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KINDS
OF 
HORMONE
REPLACEMENT THERAPY
Hormone replacement therapies are
available in many natural and synthetic forms.
Estrogens can be given alone (unopposed estrogen) or in combination with
progestins (combined hormone therapy). Each regimen and form of administration has
specific benefits and risks. No one
method can prevent all the diseases associated with loss of estrogen and aging.
Combined Hormone Replacement
Therapy
Selective Estrogen-Receptor
Modulators (SERMs)
ESTROGENS
Estrogens can and should be used
alone for women who have had their uterus, including the cervix, removed (by
hysterectomy). Estrogen can cause
uncontrolled growth of the lining of the uterus, which if untreated, may develop into uterine
(endometrial) cancer. Any woman with an
intact uterus should have annual endometrial biopsies (tissue samples of her
uterus) and report any vaginal bleeding immediately.
Estrogen comes in several pharmacologic
formulations. The most commonly prescribed
pill form of ERT is Premarin. Others are Estratab, Menest, Estradiol (Estrace), and Estropripate (Ogen, Ortho-Est). Other forms available include patches,
vaginal creams, and vaginal devices (rings).
These latter forms deliver hormones while avoiding problems such as
gallstones and blood clots that can occur with the use of oral estrogen.
COMBINED
HORMONE REPLACEMENT THERAPY
Physicians generally prescribe estrogen along with a progestin
or progesterone. Commonly prescribed progestins include medroxyprogesterone
(Provera, Amen, Curretab, Cycrin, Depo-Provera), norethindrine acetate (Aygestin, Nortulate, Activelle) synthesized
male hormones, and norgestrel. Oral forms that combine both estrogen and progestins together (Prempro, Premphase) are now available. Progestins may be prescribed alone for hot flashes or other acute
menopausal symptoms.
There are different schedules for taking HRT in pill
form. Estrogen could be taken everyday for a set number of
days, add progestin for 10-14 days, and then stop taking one or both for a
specific period of time. This same
pattern would be repeated every month. This cyclic schedule often causes a
regular monthly bleeding like a light menstrual period. Another schedule is to take estrogen and
progestin together every day of the month without a break. This continuous
pattern can stop monthly bleeding after about six months of treatment. However, problem bleeding may continue
longer.
Side effects can occur with both HRT and
ERT. These include bloating, breast
tenderness, cramping, irritability, depression, and sometimes spotting or a
return of monthly periods for a few months or years. These side effects may be controlled by changing
the amount of hormone taken, the way it is taken, or the timing of the
dose. They may disappear over time also.
SELECTIVE
ESTROGEN-RECEPTOR MODULATORS (SERMS) 
Selective estrogen-receptor modulators (SERMs), also called “designer estrogens,” act like estrogen
in some tissues but behave like estrogen blockers in others. These drugs are designed
to produce the benefits of estrogen without increasing hormone-related
cancers. Tamoxifen
(Nolvadex) is the best known
SERM. Possible side effects that may
occur while taking tamoxifen include hot flashes,
vaginal discharge, irregular or lighter menstrual cycles, weight loss, or
diarrhea. Raloxifene
(Evista) is another commonly prescribed SERM with
side effects including leg cramps and hot flashes.
Home What is menopause Advantages Controversial
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