those that are not except
that some taking progestin experienced minor uterine lining bleeding (UCLA
Health System, 2007).
Another form of cancer that has critics of HRT voicing concern is
ovarian cancer. In 2002 the National
Cancer Institute published a study that said women using estrogen therapy have
an increased risk of developing ovarian and breast cancer, which gets variably
larger over time. It was found that it
is three times more likely for women using estrogen for 20 years or more. Future research to be done is assessing the
risk of ovarian cancer in women taking an HRT combination of progestin/estrogen
to see if the risk is still heightened. (Use of
proteomic patterns in serum to identify ovarian cancer. , 2002)
There are currently studies that are being done to better understand the
benefits and risks of hormone replacement therapy for several different disease
processes; however, many of them need further research to confirm their
findings. One such study is looking at
gallbladder disease. Numerous studies
have indicated that women who are using the combination of estrogen and
progestin for therapy have an increased risk of developing gallstones. There are also studies currently being done
to link the likelihood of women developing urinary incontinence after menopause
when linked to HRT. In addition, it has
been shown that women who suffer from depression, mood swings, and sleep
problems both during and after menopause have benefitted from hormone
replacement therapy and many claim it has improved their quality of life. However, no study has been linked
scientifically to show that this actually is a beneficial treatment for certain
types of depression. Other such studies
include those involving Alzheimer’s disease which has shown no significant
conclusions; however, there are current studies being done on other forms of
memory loss. Other studies that being
conducted are to better understand the pathways, and see if there is actually
any benefit to memory loss with the help of hormone replacement therapy.
Given that many women have a decreasing production of estrogen in their
body because of menopause, their bone strength is many times compromised. This is called osteoporosis, when women have
a significant decrease in bone density.
This is because the osteoblast cells are not producing bone at a rate
fast enough to keep up with the destructive rate of the osteoclast cells. A Women’s Health Initiative study found that
women taking hormone replacement therapy drugs were 24% less likely than women
not taking them to have hip fractures (UCLA
Health System, 2007). This is
found in women that have been taking HRT drugs for a significant number of
years. Women that take them only for the
short term relief of menopause seem to have little protection from osteoporosis
in aging bones, while it also does not help those that have reached the age of
75 or older. Another problem with the
estrogen supplement is that women who stop the therapy will lose the protective
nature of the therapy and must continue the therapy in order to maintain that
level of protection (UCLA
Health System, 2007).
Obviously, there are many concerns about taking HRT. There is, however, significant symptom
relief, and clear benefit in some diseases for women taking hormone replacement
therapy drugs. One is that women taking
estrogen/progestin have been found to have a 37% decreased risk of developing
colon cancer, according to a study done by the Women’s Health Initiative (UCLA
Health System, 2007).
Regardless, women and physicians alike find it difficult to balance out
the protective nature of estrogen for the prevention of osteoporosis with the
harmful nature of the drugs on the cardiovascular system, liver, and the
possible contraction of multiple forms of cancer.
So, who can actually benefit
from hormone replacement therapy? We all
should be aware that there are major health concerns that one would take on by
taking hormone replacement drugs, but there are ways to take them to benefit
your life. Some women during menopause
develop moderate to severe hot flashes that inhibit their ability to function
in everyday life. This would not be
something that would be comfortable or “livable” for many women. In this situation, short-term therapy
significantly outweighs the potential risks that accompany HRT drugs. Each woman has to weigh their own potential
risks. According to Sharonne Hayes,
M.D., cardiologist and director of the Women’s heart Clinic at May Clinic in
Rochester, MN, “The absolute risk to an individual woman taking hormone therapy
is quite low and may be acceptable to you depending on your symptoms” (Mayo Clinic. Sept. 2007).
What many women question now
is, when is it appropriate to take hormone replacement therapy drugs for my
symptoms and what symptoms benefit most?
There are three in particular that show greater response to this
therapy. There are generally a variety
of treatments available today for any given symptom or condition because of the
competing pharmaceutical market.
However, according to Mayo Clinic, one of the leading sectors of the
medical field, “hormone replacement therapy is still the most effective
treatment for troublesome menopausal hot flashes and night sweats” (Mayo Clinic. Sept. 2007). Another symptom
of menopause is vaginal discomfort with which hormone therapy can only “ease
vaginal symptoms of menopause, such as dryness, itching, burning, and
discomfort with intercourse” (Mayo Clinic. Sept. 2007). Finally, osteoporosis prevention using
hormone replacement therapy is only recommended when all other medications for
osteoporosis have failed. This is a
symptom that would have to be a serious concern in order to simply use this
form of therapy as a preventative medication.
Western medicine has always
had an approach to patient’s care that uses medicines that try to “correct” the
internal balance of hormones within the body.
However, many supposedly alternative approaches to medicine have simply
continued practices of holistic healthcare that have been around for
centuries. Although both medical
practices have the same overall approach, to alleviate the discomfort of certain
women experiencing menopause, the alternative approaches seem to be less
invasive and do not have the same “risks” that accompany hormone replacement
drugs. The alternative medicine
approaches focus on “strengthening the female body by encouraging it to
balance, regulate, and normalize itself during the transition to menopause” (Holistic
Online. 2007).
There are few known complications with alternative approaches to
treatment. However, our society today
tends to want treatment that is not only effective, but also a therapy that
works ASASP (as soon as (superhumanly) possible). They simply have no patience for the process
of medicine to work adequately in the body.
Therefore, alternative medicine techniques may not be the best treatment
for them mentally given that the process tends to take much longer than the
average conventional medication.
There are a few “alternative” medications on the market today that seem
to be effective depending on the individual.
One specific drug that is on the market as an alternative to current
HRT, and approved by the Federal Drug Administration is Prempro by Wyeth Pharmaceuticals.
Unfortunately, as we have seen from other estrogen-progestin combination
drugs, it has been found to develop lumps in women’s breasts that then provide
an increase in mammogram abnormalities which prove to generally false
positives. In
conventional medicine there are anti-hypertensive drugs that seem to do the
trick in relieving menopausal hot flashes, but there are many women that report
having severe side effects ranging from fatigue to dizziness. If that is the women’s situation or if they
have severe hot flashes as well as high blood pressure there are drugs that are
available that do not have hormones such as Clondine, a generic drug that works
by placing pressure on the hypothalamus to stabilize. There are other drugs that are also suggested
such as inderal, aldomet, and veralipride which have shown to alleviate
discomfort with hot flashes, however, none of these drugs have been approved by
the FDA for treatment of these symptoms.
However, there are drugs that are approved by the FDA to treat hot
flashes such as Bellergal.
Unfortunately, this drug has barbiturate components and is highly
addictive with side effects including dry mouth, fatigue, and depression. Therefore, the drug isn’t a normal
recommendation for hot flashes and should be restricted to short term
usage.
Symptoms involving vaginal dryness can be a serious everyday problem for
women, especially during intercourse.
There are vaginal lubricants that are available at drug stores that
would help with the problem; however, it probably would not provide a cure for
it altogether. For bone loss, there are
many drugs out in the market today, but they are not as invasive as hormone
replacement therapy drugs that are available.
The downfall of these drugs is that they are not FDA approved and are
considered experimental. The exception
is calcitonin. This drug is known for
its ability to “inhibit bone resorption, the process by which bone is broken
down and reabsorbed in the body” (Holistic
Online. 2007). This is simply a
supplement of the naturally made calcitonin hormone that is made by the thyroid
gland in the body. This drug has shown
through treatment to slow an individual’s bone loss and increase their bone
density. Another upside to this drug is
that it has minimal side effects that affect less than 10% taking the
drug. It can be further reduced in these
individuals by taking the drug at bedtime.
However, there is one significant downside to taking this drug, which is
that calcitonin is very expensive. There
are other experimental drugs that one could try such as bisphosphonates,
Fosamax, and parathyroid hormones which are all currently undergoing
studies. They have shown a significant
increase in bone density, but the side effects are currently not known.
Although, all of these alternative therapies are available, the most
common alternative therapy that was found for menopausal symptom treatment is
exercise, a balanced diet, and a healthy mental well-being. Which all seem simple, but our society today
has simply overlooked all of these elements.
There is a drastically increasing waist line today due to our lack of
exercise and balanced diets. So, all things considered, the risks outweigh the
benefits for women taking HRT (Holistic
Online. 2007).
When all potential
possibilities are considered, every woman should keep in mind what is in their
best interest both physically and emotionally as they go through
menopause. While some women believe that
alleviating the risks permanently by taking hormone replacement drugs, other
will believe that those benefits will not adequately outweigh the risks of
taking that drug. Thus, each woman has a
mission for the health of her own body.
What do you believe is the best option for you at that stage in your
life? If they are willing to try
alternatives first and use HRT as a last resort, then that is their
decision. However, it is not the final
decision that is important, it is helping these women weigh out the benefits
and risks of taking these drugs and having them make a well educated
decision. I think that conventional
medicine should promote drug education in an effort to better equip their
patients to manage their own healthcare and exercise individual preventative
healthcare. The natural medicines that
are available on the market today seem to provide hope for the future of
alternative medicine in the menopause therapy field, but further study and
research is needed. Therefore, menopause
and its symptoms will continue to be challenge to treat for women for some time
to come.
Effect of Hormone Replacement Therapy on Breast Cancer
Risk: Estrogen Versus Estrogen Plus Progestin. (2000). Journal of National
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KEEPS. (2006). Retrieved October 28,
2007, from http://www.keepstudy.org/
Mayo Clinic. (2007, September). Retrieved
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