Menopause - Medications

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Because HRT offers protection against osteoporosis, when women stop taking HRT their risks for bone thinning and fractures increases. For women who have used HRT for several years, doctors should monitor their bone mineral density and prescribe bone-preserving medications if necessary.

Safety Concerns. Until 2002, doctors used to routinely prescribe HRT to reduce the risk of heart disease and other health risks in addition to treating menopausal symptoms. That year, the results of an important study, called the Women's Health Initiative (WHI), led doctors to revise their recommendations regarding HRT.

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The WHI, started in 1991, is an on-going health study of nearly 162,000 postmenopausal women. Part of the study focuses on the benefits and risks of hormone replacement therapy. Analysis of the data from this ongoing study and other studies have raised concerns about that HRT use is associated with an increased risk of developing breast cancer, heart attacks, strokes, and blood clots.

As a result of these studies’ findings, there have been a number of changes in the way hormone therapy is prescribed. In general, doctors recommend that patients who choose HRT take the lowest possible dose for relief of symptoms for the shortest amount of time.

Woman who should not take hormone replacement therapy include those with the following conditions:

• Current, past, or suspected breast cancer
• History of endometrial cancer
• Vaginal bleeding of unknown cause
• Current or past history of blood clots
• High blood pressure that is untreated or poorly managed
• Angina that is currently symptomatic or heart attack that occurred recently

HRT Forms and Regimens

HRT comes in several forms:

• Oral tablets or pills
• Skin patches
• Vaginal cream or tablet
• Vaginal ring
• Topical gel

Vaginal forms of HRT are called “local” therapy. Pills and skin patches are considered “systemic” therapy, because the medication delivered affect the entire body. Doctors generally prescribe vaginal applications of HRT to specifically treat symptoms such as vaginal dryness. For treatment of hot flashes, systemic therapy is recommended.