Most women experience relief from the hot flashes, sleep difficulties, and vaginal dryness within a couple of weeks of taking HRT.

Estrogen helps to decrease low-density lipoprotein (LDL) cholesterol and increase high-density lipoprotein (HDL) cholesterol in the bloodstream. Replacing the estrogen in the form of HRT helps to decrease the amount of cholesterol in the blood vessels. Therefore, the risk for cardiovascular disease is decreased.

A woman's naturally occurring low estrogen during and after menopause also affects her bone strength. HRT helps to prevent bone loss by replacing some of the estrogen. Supplemental calcium may be recommended for some women to help the estrogen increase her bone mass.

Some women have irregular bleeding when they start taking HRT, but changing the dosage often eliminates this side effect.

• Endometrial cancer - Taking estrogen alone causes the lining of the uterus to grow, and this may increase the risk for endometrial cancer. For women who still have their uterus, most doctors prescribe progestin (a synthetic progesterone) to counteract the effect of the estrogen. Progestin works to decrease the lining of the uterus. Depending on the form of HRT, taking progestin may cause bleeding similar to a period. This combination of estrogen and progesterone may be in the form of one pill or may be two separate pills.
• Breast cancer - There are controversial theories regarding HRT's role in increasing a woman's risk for breast cancer. Most physicians believe that if there is an increased risk, it is small - although the risk may be greater with long-term use.
• Thromboembolic disease - The increased risk of blood clots from taking estrogen has been recognized for years. Generally, this risk has been associated with the use of oral contraceptives that contain high doses of estrogen. It is further increased for women who smoke cigarettes. While taking estrogen increases the risk of blood clots, HRT has a much smaller amount of estrogen (compared to oral contraceptives), and therefore a smaller increased risk.

The key is to weigh the risks associated with taking HRT against the woman's risk of heart disease or osteoporosis without taking HRT. Every woman is different. Therefore, each woman's entire medical history should be evaluated individually before prescribing HRT.

Forms of HRT
HRT is available in various forms, including pills, patches, and vaginal creams. Your health care provider will start you on a regimen that is best suited for you. It may be necessary to try more than one regimen before finding the one that works best for you.

• Cyclic hormone therapy is often recommended. With this therapy, oral estrogen is taken orally (by mouth) for 25 days, with progestin added somewhere between days 10-14. The estrogen and progestin are taken together for the remainder of the 25 days. Then, no pills are taken for 3-5 days. There will be monthly bleeding with cyclic therapy.
• Continuous, combined therapy is where estrogen and progestin are taken together every day. When this therapy is started, or when switching from cyclic to continuous therapy women may experience irregular bleeding. Most women stop bleeding within one year after starting this therapy.
• HRT is also available as a patch applied to the abdomen or the thigh. This patch allows the estrogen to be absorbed through the skin into the blood stream. Some women prefer this method because they do not have to take the estrogen orally.
• Vaginal cream containing estrogen may be given to women for vaginal dryness. The cream is usually given along with one of the other forms of HRT, because the cream may not relieve many of the other symptoms.

Additional medications may be recommended for some women with severe symptoms from menopause, or women who are at very high risk for osteoporosis or heart disease. One of these supplemental drugs might be androgen, a hormone given with estrogen to relieve severe hot flashes. Other drugs for prevention of osteoporosis may include calcitonin, etidronate, and alendronate.

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