HRT for the treatment of menopause is not without controversy. Some people say treating menopause classifies it as a disease; others say treatment is a good example of preventative medicine. Who to treat, benefits and risks of treatment, and how to treat (dosing schedules, etc.), are questions that don't have easy, all-encompassing answers. The following article will shed some light on all these issues.

Who Should be Treated?

1. Women who are peri-menopausal (in the transition between ovulating and not ovulating) and post-menopausal (no longer ovulating) who have short and mid term symptoms (hot flashes, psychological symptoms, bladder and vaginal symptoms), and who have none of the contraindications listed below.
2. Women at high risk for osteoporosis (Caucasian, thin, eat poorly, drink too much alcohol. obtain little exercise and/or are smokers).
3. Women at an elevated risk for stroke, heart disease and high cholesterol.

About 20% of women have the following contraindications and should NOT be treated with HRT:

Benefits of Treatment

• Effective, safe control of short and mid term symptoms.
• Decreases bone loss and decreases the chance suffering from osteoporosis (for those most prone to getting to the disease).
• Reduces the incidence of heart attacks by 50% in some studies, perhaps due to its beneficial effects on cholesterol.

What must be remembered is that long term HRT will protect against osteoporosis and heart disease only if the woman was at risk in the first place. If her cardiovascular risk is already very low, then a 50% reduction is not terribly significant. Likewise, women who eat well, do not smoke or drink alcohol, and exercise regularly, may not need HRT.

What are the Risks?

• Endometrial Cancer - with estrogen therapy alone, there is an increased risk; adding progesterone reduces the risk to that of a woman not taking HRT. >Breast Cancer. There may be a small increase in risk of breast cancer for women on HRT. The increase appears to be significant only with higher doses, and only after long-term therapy, for instance 15 years.
• Bleeding. In some studies, over 50% of women stop HRT after 3 months, almost always due to the resumption of their menstrual periods. The newer dosing regimens address this problem effectively.
• Potential for short term side effects at the initiation of HRT, such as nausea or morning sickness, some fluid retention and weight gain. These side effects usually disappear within the first 4 to 8 weeks.
• Women prone to migraines may experience more headaches while on HRT. If migraines worsen, it is a good idea to stop HRT and consult your doctor.

Dosing Schedule

Hormone Replacement Therapy is not for every woman. Short term use for treatment of short term menopausal symptoms can be safe and effective. Long term use requires an individualized decision based on each woman's own risk for heart disease and osteoporosis without HRT, balanced against the risk of breast and endometrial cancer with HRT.

HRT is only a part of the "package" of menopausal treatment. A healthy lifestyle, including regular exercise, a healthy diet, stress reduction and quitting smoking are also very important steps to take at this time in your life.

For more details about Hormone Replacement Therapy or Menopause, talk to your doctor or pharmacist, or read more about Menopause and its symptoms.