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Facts About Menopausal Hormone Therapy 15 Amoxifen—Taken to Prevent Amoxifen—Taken to Prevent Obesity and Related Conditions

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Facts About Menopausal Hormone Therapy 15 Amoxifen—Taken to Prevent Amoxifen—Taken to Prevent Obesity and Related Conditions F acts About Menopausal Hormone Therapy Menopausal hormone therapy once seemed the answer for many of the conditions women face as they age. It was thought that hormone therapy could ward off heart disease, osteoporosis, and cancer, while improving women’s quality of life. But beginning in July 2002, findings emerged from clinical trials that showed this was not so. In fact, long-term use of hormone therapy poses serious risks and may increase the risk of heart attack and stroke.This fact sheet discusses those findings and gives an overview of such topics as menopause, hormone therapy, and alternative treatments for the symptoms of menopause and the various health risks that come in its wake. It also provides a list of sources you can contact for more information. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Heart, Lung, and Blood Institute Menopause and Hormone Eventually, your periods stop. You also can undergo menopause Therapy Menopause marks the time as the result of surgery.A surgical of your last menstrual period. procedure, called a hysterectomy, As you age, significant internal It is not considered the last until removes the uterus.This surgery changes take place that affect your you have been period-free for puts an end to your menstrual production of the two female 1 year without being ill, pregnant, cycle but does not affect hormones, estrogen and proges- breast-feeding, or using certain menopause, which still occurs terone.The hormones, which are medicines, all of which also can naturally. important in regulating the men- cause menstrual cycles to cease. strual cycle and having a successful There should be no bleeding, You go through menopause pregnancy, are produced by the even spotting, during that year. immediately if both of your ovaries, two small oval-shaped Natural menopause usually hap- ovaries are also removed organs found on either side of pens sometime between the ages at surgery.Whether you go the uterus. of 45 and 54. through menopause naturally During the years just before menopause, known as peri- menopause, your ovaries begin to shrink. Levels of estrogen and progesterone fluctuate as your ovaries try to keep up hormone production.You can have irregular menstrual cycles, along with unpredictable episodes of heavy bleeding during a period. Perimenopause usually lasts several years. Box 1 Examples of Oral Estrogen and Estrogen/Progestin Products Estrogen pills: Progestin pills: Estrogen-plus-progestin pills: Brand Generic Brand Generic Brand Generic Premarin conjugated equine Cycrin medroxyprogesterone Premphase conjugated equine estrogens acetate estrogens and Cenestin synthethic conjugated Provera medroxyprogesterone medroxyprogesterone estrogens acetate acetate Estratab esterified estrogens Aygestin norethindrone acetate Prempro conjugated equine Menest esterified estrogens Norlutate norethindrone acetate estrogens and Ortho-Est estropipate (piperazine Prometrium progesterone USP medroxyprogesterone estrone sulfate) (in peanut oil) acetate Ogen estropipate (piperazine Femhrt ethinylestradiol and estrone sulfate) norethindrone acetate Estrace micronized 17-beta- Activella 17-beta-estradiol and estradiol norethindrone acetate Estinyl ethinyl estradiol Ortho-Prefest 17-beta-estradiol and norgestimate 2 F acts About Menopausal Therapy Hormone Box 2 Box 3 Examples of Gels, Creams, Patches, and Other Hormone Therapy Hormone Products Schedules Estrogen products: Cyclic or sequential Type Brand Generic ■ Estrogen every day Vaginal Cream Estrace micronized 17-beta-estradiol ■ Progesterone or progestin added Ortho Dienestrol dienestrol for 10–14 days out of every Ogen estropipate (piperazine estrone sulfate) 4 weeks Premarin conjugated equine estrogens Vaginal Tablet Vagifem estradiol hemihydrate Continuous-combined Vaginal Ring Estring micronized 17-beta-estradiol ■ Estrogen and progestin daily Femring estradiol acetate without a break Skin Patch Alora micronized 17-beta-estradiol Climara micronized 17-beta-estradiol Esclim micronized 17-beta-estradiol to uterine cancer. If you haven’t Estraderm micronized 17-beta-estradiol Vivelle micronized 17-beta-estradiol had a hysterectomy,you’ll receive Vivelle-Dot micronized 17-beta-estradiol estrogen plus progesterone or Skin Gel Estrogel estradiol gel a progestin; if you have had a Skin Cream Estrasorb estradiol topical emulsion hysterectomy,you’ll receive only estrogen. Hormones may be taken Progestin products: daily (continuous use) or on only certain days of the month (cyclic Vaginal Gel Crinone progesterone use). (See Box 3.) IUD Mirena levonorgestrel Estrogen plus progestin products: They also can be taken in several ways, including orally, through Skin Patch Combipatch 17-beta-estradiol and norethindrone a patch on the skin, as a cream acetate or gel, or with an IUD (intrauter- Ortho-Prefest 17-beta-estradiol and norgestimate ine device) or vaginal ring (See Box 2.). How the therapy is taken can depend on its purpose. For or surgically, symptoms can result called night sweats.) But the drop instance, a vaginal estrogen ring as your body adjusts to the drop in estrogen also can contribute to or cream can ease vaginal dryness, in estrogen levels.These symptoms changes in the vaginal and urinary urinary leakage, or vaginal or uri- vary greatly—one woman may tracts, which can cause painful nary infections, but does not go through menopause with few intercourse and urinary infections. relieve hot flashes. symptoms, while another has difficulty. Symptoms may last for To r elieve the symptoms of Hormone therapy may cause side several months or years, or persist. menopause, doctors may prescribe effects, such as bleeding, bloating, hormone therapy.This can involve breast tenderness or enlargement, The most common symptoms are the use of either estrogen alone headaches, mood changes, and hot flashes or flushes, night sweats, or with another hormone called nausea. Further, side effects vary and sleep disturbances. (A hot flash progesterone, or progestin in its by how the hormone is taken. For is a feeling of heat in your face synthetic form (See Box 1.). The instance, a patch may cause irrita- and over the surface of your body, two hormones normally help to tion at the site where it’s applied. which may cause the skin to regulate a woman’s menstrual cycle. appear flushed or red as blood Progestin is added to estrogen to There also are nonhormonal vessels expand. It can be followed prevent the overgrowth (or hyper- approaches to easing the symp- by sweating and shivering. Hot plasia) of cells in the lining of the toms of menopause. Box 4 offers flashes that occur during sleep are uterus. This overgrowth can lead a list of some of these alternatives. 3 Box 4 Alternatives to Hormone Therapy To Help Prevent Postmenopausal Conditions and Relieve Menopausal Symptoms You may want to consider alternatives to hormone therapy For Menopausal Symptoms: to ease menopausal symptoms. The list below includes Hot flashes some locally applied hormone products, which might ■ Lifestyle changes. These include dressing and eating not carry the same risks as those that deliver medication to avoid being too warm, sleeping in a cool room, and throughout the body. reducing stress. Avoid spicy foods and caffeine. Try deep breathing and stress reduction techniques, including medi- Be aware that some of these remedies are regulated by the tation and other relaxation methods. Federal Government as dietary supplements, and as such do ■ Phytoestrogens. Soybeans and some soy-based not undergo premarket approval and may not have data show- ing them to be safe and effective (See Box 5.). Talk with your foods contain phytoestrogens, which are estrogen-like doctor or other health care provider about the best treatment compounds. Soy phytoestrogens can be consumed for you for each symptom. through foods or supplements. Soy food products include tofu, tempeh, soy milk, and soy nuts. Other plant sources Positive moves you can make to feel better are related to of phytoestrogens include such botanicals such as black adopting a healthy lifestyle—don’t smoke, eat a variety of cohosh, wild yam, dong quai, red clover, and valerian root. foods low in saturated fat, trans fat, and cholesterol and mod- However, there is no solid evidence that the phytoestrogens erate in total fat. Include grains, especially whole grains and a in soybeans, soy-based foods, other plant sources, or variety of dark green leafy vegetables, deeply colored fruit, and dietary supplements really do relieve hot flashes. Further, dry beans and peas in your eating plan. Also, maintain a the risks of taking the more concentrated forms of soy healthy weight, and be physically active for at least 30 minutes phytoestrogens, such as pills and powders, are not known. most days of the week, preferably daily. Alternatives include: Dietary supplements with phytoestrogens do not have For Postmenopausal Conditions: to meet the same quality standards as do drugs. Little is Osteoporosis known about the safety or efficacy of these products. ■ See Box 13 for lifestyle behaviors to protect bone density. ■ Antidepressants, such as Effexor, Paxil, and Prozac. ■ Designer estrogen raloxifene (Evista), which preserves bone These medications have been proved moderately effective density and prevents fractures (although not hip fractures). in clinical trials. ■ Bisphosphonates Actonel or Fosamax, which preserve Vaginal dryness bone density, prevent fractures, and can reverse bone loss ■ Vaginal lubricants and moisturizers
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