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Title : Hormone Replacement Therapy
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Hormone Replacement Therapy

Until recently, doctors often prescribed Hormone Replacement Therapy (HRT) to postmenopausal women, not only to help control the symptoms of menopause, but also to reduce their risk for coronary artery disease. They had reason for doing so—numerous large observational studies concluded that those taking estrogen after menopause were one-third to one-half as likely to have heart attacks or develop cardiovascular disease as those who didn’t.

But more recent randomized controlled trials burst the HRT bubble. Several large trials have concluded that HRT doesn’t help prevent heart problems and may even cause them. The American Heart Association now advises physicians not to prescribe HRT solely to prevent heart attacks and strokes in women with cardiovascular disease. But some experts believe that future research may still determine that, for some women, HRT helps prevent heart disease. Most of the clinical trials thus far have focused on women well beyond menopause—the average age has been sixtyseven. But HRT might be beneficial when started by younger women who have just gone through menopause.

Until more and better information is available, women should discuss HRT with their doctor. The decision is personal and should be based on a woman’s postmenopausal symptoms as well as her risks for breast cancer, endometrial cancer, heart disease, osteoporosis, and other hormone-related conditions. Here are the recommendations that generally given to patients :

• If you have heart disease, don’t start HRT just to treat this condition or to prevent a heart attack. Instead, focus on proven prevention strategies such as eating healthily, getting more exercise, controlling blood pressure, and lowering cholesterol. Estrogen that was prescribed to treat high cholesterol should be replaced with a cholesterol-lowering medication.
• If you’ve been on HRT for several years, you should discuss with your doctor whether you still need this treatment, but you’re probably past the early period of increased risk. The American Heart Association recommends that women stop HRT at least temporarily following a heart attack or if they are confined to bed for some reason, and that they start again only for reasons other than heart health. Also, women who take HRT face a small increased risk for breast cancer. So it’s a good idea to work with your doctor to evaluate your risk for breast cancer.
• If you don’t have heart disease, base your decision about whether to use HRT on its proven ability to relieve menopausal symptoms. But keep in mind that there are a variety of alternatives to taking an estrogen pill for these problems.

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