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Thinking About Hormone Replacement? Ask Your Doctor About the Patch
The history of estrogen and progesterone hormone replacement therapy (HRT) for menopausal woman is long and very complicated. Indeed, there is still considerable uncertainty when it comes to who should get therapy, how long a woman should take hormones after menopause, and what form of estrogen should be chosen. All this, despite the fact that HRT has been available since 1942.
When is HRT Recommended?
Currently, the only widely accepted indication for HRT is for symptoms of menopause that are intolerable and not controlled with other options. Symptoms can include hot flashes, insomnia, irritability, mood swings, and vaginal dryness. A woman who has not had a hysterectomy must take progesterone along with estrogen, since estrogen alone raises the risk for cancer of the uterus. A woman who has had a hysterectomy does not require progesterone. For more background on HRT, click here to read my November 17, 2011 post.
What is the safest way to prescribe HRT?
Most HRT is prescribed in pill form, but a number of scientific studies to date have suggested that the estrogen patch is a safer way to go. It delivers the hormone in a more physiologic way, meaning that the blood levels tend to be steadier, with fewer peaks and valleys. Since the liver is not involved in breaking the drug down, the patch will not raise triglycerides, and it appears to have much less of an inflammatory effect.
Several small studies have reported a lower risk of heart attacks and strokes with the patch, as compared to the pill. HRT is also known to raise the risk of blood clots in the deep veins of the legs, which can travel to the lungs, causing a potentially fatal condition known as a pulmonary embolus. This led Canadian researcher François Laliberté and colleagues to evaluate whether the patch might also be associated with a lesser risk for blood clots. They studied over 50,000 women with an average age of 49 who were treated with estrogen, but not progesterone. Half were on estrogen pills, and half used the patch. Although the risk of blood clots was quite low overall, it was about 30 percent lower for women treated with the patch.
Making the Decision
The choice of HRT is a very personal one, and should be made in consultation with a primary physician or gynecologist who is familiar with your medical history and risk factors. There is no “one size fits all” therapy, and what works perfectly for one woman may make the next woman absolutely miserable. No form of HRT is without risk. Nevertheless, as a cardiologist I generally advise my patients who require HRT to consider the patch, as it appears to be a significantly safer and more effective way to boost estrogen levels and improve the symptoms of menopause.
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