Many different types of estrogen are available for use, and ERT can be given through pills, patches, and vaginal creams or tablets. HRT is ERT that includes another hormone along with estrogen (usually progesterone). HRT is usually recommended for women who have not had a hysterectomy (see below).

ERT and HRT are the best treatments available to:

• help decrease vaginal dryness
• prevent hot flushes

ERT and HRT can also prevent osteoporosis after menopause. Other medications besides ERT or HRT are also available for preventing osteoporosis, and calcium supplementation is recommended for all postmenopausal women to help to reduce bone loss.

Numerous studies have been done on the other beneficial effects of ERT/HRT, but the results are less clear. Many long-term studies have suggested that ERT helps to prevent heart disease, although recent studies have been conflicting. Promising new research has also suggested that ERT may help prevent Alzheimer's disease or decrease the risk of colon cancer, although these results are too preliminary to regard seriously. ERT has been shown to improve irritating bladder symptoms (frequent urination, urinary urgency and burning) that are often associated with urinary incontinence, but the amount of incontinence or urinary leaking does not appear to improve with estrogen treatment.

ERT and HRT are also associated with potential risks.  ERT (when given by itself) can cause increased growth of the uterine lining (endometrium) and endometrial cancer.  However, when progesterone is added to the estrogen therapy (HRT), that risk disappears. Therefore, women who have not had their uterus removed are usually treated with HRT rather than ERT.

Some studies have shown that ERT and HRT are associated with a small increased risk for breast cancer. This risk seems to be limited to women who take ERT or HRT for more than 5 years. Other studies have not found this increased breast cancer risk. However, it is usually recommended that women who are at a very high risk for developing breast cancer, or those who have been treated for breast cancer in the past, should not take ERT or HRT.

Other potential risks associated with ERT or HRT use include an increase in gallbladder disease and a small increased risk for venous blood clots such as deep venous thrombosis (blood clots in the legs).

There are now many ongoing research studies investigating the effects of menopause. The results of these studies may help physicians advise their patients on how to effectively and safely manage menopause. Until more is known about ERT and HRT, women should weigh the benefits and the possible risks against the symptoms being experienced. Thorough discussion with a physician is recommended.

To reduce the risks of estrogen replacement therapy and still gain the benefits of the treatment, physicians may recommend:

• adding progesterone to the estrogen (HRT)
• using a lower dose of estrogen or a different estrogen preparation (for instance a vaginal cream rather than a pill)
• having frequent and regular pelvic exams and Pap smears to detect problems as early as possible
• having frequent and regular physical exams, including breast exams and mammograms

Side effects of estrogen replacement are generally rare but may include:

• vaginal bleeding
• breast tenderness
• nausea
• abdominal bloating
• uterine cramps

Prognosis

Although menopause is a difficult period for some, most women will experience menopause without long-term problems. Many women report an increase in energy, more self-confidence, and a better attitude.

Complications

Decreased estrogen levels are associated with an increased risk of developing osteoporosis and possibly an increased risk of cardiovascular disease.

Call Your Health Care Provider If:

Call for an appointment with your health care provider if you are a woman older than age 40 who is experiencing the symptoms of menopause and would like treatment for them. Specifically:

• irregular menstrual periods
• hot flashes
• vaginal dryness

Call if you are postmenopausal and are experiencing any bleeding.

Also call if you are experiencing the symptoms of menopause and you are under age 40.

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