Hormone Replacement Therapy Health Article

Preparation

Women who are considering HRT should visit their doctor for a series of tests to make sure that they do not have any serious health disorders. They should have a Pap smear and breast examination to rule out cancer. They should also have a urinalysis,a bone density test, and blood tests to measure their red blood cell level, blood sugar level, cholesterol level, and liver and thyroid function.

In addition to these tests, most doctors will also give a progesterone challenge test. It consists of doses of progesterone given over a 10-day period to see if the woman is still producing her own estrogen. If she bleeds at the end of the test, she is still producing estrogen.

Aftercare

Aftercare is a very important part of HRT. Women who are taking HRT will need to see their doctor more frequently. At a minimum, they should be checked twice a year with a blood pressure test and breast examination. They should have a complete physical on a yearly basis. Any abnormal bleeding must be reported to the doctor as soon as it occurs. The doctor will need to order a tissue biopsy or dilation and curettage (D & C) in order to rule out cancer of the uterus.

Women who are taking HRT and decide to stop should taper their dosage over a period of several months rather than discontinuing abruptly. A gradual reduction minimizes the possibility of hot flashes and other side effects.

Risks

The short-term risks associated with HRT include a range of physical side effects. Common side effects include fluid retention, bloating, weight gain, sore breasts, leg cramps, vaginal discharges, migraine headaches, hair loss, nausea and vomiting, acne, depression, shortness of breath, and dizziness. Potentially serious side effects include tissue growths in the uterus (fibroids), gallstones, thrombophlebitis, hypoglycemia, abnormal growth (hyperplasia) of uterine tissue, thyroid disorders, high blood pressure, and cancer.

Normal results

Normal results of HRT include relief of hot flashes, night sweats, vaginal dryness, and urinary symptoms associated with menopause.

BOOKS

Compton, Madonna Sophia, MA. Women at the Change: The Intelligent Woman's Guide to Menopause. St. Paul: Llewellyn Publications, 1998.

Goldman, Lee, et al, eds. Cecil Textbook of Medicine. 21st ed. W. B. Saunders, 2000.

Goroll, Alan H. Primary Care Medicine. 4th ed. Lippincott Williams & Wilkins, 2000.

Greer, Germaine. The Change: Women, Aging, and the Menopause. New York: Fawcett Columbine, 1991.

Greenwood, Sadja. Menopause, Naturally: Preparing for the Second Half of Life. Volcano, CA: Volcano Press, 1992.

Nurses Drug Guide 1995. Ed. Billie Ann Wilson, et al. Norwalk, CT: Appleton & Lange, 1995.

Sander, Pela. "Natural Healing Therapies." In Women of the 14th Moon: Writings on Menopause. Ed. Dena Taylor and Amber Coverdale Sumrall. Freedom, CA: The Crossing Press, 1991.

ORGANIZATION

American Heart Association. 7320 Greenville Avenue, Dallas, TX 75321. (214) 373-6300.

National Women's Health Network. 514 10th Street, NW, Washington, DC 20004. (202) 347-1140.

North American Menopause Society (NAMS). 11100 Euclid Avenue, 7th Avenue, McDonald Hospital, Cleveland, OH44105.

Women's International Pharmacy. 5708 Monona Drive, Madison, WI 53716. (800) 279-5708.

OTHER

Menopausal Hormone Replacement Therapy. Fact sheet. National Cancer Institute. <http://rex.nci.nih.gov>.

Laith Farid Gulli, M.D.

KEY TERMS

Dilation and curettage (D & C)—A surgical procedure in which the patient's cervix is widened (dilated) and the endometrium is scraped with a scoop-shaped instrument (curette).

Estrogen—The primary sex hormone that controls normal sexual development in females. During the menstrual cycle, estrogen helps prepare the body for possible pregnancy.

Follicle-stimulating hormone (FSH)—A hormone produced by the pituitary gland that stimulates the follicles in the ovaries to swell and release ripe ova. Doctors sometimes use its levels in a woman's blood to evaluate whether she is in menopause.

Hormone—A substance secreted by an endocrine gland that is carried by blood or other body fluids to its target tissues or organs.

Hot flash—A warm or hot sensation on the face, neck and upper body, sometimes accompanied by flushing and sweating. Some women refer to hot flashes as hot flushes.

Osteoporosis—A bone disorder in which the bones become brittle, porous, and easily broken. It is a major health concern for postmenopausal women.

Ovary—The female sex gland that produces eggs and female reproductive hormones.

Ovulation—The cyclical process of egg maturation and release from the ovary.

Progesterone—A female hormone produced by the ovary. It functions to prepare the lining of the uterus to receive a fertilized ovum.

Progesterone challenge test—A test that is given to see if a woman is still secreting estrogen. It consists of doses of progesterone given over a 10-day period.

Progestin—Synthetic progesterone available as an oral medication.

Testosterone—A male sex hormone that is sometimes given as part of HRT to women whose ovaries have been removed. Testosterone helps with problems of sexual desire.

Uterus—The hollow organ in women in which fertilized eggs develop during pregnancy. The uterus is sometimes called the womb.