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Hormone Replacement Therapy – Pros and Cons

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As women age and the amount of reproductive hormones in their body decreases, some women chose to use hormone replacement therapy or HRT. You can learn more this therapy in the HRT Overview article.  Hormone replacement therapy is a controversial topic in women’s healthcare because of the possible side effects from the treatment. 

Here are some of the pros and cons to consider if you are thinking about using HRT:

Pro: As hormone levels drop, many women experience symptoms of menopause including hot flashes, mood swings, and depression.  Because HRT restores the levels of these hormones to what the body is used to, these symptoms often go away when a women uses HRT.

Pro: Estrogen supplements have been shown to improve cholesterol levels by lowering LDL levels (bad cholesterol) and raising HDL levels (good cholesterol).   This may be a side benefit of HRT treatment, but is not a good reason to start HRT.  Other methods of controlling cholesterol are much more effective.

Pro: Menopausal women may be at increased risk for osteoporosis, which is a condition that causes the bones to become weak or brittle.  Some types of HRT can help reduce the risks of osteoporosis.

Pro: HRT that uses a combination of the hormones estrogen and progestin appears to lower the risk of cancer of the colon or rectum by approximately 40 percent..
 
Con: Some women have uncomfortable side effects when using HRT which may include tenderness in the breasts, spotting or monthly bleeding (return of the period), cramping, and bloating.

Con: Some women who use HRT are at higher risk for serious diseases including heart disease, stroke, blood clots, and breast cancer.

Con: HRT using only the hormone estrogen appears to greatly increase the chances that a woman will develop cancer of the endometrium, which is the lining inside the uterus or womb.  Estrogen given in combination with progestin does not appear to have this same risk.  A woman who has had a hysterectomy no longer has a uterus and is not at risk for this kind of cancer.

Con: The hormone progestin, which is often given in combination with estrogen to protect against endometrial cancer, may cause an increased risk of breast cancer.

Con: Use of HRT may cause an increased risk of dementia, including Alzheimer’s disease.

Age appears to be an important factor when deciding if HRT is right for you.  Women who are over 60 when they start hormone replacement therapy tend to see fewer benefits and much higher risks of certain diseases.  Women who are younger than 60 when they start HRT do not seem to be at increased risk of heart disease.  For this age group, the risks and benefits appear to be balanced. 

The U.S. Food and Drug Administration’s current recommendation for women who chose to use HRT to relieve moderate to severe symptoms is to use it for the shortest time needed and at the lowest dose that is effective.  Talk to your doctor or gynecologist to help you decide whether HRT is the best treatment for you.

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