Hormone Replacement Therapy has been administered for years regarding women entering menopause. However, most hormonal replacement therapies of the past have used synthetic estrogen and progesterone to regulate hormonal balance. New research suggests that these synthetic hormones can have negative effects on other elements of the body and that the natural hormone extracts are available and work much better. Some of these natural hormones are currently used as standard practice on fertility treatment. Natural progesterone aids in not only preventing miscarriage, but it’s use also helps eliminate some of the symptoms of PMS. Likewise, natural estrogen, a newer “natural” hormone, helps promote follicular, as well as uterine lining development.

Doctors usually prescribe HRT, which combines estrogen and progestin (a form of progesterone). Estrogen can and should be used alone (estrogen replacement therapy) for women who have had their uterus, including the cervix, removed (by hysterectomy). Estrogen alone comes in many forms. You can use the pill or tablet form, vaginal creams, vaginal ring insert, implants, or shots. There are also patches that stick to the ski. The body absorbs estrogen from the patch through the skin. Progestin usually is taken in pill form, sometimes in the same pill as the estrogen. It is also available as an IUD (intrauterine device), a vaginal gel, and shots.

There are different schedules for taking HRT in pill form. You could take estrogen for a set number of days, add progestin for 14 days, and then stop taking one or both for a specific period of time. You would repeat the same pattern regular monthly bleeding like a light menstrual every month. This cyclic schedule often causes regular monthly bleeding like a light menstrual period. Or you could take estrogen and progestin together everyday of the month without any break. This continuous pattern can stop monthly bleeding after about 6 months of treatment. However, problem may continue for a loner period of time. Talk with your doctor about the schedule that is best for you.

b. b. History

The use of hormones after menopause is a recent innovation in human history. Relatively, few women even survived the rigors of more primitive societies to face the issue of postmenopausal aging. How long a woman lived did not depend on sophisticated hormonal therapies synthesized in a laboratory, but rather, on a combination of good genes, familial longevity, a healthy lifestyle with adequate nutrition, balanced responses to stress and a balance of physical activity and rest. Only since the turn of the century have women begun to outlive their menopause and continue to do so for several decades.

Scientists first isolated estrogen and progesterone in the laboratory in their purified state during the 1920’s. In the decades before this advance, physicians prescribed various formulations of the whole gland. Animal ovaries were powdered, pulverized and liquefied and then given by health care providers to women who had gone through surgical menopause or to those who suffered from menstrual cramps. Use of hormones remained limited throughout the 1930’s and 1940’s. By the 1950s and 1960s, the benefits of estrogen in treating menopausal symptoms were understood and appreciated and its use became widespread. A number of books and articles were written during this era about estrogen’s many benefits, both real and fancied. Many women benefited from the relief estrogen brought from unpleasant hot flashes, vaginal dryness, mood swings and other symptoms. Women were told that estrogen would even enhance their attractiveness and youthfulness. However, very little was understood or communicated to women about the risks of using estrogen.

The first adverse reports about estrogen therapy surfaced in 1975. Several research studies published that year linked estrogen use in postmenopausal women with cancer of the lining of the uterus (A.K.A endometrium). In those studies, women who used estrogen were f4 to 8 times more likely to develop this cancer. Fearful of cancer, postmenopausal women avoided estrogen in dramatic numbers and physicians were equally hesitant about prescribing it. This decline lasted for several years until further research studies showed that the combined use of estrogen and progestin (synthetic forms of progesterone) offered women excellent protection against the development of cancer of the uterine lining. In the regimens tested, women used estrogen 25 days each month, adding a progestin the last 10 to 14b days of the monthly treatment schedule.

Today, physicians prescribe estrogen and some form of synthetic or natural progesterone to combat early and post menopausal symptoms. Physicians currently are able to use HRT with mush greater wisdom and very little risk. Many research studies done on HRT now enable physicians to prescribe specific types of hormone and dosage regimens for each individual woman’s needs.

II. Body

1. Kinds of hormone replacement therapy

a. Estrogen Replacement Therapy (ERT)

ERT replaces the hormone estrogen that is no longer made in the ovaries at menopause. Estrogen helps prevent or lessen many menopausal symptoms. When estrogen is used alone, it called “unopposed” estrogen therapy. This type of estrogen replacement is usually given to women who have had their uterus removed (hysterectomy). If you have your uterus, but decide to take estrogen without the protection of a form of progesterone (the female hormone that helps keep the uterus lining healthy), you will need regular ultrasounds or uterine biopsies (tissue samples). These are quick office tests that help your doctor check the amount of growth along your uterine walls.

a.1 Oral Estrogen Tablet

Many women take estrogen by mouth in pill form, known as “oral estrogen”. Estrogen tablets are the most commonly used form of ERT. The estrogen tablets available in the market in the United States are composed of different forms of estradiol and estrone. As you may remember, estradiol is the main type of estrogen manufactured by the ovaries, and estrone is the primary type of estrogen that we produce after menopause.

The most commonly prescribed estrogen tablet is the Premarin, a conjugated equine estrogen derived from a pregnant mare’s urine. It has been available since 1941, and much of the medical research has been done using this product. As a result, the benefits and side effects of Premarin are very well understood. Besides Premarin, currently available are generic, conjugated estrogen and synthetic and semi synthetic estrogen compounds. Other products include Ogen, which contains estrone, and Estrace, which contain estradiol.

The use of estrogen in pill form has some drawbacks. A more serious drawback to the use of oral estrogen is that after ingestion, a large amount of estrogen is concentrated in the digestive tract. When estrogen passes through the intestinal tract, intestinal bacteria transform the estrogen chemically. This can change the type as well as the potency of the estrogen that is reabsorbed back into the body. Once the estrogen is reabsorbed, enters the blood circulation and is transported to the liver. In the liver, estrogen is again metabolized and converted to the other forms before it finally enters the general circulation. How efficiently this occurs depends on the health of the liver. Women with a history of liver or gall bladder disease or hypertension and clotting problems (which are affected by various actions in the liver) may do well to avoid oral estrogen. They might instead use another route that circumvents the digestive tract and instead, disperses estrogen into the general circulation.

For those women who can assimilate oral estrogen without a problem, the most commonly prescribed dose is 0.625 mg. However, some women need higher doses such as 0.9 mg or 1.25 mg to attain symptom relief. Occasionally, women drop their doses in half to 0.3 mg to avoid side effects, but this dose may not be enough to benefit bones and avoid bone loss. Only trial and error will tell you which dose works best for you. Women who have already had a hysterectomy can take estrogen tablets alone because they obviously have no risk of developing uterine cancer. Women who have intact uterus should always take a formulation that includes progestin for at least 10 to 13 day of each month for cancer protection.

a.2 Transdermal Estrogen

The transdermal system, marketed under the name Estraderm, was created to avoid the problem inherent in oral estrogen’s first pass through the liver. In the innovative system, estrogen is absorbed into the general circulation through a medical patch on the skin. This method avoids the initial pass through the digestive tract and the liver, so women with liver and gallbladder disease are more likely to be able to tolerate ERT. This is also true for women with hypertension and clotting problems, provided clotting factors are normal.

The patch looks like a small, round; clear Band-Aid that is several inches in size. It is placed on the skin of the abdomen, buttocks or thigh and changed twice a week. Each patch contains a reservoir of estrogen placed in a membrane that releases estrogen at a controlled, standardized level. The nonabsorbent patch allows for greater freedom because it can be kept on while you are shower or bathe.

Basically, the transdermal patch is available in two dosages: 0.05 mg and 0.1 mg. Some women find they do not tolerate these dosages well and develop side effects. A new transdermal patch called Vivelle, may solve this problem for some women. It will. It will be available in four dosages from 0.0375 mg to .1 mg. To decrease the amount of hormone released from the patch, part of the backing can be occluded by a small piece of ordinary adhesive bandage. This reduces the total surface area of the skin exposed to the hormone.

As with oral estrogen, the patch is used in conjunction with progesterone if the woman is still has an intact uterus, and progesterone should be taken for the recommended number of days each month. The patch appears to be as effective in relieving menopausal symptoms as the oral estrogen tablets. Studies to date suggest that its effect on calcium absorption and blood lipids is almost identical to oral estrogen.

a.3 Estrogen Vaginal Cream

The use of estrogen vaginal cream is much more limited in its clinical applications. Estrogen cream is primarily applied to the vagina and urethral area to prevent atrophy and breakdown of the tissues caused by lack of natural estrogen. Though estrogen is absorbed from the vaginal mucosa into the bloodstream and can affect other parts of the body, the effects tend to be undependable. Occasionally, however, patients complain of more generalized side effects from using the vaginal cream, such as breast tenderness or mild fluid retention. These side effects often occur early in the course of treatment. Because of the vaginal atrophy that exists when women first begin treatment, estrogen tends to be absorbed rapidly. This can cause the blood levels of estrogen to rise significantly. However, once the estrogen thickens the vaginal walls and changes the cellular pattern of the mucous membranes to a more youthful and healthier condition, estrogen absorption into the bloodstream slows down. Not only will estrogen thickens the vaginal wall, making it less traumatized by sexual intercourse or foreplay, but it also reduces the incidence of bladder infections. It also does not make an initial pass through the liver. As a result, the use of estrogen vaginal cream may not aggravate liver or gallbladder disease, hypertension or clotting tendencies, unless clotting factors are abnormal. However women with the pre-existing breast cancer or who are also positive for estrogen receptors may not be good candidates for estrogen vaginal creams. This is currently being deated and the controversy may be resolved by using small topical doses with low risk.

PREMARIN CREAM is one of the most commonly used vaginal creams, although other brands are available. Premarin cream comes with an applicator that allows for the use of 2 or more grams per day. One half to one full applicator of Premarin cream deliver 1.25 to 2.5 mg of estrogen to the vaginal tissues.

Initially, you may want to use estrogen cream daily, at least for the first week or two. Be sure the most sore or abraded areas come directly in contact with the cream, either through placement of the applicator or by applying the cream to sore and tender areas with your fingers. After healing has begun and sexual activities become more comfortable, many women reduce usage to two or three times per week. Use it as often as required to keep your vaginal tissues healthy and functional.

Vaginal creams have several drawbacks, none of which are serious. The cream tends to be messy and can leak into your underwear. Estrogen vaginal cream should not be used as a lubricant or applied prior to lovemaking. Some men are concerned about the adverse effects of absorbing estrogen through their penis if the cream is still in the woman’s vagina during sexual activity. Estrogen cream can, however, be inserted following lovemaking, particularly just prior to retiring at night.

If you are concerned about using estrogen for protection against osteoporosis or cardiovascular disease, estrogen vaginal cream is inadequate to meet these goals. You will have to use additional estrogen, either by the transdermal or oral routes to keep your blood levels of estrogen consistently high enough to confer protection. In addition, a course of progesterone needs to be used, at least every three months, to “clean out” the uterus and allow the lining to shed. The addition of the progesterone will help mature the lining of the uterus and thereby prevent the buildup of cells lead to hyperplasia or even cancer.

a.4 Alternative Routes for Estrogen Administration

a.4.1 Intramuscular Injection

Intramuscular injection was used occasionally before the development of the transdermal patch, and may still be used for women who can neither take oral estrogen nor the transdermal patch. This method does have several disadvantages. The injection delivers large amounts of estrogen into the bloodstream, and then diminishes to lower levels with time. Thus, there is not a continuous delivery of the hormone to the body that the transdermal patch now makes possible.

Finally, injections are usually given at monthly intervals and require administration in a physician’s office, which are expensive in terms of time and money.

a.4.2 Subcutaneous Pellets

A subcutaneous pellet of estrogen therapy, used during the 1960s and 1970s, is not currently a method of treatment. The hormone was impregnated into a solid pellet, which was then implanted by a small incision into the subcutaneous fat of the buttocks or abdomen. The pellets would dissolve slowly, releasing hormone into the fatty tissues. Research is now oriented toward trying to improve types of implants, as well as the more controlled release of the hormone into the system. Thus, it is possible that subcutaneous implants will be used once again for ERT.

a.4.3 Buccal Estrogen

A low-dose estrogen tablet has been developed that can be placed directly against the mucous membranes inside the mouth. The tablet dissolves rapidly and the estrogen that is released from the tablet is absorbed directly into the bloodstream. Estrogen released by this method is sufficient to relieve common symptoms such as hot flashes. It is still pending approval by the US Food and Drug Administration.

a.4.4 Estrogel

Estrogel is a form of estrogen replacement therapy used frequently in France. The estrogen is in gel-base that is rubbed on the skin of the abdomen and absorbed into the body. The dose can be varied easily by changing the amount of gel used.

b. Progesterone Replacement Therapy

This replaces the hormone progesterone that lessens at menopause. Progesterone levels normally rise during the second half of the menstrual cycle. Some pre- and peri-menopausal women may be able to regular their periods with a form of progesterone therapy. Progesterone may also offer relief from hot flashes and help keep bones healthy.

b.1 Synthetic

b.1.1 Oral progestins

Oral tablets of synthetic progesterone are the most widely prescribed form of progesterone. The progestins change the cells of the uterine lining from a pattern of rapid growth to a mature form. The cells become secretory in nature, which prepares the uterus to nourish and maintain an early pregnancy during the active reproductive years. With the proper dose and ratio to the estrogen, once a woman stops producing progesterone the uterine lining is sloughed off and menstrual period or bleeding episodes occur. All the accumulated proliferated cells, tissue and blood leave the body. No pile up of abnormal cells occurs and the uterine lining is left healthy and ready for the next month’s estrogen therapy, therefore reducing the risk of uterine cancer.

Reaching this beneficial goal requires only small doses of progestins’ usually doses of 5 to 10 ma. Some women need slightly higher or lower doses. Women who develop side effects such as fatigue and depression may need to drop their dose to as slow as 1.25 mg per day, while others must use up to 10 per day to achieve the therapeutic effects.

Progestins are given as a “challenge test” to see if the lining of the uterus is still being stimulated. If you bleed after stopping the progestins, your body is still producing estrogen. In this case, the progestins must be used on a monthly bass, even without additional estrogen therapy. The risk of endometrial cancer is higher in women taking no hormones than those on HRT because of e woman’s unopposed endogenous estrogen.

The most commonly used brand of progestins is Provera. Norlutate is also frequently prescribed, but it may cause side effects similar to androgens such as oily skin and acne. A third progestin currently on the market is Amen.

b.2 Non synthetic

b.2.1 Oral Micronized Progesterone

Synthetic progestins were used originally instead of natural progesterone because they may be taken orally. Unfortunately, natural progesterone cannot be ingested because it is destroyed during digestion and never reaches the bloodstream. In recent years, a new micronized form of progesterone is available that is protected from destruction by stomach acid and enzymes and can be absorbed and utilized by the body. Made from the natural progesterone found in yams soybeans, oral micronized progesterone has gained wide acceptance by physicians as a treatment for menstrual syndrome.

Menopausal women are beginning to use this form of progesterone more frequently because it causes fewer side effects than the synthetic progestins. While the progestins can cause depression, fatigue, bloating, tenderness, and also adversely affect blood cholesterol levels, the natural progesterone seems to cause fewer adverse reactions. However, natural progesterone may still cause drowsiness because of its sedative effect on the brain.

The main drawback to natural progesterone is its expense. It is more expensive than the synthetic progestins, a deterrent for women on a tight budget. In menopausal women, dosages of 200 mg daily can be effective, although the dose can vary in either direction. Like the synthetic progestins, it is used 10 to 13 days per month and appears to confer an equal amount of protection against uterine cancer. Besides the oral form, it can also be obtained as a rectal or vaginal suppository. PMS patients use this route of administration successfully, as vaginal suppositories allow excellent local intake of progesterone into the uterus.

b.2.2 Progesterone Skin Cream

Applied to the skin and absorbed into the general circulation. Recent research has shown that it not only elevates progesterone levels, but it also elevates DHEA levels in the body. Because it is absorbed through the skin, it bypasses the liver, thereby escaping the liver metabolism. Unlike the synthetic progestins, there are few side effects reported by its use.

Pro-Gest is applied to the skin twice daily in one quarter to one half-teaspoon amount. It is generally used in rising and before gong to bed at night. It can be applied to any area of your skin. Many women will rub it into their chest, abdomen, arms or back. If the cream is absorbed rapidly, it means that the body needs a higher dose and a slightly higher amount may be used. Few physicians have any experience using Pro-Gest cream to date and as more likely to be used by physicians knowledgeable about alternative therapies. You may want to check with physicians practicing alternative therapies in your area to find one prescribing progesterone topical cream.

c. Combined Hormone Therapy, Opposed Estrogen Therapy

This replaces both the estrogen and progesterone. Estrogen and progesterone work in hundreds of areas in your body, including the brain, bones, breasts, blood vessels, reproductive organs, urinary organs, skin, mucous membranes and the endocrine system. While estrogen helps lighten many menopausal discomforts, it also causes growth the lining of the uterus. This thickening of the uterine lining is a risk factor for cancer. Taking a form of progesterone helps prevent uterine cancer by protecting the uterine wall from the tissue build-up that can occur when estrogen is taken alone. Hormone replacement therapy also helps keep bones strong and your heart healthy.

d. Testosterone Replacement Therapy

This replaces the hormone testosterone that can also decrease at menopause. Replacing testosterone offers some relief from menopausal hot flashes in women who do not respond well to estrogen. Testosterone can also provide some women with a greater energy level, a higher sex drive and an improved sense of well-being. The women who are most likely to respond to testosterone therapy are those whose ovaries have been surgically removed or who had low levels of testosterone before menopause.

2. What to Consider When Evaluating Hormone Replacement Therapy?

When deciding whether to use hormone replacement therapy and which therapy to use, the following factors need to be taken into consideration.

a. Your age

b. Your medical history

c. The reason for treatment and the severity of menopausal symptoms

d. Possible side effects

e. Your family history of estrogen-dependent cancers, such as cancers of the breast or uterus

f. Your risk for heart disease. Risk factors include; Family history

Cholesterol levels

Triglycerides level

g. Your risk for osteoporosis

3. Steps to Follow Before Starting HRT

If you are considering beginning HRT therapy, schedule an initial health evaluation to determine if any risk factors exist that the use of hormones could aggravate. In addition to determining the suitability of your using HRT, a good medical evaluation will identify any undiagnosed health issues that can be adequately treated.

A pre-HRT evaluation may vary in its components depending on your medical status and what specific menopause related health problems your physician is most concerned about. Test used in evaluating a woman for HRT may include the following:

a. A complete physical examination, including a pelvic exam and breast exam.

b. A PAP smear to determine a cancerous or precancerous lesion of the cervix.

c. Blood tests to check liver function, blood sugar, cholesterol, triglycerides, calcium and phosphorus levels, as well as tests of thyroid function.

d. Complete blood count to check for anemia, as well as urinalysis.

e. Mammography and professional breast examination to check for breast cancer. Mammograms done by experienced radiologists are capable of detecting 90% of all breast cancers.

f. Bone density studies (dual x-ray absorptiometry, DEXA) to help determine the level of bone loss. This is an important test for the women who maybe at high risk for osteoporosis.

g. A review of your family medical history to gather clues about your risk of cardiovascular disease, osteoporosis, and breast and other cancers.

h. Endometrial biopsy or vaginal ultrasound may be done to check for hyperplasia (overgrowth) of the uterine lining and eudiometrical cancer. A progesterone challenge test may also be done after menopause to check for eudiometrical hyperplasia.

If the results of these tests do not contraindicate the use of HRT and you decide to use hormonal therapy, expect frequent follow-up visits with your doctor. He or she will want to monitor the amount of hormones you are taking and their effect on menopausal symptoms as well as your general health. Most physicians recommend annual visits. At this time, you should discuss any remaining symptoms or possible side effects that have developed since beginning HRT. Blood pressure will be monitored at each visit and breast and pelvic exam done to check the health of the tissues. Most importantly, it is an excellent time to ask your doctor any questions that you maybe concerned about. It is crucial that you tell your doctor any concerns or issues that you may have regarding your therapy. If you are not satisfied with your physician’s answers or feel that your physician is standoffish or abrupt, you may wish to seek another opinion or doctor in your community. Unexpressed concerns that are not discussed with your physician may delay the diagnosis and treatment of health problems that can arise during the course of treatment. The best result occurs when the true partnership exists between doctor and patient.

4. General Guidelines of Hormonal Use

a. Choose the Lowest Dose that Works

In general, use the lowest possible dosage of both estrogen and progesterone that will relieve your symptoms and prevent long term health problems associated with hormonal deficiency such as osteoporosis and cardiovascular disease. Medical research has shown this to be 0.625 mg for the Premarin oral tablet and 0.05 mg for the estrogen transdermal patch. If you start a higher dose, you are more likely to encounter side effects such as anxiety, mood swings, fluid retention and breast tenderness.

To know your risk potential, have your physician perform the appropriate tests. If you feel comfortable at the smaller dosages, you may wish to combine estrogen with the alternative therapies. At the other end off the spectrum, you may your best only when using estrogen in the high dose ranges. If you have experienced a surgical menopause below the age of 40,you may need more estrogen than woman who go through natural menopause at a later age. Obviously, with estrogen, one dosage does not fit all women and therapy must be carefully individualized to each woman’s needs.

Progesterone should also be used in the lowest possible dose to prevent side effects. This is particularly true for the synthetic progestins, which can cause the most problems.

b. Choose the Route of Administration that Is Most Comfortable

Some women find it difficult to remember to take one or two pills each day. They may, occasionally, miss days. This does not create the same potential problem that missing a day or two of birth pills will, because menopausal women do not have to worry about unplanned pregnancies. However, if you find pill taking too estrogen or unpleasant, then you are better off asking your physician about the alternative routes of administration such as the estrogen transdermal patch or progesterone cream.

c. Choose the HRT Regimen that Suits You Best

Traditionally, estrogen was taken only three weeks per month with one week off. Provera, a common progestin, was added during the last 10 to 13 days of the regimen to prevent the development of endometrial cancer. Taking one week off estrogen reduces the time during which the uterine lining is exposed to estrogen, therefore, reducing the risk.

While some physicians still use the traditional 3 weeks on, one week of regimen with their patients, other regimens have very popular in recent years. With one protocol, estrogen is taken everyday and a progestine is added on an intermittent basis, usually dung the first few days of the calendar month. More than two thirds of the women on this regimen, if they have uterus, experience bleeding when administration of progestin stops after the twelfth day. With combined continuous therapy, both estrogen and low doses of progetins are used on a daily basis without stopping. Women on this regimen may experience irregular bleeding during the first six months of treatment, which then diminishes. With both continuous and combined continuous therapy regimens, bleeding often doesn’t persist indefinitely. For many women, bleeding become slighter and stops entirely after a few years. This occurs as the endometrium eventually becomes inactive.

d. Pick a physician who will tailor HRT to your needs.

One of the most important factors in developing a successful menopause relief program is to work with the physician who is a knowledgeable and dedicated to helping you achieve the best therapeutic results. How does one find such a physician? You might try asking your friends for a referral. Choose several physicians and interviews them to determine if their philosophy of HRT and personality fit with you. Ask many questions and evaluate the responses. Remember, this relationship between you and your physician will be a long term one.

e. Stop hormone use gradually

What if you have been on HRT for some time and now feel that its time to stop using it? While many women stay on HRT in indefinitely, other women do not feel the need to continue with HRT after using it for a short period of time. Once the initial symptoms are relieved and the body is adjusted to the postmenopausal period, they may wish to see how they feel without hormones. Others dislike the side effects that develop with HRT, so choose to discontinue it. Whatever the reason for stopping the HRT, don’t do it abruptly. This can cause a severe recurrence of symptoms as your body reacts to the rapid decline in estrogen. Just as during the early postmenopausal period, the pituitary pumps out high levels of FSH in an attempt to make your body produce the estrogen that has suddenly disappeared. Hot flashes and night sweats can reappear as the pituitary-hypothalamic axis goes of balance.

5. Risks/Benefits

a. Risks

Another important area to discuss is the risks of HRT. There is no evidence that HRT at post-menopausal doses increases hypertension or clotting abnormalities. Common possible side-effects include withdrawal bleeding with cyclic dosing, spotting during the first three to six months with combined continuous therapy, mastalgia, edema, abdominal bloating, and increase in the size of uterine leiomyomata. Rarely, symptoms of anxiety and depression can be worsened with initiation of HRT. Although there is no increase in asymptomatic gallstones, a 2.7-fold increase (3.4% to 9.8%) in cholecystectomy has been noted.

B. Benefits

It is clear that use of estrogen (ERT) or estrogen and progestin (HRT) is highly effective, compared with placebo, in suppressing the symptoms of thew “hot flash.” Even low doses (0.01 mg of ethinyl estradiol daily or 0.625 mg of Premarin daily) are effective. Genital atrophy, vaginitis, and dyspareunia are all relieved by estrogen therapy, which may be systematic or local (by means of estrogen-containing cream). Estrogen replacement has been shown to be effective not only in reducing calcium loss, but also in preserving bone density , even at relatively low doses. Estrogen replacement also reduces the actual number of fractures in estrogen-deficient women. Thus, at present, long-term post-menopausal estrogen replacement is indicated for prevention of osteoporosis.

Exogenous estrogen has beneficial effects raising HDL (when taken orally), decreasing LDL cholesterol, and lowering the increased fibrinogen levels that are common in post-menopausal women. Androgens, on the other hand, do the opposite.

Numerous epidemiological studies have shown that post-menopausal women taking estrogen replacement therapy have a significant reduction, on the order of 40% to 60%, of their risk of coronary events, CAD-related death, and all-cause mortality compared with women not taking estrogen. The prevention of CAD may represent an even more compelling indication for ERT the does osteoporosis, as CAD is a much more common cause of disability and death.

III Conclusion

Menopause is the irreversible cessation of the female reproductive cycle and menses. Every woman undergoes this stage. This follows from a permanent loss of ovarian response to gonadotrophins. This change generally occurs spontaneously between ages of 45 and 55, w/ an average age of 51. Women at this stage sometimes prescribed by doctors to take hormones estrogen and progestins, in a treatment called Hormone Replacement Therapy (HRT).

In study after study, postmenopausal hormonal replacement therapy has been shown to reduce menopausal symptoms, preserve cardiovascular and skeletal health and even maintain cognitive function. Yet HRT continues to be under utilized by patients. Fear of breast cancer may be the strongest factor limiting postmenopausal hormone use, but it is hardly the only one. Even before reports of an association were published, adherence to HRT was poor because of lack of appreciation of systematic benefits, fear of weight gain, and frequency of annoying side effects as irregular bleeding and breast tenderness.

Today, situation has been transformed. Through these many research studies done on HRT, physicians now are able to prescribe and use HRT with much greater wisdom and very little risk.

HRT is a great help to many women entering the menopausal stage. Although, there are side effects, your physician through adjusting the dosage of can remedy these hormones that will best fit to your body’s needs. So if you have made the decision to use HRT, it is important that you consult first a physician who is knowledgeable and dedicated to helping you achieve the best therapeutic result.

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