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Hormone therapy (HT) refers to
the use of
progestin for the treatment of
Estrogen and progestin combinations (pills or tablets)
Transdermal combination preparations (a patch placed on the skin that continuously releases estrogen and progestin)
Oral progestin (pills or tablets; used along with an estrogen-only preparation)
Progestin intrauterine device (IUD; used along with an estrogen-only preparation)
Estrogen-progestin hormone therapy, or HT, is recommended
for all women with a uterus who choose to take estrogen. Using estrogen without
progestin greatly increases your risk of
endometrial cancer. Taking progestin with estrogen
eliminates this increased risk.1
HT increases the estrogen and progestin
levels in your body. There are several ways to take HT,
including continuous and cyclic along with higher-dose and low-dose.
Combining progestin with estrogen:
The estrogen in hormone therapy is
used by some postmenopausal women to increase estrogen levels. This helps
osteoporosis and perimenopausal symptoms, such as hot
flashes and sleep problems.
But HT slightly increases risks of
some serious health problems. In a small number of women, HT
may increase the risk of blood clots, stroke,
heart disease, breast cancer, ovarian cancer, or dementia. In
women who are 10 or more years past menopause, using HT slightly raises the
risk of heart disease.2
Because of the risks of HT, many experts recommend that HT be used for:
Who should not use HT
You should not use HT if you:
HT increases estrogen levels,
Side effects that can occur
with all forms of estrogen but are more frequent with oral estrogen
In addition, the estrogen patch (transdermal estrogen)
may cause skin irritation.
Some of these side effects, such as
headaches, nausea, fluid retention, weight gain, and breast tenderness, may go
away after a few weeks of use.
The side effects of
progestin often cause women to stop using hormone therapy (HT).
Adjusting the progestin dose, changing the dosing schedule, or changing the
type of progestin may reduce side effects. The progestin
intrauterine device (IUD) reduces or eliminates side
effects that are common with oral progestin.1
Progestin side effects include:
Cyclic progestin (taken 10 to 14
days a month) is more likely to cause:
The combination transdermal patch may cause skin irritation.
See Drug Reference for a
full list of side effects. (Drug Reference is not available in all
therapy (HT) may increase the risk of health problems in a small number of women. This
increase in risk depends on your age, your personal risk, and when HT is started.2 Talk with
your doctor about these risks. Using HT may increase your risk of:
Experts do not yet know whether lower-dose, shorter-term
HT reduces or eliminates these risks.
If you have been taking HT, talk with your doctor about your reasons for
taking it. Are you taking it to help with perimenopausal symptoms or for
long-term health reasons? Consider changing to another treatment, depending on
the problem you are using HT to treat. If HT seems like the best choice for
you, plan to use the lowest possible effective dose.
If you are
unable to tolerate the side effects of progestin in hormone therapy
and you have not had a
hysterectomy, try nonhormonal treatment options.
When given with a skin patch, estrogen-progestin
enters the bloodstream directly, without passing through the liver. The
estrogen and progestin in pills must be processed by the liver before entering
the bloodstream. This is why women with liver or gallbladder disease can
usually use a patch form of HT.
Direct sunlight or
high heat can increase, then decrease, the amount of hormone released from a
patch. This can give you a big dose at the time and leave less hormone for the
patch to release later in the week. Avoid direct
sunlight on the hormone patch. Also avoid using a tanning bed, heating pad,
electric blanket, hot tub, or sauna while you are using a hormone patch.
Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.
Fritz MA, Speroff L (2011). Postmenopausal hormone therapy. In Clinical Gynecologic Endocrinology and Infertility, 8th ed., pp. 749–857. Philadelphia: Lippincott Williams and Wilkins.
North American Menopause Society (2010). Estrogen and
progestogen use in postmenopausal women: 2010 position statement of the
North American Menopause Society. Menopause, 17(2):
242–255. Also available online: http://www.menopause.org/PSht10.pdf.
Fritz MA, Speroff L (2011). Menopause and perimenopausal transition. In Clinical Gynecologic Endocrinology and Infertility, 8th ed., pp. 673–748. Philadelphia: Lippincott Williams and Wilkins.
August 8, 2012
Anne C. Poinier, MD - Internal Medicine & Carla J. Herman, MD, MPH - Geriatric Medicine
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