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Hormone Replacement Therapy- Evexipel, Creams, Troche

Hormone Therapy Fact Sheet

The American College of Obstetricians and Gynecologists (ACOG)
Patient Education Fact Sheet
PFS003: Hormone Therapy (April 2015)

Hormone Therapy

Menopause is the time in a woman’s life when she naturally stops having menstrual periods. Menopause marks the end of the reproductive years. The average age of menopause for women in the United States is 51 years.

Most women enter a transitional phase in the years leading up to menopause called perimenopause. Perimenopause is a time of gradual change in the levels of estrogen, a hormone that helps control the menstrual cycle. Changing estrogen levels can bring on symptoms such as hot flashes and sleep changes. To manage these symptoms, some women may choose to take hormone therapy.

Your Body’s Hormones

During your childbearing years, monthly changes in the production of two hormones, estrogen and progesterone, control your menstrual cycle. These hormones are made by the ovaries. Estrogen causes the endometrium (the lining of the uterus) to grow and thicken to prepare for a possible pregnancy. On about day 14 of your menstrual cycle, an egg is released from one of the ovaries, a process called ovulation. If the egg is not fertilized, no pregnancy occurs. This causes the levels of estrogen and progesterone to decrease, which signals the uterus to shed its lining. This shedding is your monthly period.

Perimenopausal Signs and Symptoms

The signs and symptoms that many women experience during perimenopause are caused by gradually decreasing levels of estrogen. You may have only a few symptoms, or you may have many. Symptoms may be mild, or they may be severe.

Changes in Your Menstrual Cycle

A common sign of perimenopause is a change in your menstrual cycle. Cycles may become longer than usual for you, or they may become shorter. You may begin to skip periods. The amount of flow may become lighter or heavier.

Although changes in menstrual bleeding are normal as you approach menopause, you still should report them to your health care provider. Abnormal bleeding may be a sign of a problem. Talk to your health care provider if you have any of the following:

Although the removal of the uterus (a hysterectomy) ends menstrual periods, it does not cause menopause unless the ovaries also are removed. This type of surgery is called an oophorectomy. An oophorectomy causes immediate menopause signs and symptoms if it is done before a woman reaches menopause.

Hot Flashes

Hot flashes are one of the most common symptoms of perimenopause. A hot flash is a sudden feeling of heat that spreads over the face and body. The skin may redden like a blush. You also may break out in a sweat. A hot flash may last from a few seconds to several minutes or longer.

Some women have hot flashes a few times a month. Others have them several times a day. Hot flashes that happen at night (night sweats) may wake you up and cause you to feel tired and sluggish during the day.

Vaginal and Urinary Tract Changes

As estrogen levels decrease, changes take place in the vagina. Over time, the vaginal lining gets thinner, dryer, and less elastic. Vaginal dryness may cause pain during sexual intercourse. Vaginal infections also may occur more often.

The urinary tract also changes with age. The urethra can become dry, inflamed, or irritated. Some women may need to urinate more often. Women may have an increased risk of urinary tract infections after menopause.

Bone Changes and Osteoporosis

Bones are constantly changing throughout life. Old bone is removed in a process called resorption. New bone is built in a process called formation. During the teen years, bone is formed faster than it is broken down. The amount of bone in the body sometimes called the “bone mass” reaches its peak during the late teen years. In midlife, the process begins to reverse. Bone is broken down faster than it is made. A small amount of bone loss after age 35 years is normal for men and women. But during the first 4 to 8 years after menopause, women lose bone more rapidly. This rapid loss occurs because of the decreased levels of estrogen. If too much bone is lost, it can increase the risk of osteoporosis. Osteoporosis increases the risk of bone fractures. The bones of the hip, wrist, and spine are affected most often.

Types of Hormone Therapy

Hormone therapy can help relieve the symptoms of perimenopause and menopause. Hormone therapy means taking estrogen and, if you have not had a hysterectomy and still have a uterus, progestin. Progestin is a form of progesterone. Taking progestin helps reduce the risk of cancer of the uterus that occurs when estrogen is used alone. If you do not have a uterus, estrogen is given without progestin. Estrogen plus progestin sometimes is called “combined hormone therapy” or simply “hormone therapy.” Estrogen-only therapy sometimes is called “estrogen therapy.”

Systemic Therapy

Hormone therapy can be either “systemic” or “local.” These two terms describe where and how the hormones act in the body. With systemic therapy, the hormones are released into your bloodstream and travel to the organs and tissues where they are needed.

Systemic forms of estrogen include pills, skin patches, and gels and sprays that are applied to the skin. If progestin is prescribed, it can be given separately or combined with estrogen in the same pill or in a patch.

For women taking estrogen-only therapy, estrogen may be taken every day or every few days, depending on the way the estrogen is given. For women taking combined therapy, there are two types of regimens:

  1. Cyclic therapy: Estrogen is taken every day, and progestin is added for several days each month or for several days every 3 months or 4 months.
  2. Continuous therapy: Estrogen and progestin are taken every day.

Local Therapy

Women who only have vaginal dryness may be prescribed “local” estrogen therapy in the form of a vaginal ring, tablet, or cream. These forms release small doses of estrogen into the vaginal tissue. The estrogen helps restore the thickness and elasticity to the vaginal lining while relieving dryness and irritation.

Benefits, Risks, and Side Effects of Hormone Therapy

Hormone therapy has many benefits, but it also has risks. Side effects also may occur.

Benefits

Risks

Hormone therapy may increase the risk of certain types of cancer and other conditions:

Side Effects

Combined hormone therapy may cause vaginal spotting. Some women may have heavier bleeding like that of a menstrual period.

Other side effects include:

Current Recommendations

Hormone therapy can help relieve some of the symptoms that affect women at menopause. However, it is important to weigh the benefits and the risks for your individual situation.

In general, hormone therapy should be limited to the treatment of menopausal symptoms at the lowest effective dose for the shortest amount of time possible. Continued use should be reevaluated yearly.

Other Therapies

Medications

An antidepressant is available for the treatment of hot flashes. Gabapentin and clonidine also may help reduce hot flashes and ease sleep problems.

Plant-Based Alternatives

Plants and herbs used for menopause symptoms include soy, black cohosh, and Chinese herbal remedies. Only a few have been studied for safety and effectiveness.

Bioidentical Hormones

Bioidentical hormones come from plant sources. Compounded bioidentical hormones are not regulated by the FDA and have the same risks as FDA-approved hormone therapies.

Vaginal Moisturizers and Lubricants

These over-the-counter products can help with vaginal dryness and painful intercourse. Water-soluble lubricants are easier to clean and may need to be reapplied frequently. Oil-based lubricants should not be used with latex condoms.

Follow-up

If you choose to take hormone therapy, regular follow-up is important. Your health care provider should assess your continued use yearly. Report any side effects, especially vaginal bleeding, right away.

Glossary

Source: ACOG Patient Education Fact Sheet, April 2015.