Menopause and Hormone Replacement Therapy

Menopause and Hormone Replacement Therapy


Menopause is a process in which a woman’s body undergoes changes which are basically due to the ovaries producing less estrogen and progesterone. Menopause usually begins in the late 30’s and early 40’s. The remaining eggs in the ovaries are less likely to be fertilized. Eventually the menstrual period stops completely and a woman can no longer become pregnant. This process occurs over a period of years. Estrogen and progesterone are hormones described below and in our glossary, which is called What It Means.

There are two basic types of menopause:

  • Natural Menopause
  • Surgical Menopause

A brief discussion of each type follows.

Natural Menopause – Is commonly divided into the following two phases:

Phase 1 – Perimenopause

Begins when a woman develops menopausal symptoms although she is still having periods. Hormone levels rise and fall unevenly, and there may be hot flashes (feelings of heat in the face or upper body causing the skin to become flushed or red as the blood vessels expand).There may also be changes in periods. The flow may be irregular, or heavier or lighter than usual. This process leads up to menopause, and is different for every woman. However, it usually starts about three years before the last period.

Phase 2 – Postmenopause:

After a woman has had no periods for one year, she is considered to have entered the postmenopausal phase, and the ovaries produce little or no estrogen or progesterone. However, occasional spikes in hormone levels may cause periodic light bleeding. This spotting is not considered a period because the changes in hormone levels are not regular

Surgical Menopause – After a total hysterectomy (removal of the uterus and both ovaries), there is a sudden loss of estrogen. If the ovaries are not removed with the uterus (called a partial hysterectomy), a woman usually does not develop menopause as a result of the surgery. After surgery, symptoms of menopause often develop at once.

Common symptoms of natural menopause are:

  • hot flashes
  • night sweats
  • painful intercourse (less common) from vaginal dryness

Although most women have some of these symptoms, the extent varies from woman to woman, and can be severe in some women. They may continue for a few months to several years, but usually finally stop.

Other problems related to estrogen loss generally don’t go away, such as:

  • osteoporosis (described elsewhere in our Women’s Health Channel)
  • painful sexual intercourse (Treatment with lubricants sometimes helps)
  • frequent urination or urinary incontinence (lack of bladder control)

Women’s Health Initiative of NIH and Hormone Replacement Therapy

For many years, hormone replacement therapy (HRT) was widely used to decrease or eliminate symptoms of menopause. Some refer to this treatment as estrogen replacement therapy (ERT). Although some women are treated with estrogen alone, and others receive estrogen and progesterone, combined. The term Hormone Replacement Therapy is used to refer to both treatments.

The largest single study on Hormone Replacement Therapy, which is being conducted by the National Institutes of Health (NIH), is a part of its Women’s Health Initiative. Since reports in July 2002 from this study, there as been much difference of opinion and confusion about whether the advantages of hormone replacement therapy outweigh the disadvantages.

The reason for the conflict is the following small, but significant, study findings regarding risk:

Study Findings from the Use of Estrogen plus Progestin;

Increased Risk of: Decreased Risk of: No Difference In Risk For:
Breast Cancers Colorectal Cancer Deaths
Stroke Bone Fractures (usually of the Hip) Total Cancer Cases
Heart Attack/Coronary Heart Disease
Blood Clots

Study Findings from the Use of Estrogen Alone:

Increased Risk of: Decreased Risk of: No Difference In Risk For:
Stroke Bone Fractures Coronary Heart Disease
Deep Vein Thrombosis Colorectal Cancer and Total Cancer Cases
Breast Cancer

While hormone replacement is still an approved treatment for menopausal symptoms, a woman’s decision about whether to use it is now more difficult. She must decide whether or not the risks found by the WHI study are acceptable to her. She should discuss the following issues with her doctor:

  1. Why she wants to receive hormone replacement therapy (if she does)
  2. What personal benefits she expects from HRT
  3. What her increased risks might be, after taking into consideration her individual and family history for breast cancer, heart disease, and the other conditions listed above

Even if a woman decides to take hormone replacement therapy, she should try to limit the amount of time she takes it, and develop a plan around that concept with her doctor.

About Estrogen and Progesterone

Estrogen: A hormone produced by the ovaries and testes. It stimulates the development of secondary sexual characteristics and induces menstruation in women. Estrogen is important for the maintenance of normal brain function and development of nerve cells. It is used to treat breast and prostate cancer and osteoporosis, and to relieve the discomforts of menopause. Some research suggests that estrogen may be beneficial in preventing Alzheimer’s disease

Progesterone: A steroid hormone involved in the female menstruation cycle and pregnancy. Progesterone prepares the lining (endometrium) of the uterus (the womb) to receive and sustain the fertilized egg and thus supports pregnancy. Progestins are the synthetic (artificial) forms of progesterone used in hormone replacement therapy. Progesterone is also known as progestational hormone.

For more information hormone replacement therapy, and the Women’s Health Initiative, contact the National Heart, Lung and Blood Institute of the National Institutes of Health (NIH), which is conducting the Women’s Health Initiative (several additional studies related to women are still underway). Tel. 301-592-8573.