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hormone replacement therapy

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Alternative Names
HRT, oestrogen replacement therapy, ORT, progesterone replacement therapy

Hormone replacement therapy is the use of man-made or natural hormones to treat a person who is lacking these hormones. It is often prescribed for women in menopause. Hormone replacement therapy consists of the hormones oestrogen and progesterone taken together. Sometimes oestrogen is taken alone.

What is the information for this topic?
When women go through menopause, the level of the hormone oestrogen in their bodies drops. Low levels of oestrogen produce the common symptoms of menopause: Hormone replacement therapy is often given to women in menopause to reduce these uncomfortable symptoms. Women take either a combination of oestrogen and progesterone together or they take oestrogen alone. Women who have had their uterus removed during a hysterectomy generally take oestrogen alone. Women who still have their uterus in place need to take oestrogen along with progesterone.

More than 60% of women have hot flushes during menopause. The face and neck become reddened. The woman may get blotches and feel very hot. A cold shivering or sweating can follow as the body readjusts its temperature. A hot flash can last up to 30 minutes. About 80% of women who have hot flushes get them for two years or less.

The drop in oestrogen during menopause can lead to a drier vagina. This can make sexual intercourse uncomfortable. Avoiding sex is not necessary since both oestrogen creams and oral oestrogen can correct this problem. It is not known whether the drop in oestrogen causes a woman to become less interested in sex, or whether the discomfort causes a drop in sexual desire during this time of life.

Perimenopause is the time when a woman may be having sporadic periods but is not yet in menopause. Women are sometimes given oral contraceptives, or birth control pills, at this time to control their irregular menstrual periods. These pills typically contain both oestrogen and progesterone at higher doses than are used in hormone replacement therapy. Women in perimenopause who wish to avoid pregnancy need to take these pills until a blood test shows that menopause is present, or until a woman does not get her period for 12 months in a row. After that, a woman may switch to the lower doses of hormones that are given with hormone replacement therapy.

The potential benefits of hormone replacement therapy include the following:
  • relief of hot flushes and improvement in vaginal dryness
  • slowing of bone loss and the development of osteoporosis. This also prevents bone fractures related to osteoporosis
  • improvement in cholesterol levels. There is still conflicting evidence on whether this protects women from heart attacks.
The risks of hormone replacement therapy (HRT) and oestrogen replacement therapy (ERT) are also still being established. Currently, it is thought that:
  • if a woman still has her uterus, taking oestrogen alone increases the risk of cancer of the uterus. Adding progesterone does not increase this risk.
  • HRT may cause bloating or irritability
  • HRT and ORT may increase the risk of breast cancer in some women. Women who use hormone replacement therapy for a long time may be at the greatest risk.
  • HRT and ORT may be dangerous for women who have an increased risk of blood clots, such as deep venous thrombosis.
  • HRT may not lessen the chance of a having a heart attack for women who have coronary artery disease. It is not known whether HRT will prevent heart disease in women.
A woman can work with her doctor to choose from several strategies to cope with the symptoms of menopause and perimenopause. These include:
  • doing nothing
  • taking oral contraceptives to control irregular periods during perimenopause
  • taking HRT or ORT during menopause to cope with uncomfortable symptoms
  • using natural alternatives to HRT, such as food high in phytoestrogens, or plant oestrogens
  • taking designer oestrogens, or SERM's. These are products with natural compounds that are similar in chemical structure to oestrogen. No one knows whether these compounds are better and safer than HRT. It is also not known if they carry with them the same side effects and risks as prescription oestrogen.
  • using oestrogen creams for vaginal dryness
A woman can work with her doctor to evaluate her risk factors and choose a course of action. The risks may not be worth it for one woman, but may be well worth it for another. If menopause symptoms are very bothersome, some risk may be worth the relief. If a woman's personal health history shows an increase in some risk factors, then some added risk may not be worth the relief from symptoms.

Using HRT or ORT for a short time during menopause can make life for women who have severe hot flushes much more comfortable. There is probably not an increased risk of breast cancer in women who take HRT or ORT for fewer than 5 years. The risks are still being established, especially for long-term use.

Deciding to use HRT is a choice a woman will make together with her doctor. Currently, HRT use is recommended for 5 years or less. After 5 years, the use of HRT is associated with an increased risk of breast cancer. At that point, all of the benefits and risks for a particular woman need to be reevaluated.

Author: Terry Mason, MPH
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request

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