Hormone Replacement Therapy

What Is Hormone Replacement Therapy (HRT)?

Hormone replacement therapy (HRT) is a treatment for women who have reached or passed menopause, which often is referred to as “the change of life.” HRT involves taking small doses of one or two female hormones, estrogen and progesterone.

Around age 50, a woman’s menstrual periods become less frequent. Menopause is the point at which they stop altogether.

Estrogen and progesterone are produced naturally by the ovaries until the time of menopause, when their production gradually slows down and eventually stops. Both of these hormones are necessary for the proper functioning of a woman’s reproductive system. Estrogen has many other important roles in the body as well.

Some undesirable changes can accompany menopause:

• Menopause can be accompanied by troublesome symptoms, such as hot flashes and sleep disturbances, and vaginal dryness.
• Menopause raises a woman’s risk for serious health problems, such as heart disease and stroke, as well as bone loss that can lead to osteoporosis and fractures.

For further information about heart disease, go to Heart Disease.

For further information about stroke, go to Stroke.

For further information about osteoporosis, go to Osteoporosis.

Hormone replacement therapy, one of the most commonly prescribed treatments in the United States, is designed to replace the estrogen hormone that the natural aging process takes away.

Researchers developed the concept of hormone replacement therapy in the mid-1960s. HRT has been proven to ease symptoms of menopause and protect against menopause-related health risks.

Recently, however, there has been some concern about whether HRT creates other health risks. This remains an area of considerable debate and ongoing research within the medical community.

Although millions of women take HRT, this may not be the right choice for everyone. Health care professionals advise women to gather as much information as they can and consider the personal benefits and risks.

What Happens In Menopause?

A woman’s reproductive organs include:

• The uterus, or womb
• Two ovaries, which produce eggs as well as the female hormones estrogen and progesterone (and also produce small amounts of the male hormones testosterone and androsterone )
• Two Fallopian tubes, which transport the eggs from the ovaries to the uterus
• Two glands near the brain that release hormones, which stimulate the ovaries to produce estrogen

Menopause marks the end of menstruation in women. Estrogen and progesterone play important roles in menstruation and reproduction.

• Every month, estrogen causes the lining of the uterus to grow in preparation for pregnancy implantation.
• Progesterone causes the lining to thicken and produce glycogen – a source of food for the embryo.
• An egg is released from one of the two ovaries.
• If the egg is fertilized, it implants in the thickened lining, and pregnancy begins.
• If the egg is not fertilized, it does not implant. Progesterone production then stops, and this causes the lining of the uterus to shed, resulting in a menstrual period.

As hormone production by the ovaries gradually decreases, there is a length of time (it could be five years or more) when the levels of estrogen and progesterone in a woman’s body are unpredictable. This can cause:

• Menstrual periods that are very light or close together.
• Menstrual periods that may be skipped
• Menstrual periods than may be much heavier than usual.

The term menopause actually refers to the time that begins when a woman has her last menstrual period. However, many use it to cover the entire time during which the production of hormones by the ovaries gradually decreases and eventually stops. This is frequently called the perimenopausal period. For most women, this is a gradual process rather than a sudden event.

What Are The Benefits Of Hormone Replacement Therapy (HRT?

Women today can expect to live 30 or 40 years after menopause. The lower amount of estrogen during these decades can affect their bodies in two general ways:

• It can cause physical changes and uncomfortable symptoms that are associated with menopause. However, not every woman experiences bothersome symptoms of menopause.
• It puts women at greater risk for certain dangerous diseases, like osteoporosis, which can lead to fractures.

The benefits of hormone replacement therapy include:

• Controlling menopause symptoms
• Preventing heart disease
• Preventing osteoporosis
• Preventing some hard-to-detect female cancers
• Other good reasons
• What if you’ve had a hysterectomy?

Controlling Menopause Symptoms

As a woman approaches menopause and her body slows its production of estrogen, she may experience certain symptoms:

• Hot flashes – These may occur at any time and usually last from a few moments to several minutes. The face and neck may be flushed and blotches may appear for a short time on the upper body.
• Night sweats – These are hot flashes that occur at night and can cause excessive perspiration.
• Vaginal dryness, which can result in painful intercourse – Without estrogen, the vaginal walls become thinner, less moist, and less elastic.
• A tendency to develop hair on the face – This occurs because all women have some of the male hormone testosterone. As estrogen levels in a woman diminish, the male hormone’s effects may become more dominant.
• A loss of muscle tone in the bladder and urethra – This can lead to frequent urination or leakage when a woman sneezes, coughs, laughs, or lifts something heavy.
• Skin changes – The skin can become thinner and dry after menopause, and can lose its elasticity. Some women also notice that their hair becomes dry and their nails more brittle.
• Sleep disruption – This can result from night sweats or psychological stress associated with “the change of life.”
• Mood swings – Some women experience an increase in anxiety or irritability. Some find they are more forgetful than usual and have trouble concentrating. These symptoms can be the result of hormonal changes, but they also can be unrelated to menopause.

Hormone replacement therapy can ease these symptoms.

Preventing Heart Disease

In the U.S., heart disease is the number-one killer of men – and it is the number-one killer of women as well. Before menopause, a woman has a much lesser risk for heart disease than a man does. But after menopause, a woman’s risk begins to increase toward that of a man’s.

Changes in estrogen levels after menopause are accompanied by changes in the fat (lipid) levels in the blood, especially the different types of cholesterol. These changes are considered to be major factors in the increased incidence of heart attacks and atherosclerosis, also called “hardening of the arteries.”

Hormone replacement therapy can correct these unfavorable lipid changes.

Among estrogen’s positive effects on the heart are:

• Reducing the LDL (“bad”) cholesterol in the blood.
• Increasing the HDL (“good”) cholesterol in the blood.
• Helping to keep blood vessels open.
• Lowering blood pressure at night.
• Reducing blood viscosity (how sticky the blood is), a property that may cause blood clots which could result in a heart attack or stroke. Estrogen’s effects on clotting are complicated, however, since there also is an increased risk for thromboembolism (a blood clot that blocks a vessel) in women taking estrogen.
• Possibly enhancing fibrinolysis, which is the body’s natural process for breaking down blood clots.

However, estrogen increases a blood inflammatory protein (C-reactive protein) which has been shown to be a predictor of heart attacks. Thus many blood proteins change with estrogen use. It is unclear whether estrogen can prevent cardiovascular disease, including heart attacks and strokes in normal women.

Preventing Osteoporosis

Hormone replacement therapy can help protect women against osteoporosis, a disease that causes bones to become more porous, which gradually makes them weaker and more brittle. Major studies have reported that women who take estrogen after menopause experience fewer bone fractures than women who do not.

The bones of both men and women are at their strongest and most dense around age 30 or 40. After this, there is a gradual thinning of bones. Bones affected by osteoporosis break more easily, particularly the spine, hip, and forearm. Unfortunately, these are the bones that allow people to remain active.

About 80% of the 24 million Americans who have osteoporosis are women. After menopause, bone loss accelerates to an average of 1 to 2 percent a year. This is because estrogen protects the skeleton by helping the body’s bone-forming cells to keep working. After menopause, when the level of estrogen in a woman’s body sharply decreases, some of this protection is lost.

Osteoporosis has been called “the silent epidemic” because it usually does not cause any symptoms until a fracture occurs. The human and economic costs of osteoporosis are significant:

• As many as 20 percent of the people who break their hip because of osteoporosis die within a year.
• Another 20 percent may be unable to walk for a year afterwards.
• Up to 50 percent cannot walk as well as they did before the fracture.

Calcium and vitamin D are important companions to hormone replacement therapy for prevention and treatment of osteoporosis. HRT must be taken for many years to sustain protection against bone fractures.

Preventing Some Hard-To-Detect Female Cancers

When women first started taking hormone replacement therapy, it consisted of estrogen alone. Studies later showed that estrogen alone increased a woman’s risk of cancer of the uterus, called endometrial cancer.

To prevent this, a second hormone (progesterone) is added to HRT if the woman still has her uterus. Some studies have indicated that women who take both of these hormone replacements may have a lower incidence of endometrial cancer.

Other Good Reasons

Extensive research has shown hormone replacement therapy may have additional benefits for women after menopause.

• Memory loss and mental function. Studies have shown estrogen can protect against some memory loss and improve learning, even in some Alzheimer’s disease patients.
• Colorectal cancer. Various studies have pointed to a decreased risk in colorectal cancer in women who take HRT.
• Diabetes. HRT may help women with diabetes control their blood sugar levels better after menopause.
• Incontinence. A decline in estrogen levels may contribute toincontinence. HRT can help restore the lining of the urethra help support the bladder.
• Migraine. Many postmenopausal women report a decreased incidence of migraines after take HRT. However, women who had experienced migraines related to their menstrual period may report flare-ups of the headaches.
• Urinary tract infections. Some women experience an increase inurinary tract infections during menopause. Researchers believe that the use of estrogen may help the body resist infection.
• Teeth. Women who take estrogen are less likely to lose their teeth, because the same properties that help prevent bone loss apply to preventing bone loss in the mouth.
• Vision. Evidence exists that HRT may help prevent glaucoma and macular degeneration, two common causes of blindness.

Because reports of the true value of estrogen in these areas are conflicting, women should not choose hormone replacement therapy solely for these other reasons. But they can be considered as part of the larger picture in the decision of whether to begin HRT.

What If You’ve Had A Hysterectomy?

A woman who has had a hysterectomy, but whose ovaries were left intact, most often will have a normal menopause. She may have the same symptoms as other women, except that her menstrual periods will have stopped immediately after the surgery. In a woman whose ovaries are removed as part of the hysterectomy, menopause will begin immediately.

When women first started taking hormone replacement therapy, it consisted of estrogen alone. Studies later showed that estrogen alone increased a woman’s risk of cancer of the uterus, called emdometrial cancer. To prevent this, a second hormone (progesterone) was added to HRT for women who still have a uterus. But a woman who has had a hysterectomy does not have a uterus and is therefore not at risk for developing endometrail cancer. Therefore, women with hysterectomies can take estrogen alone, without progesterone.

What Are The Risks Of Hormone Replacement Therapy (HRT)?

A major risk of estrogen treatment is blood clots in the veins, and pulmonary embolism, which is the movement of these clots to the lungs. These are rare but serious problems. If a woman has ever had a deep vein clot or pulmonary embolism, she should not use estrogen without a careful evaluation by her doctor.

Most experts agree that taking hormone replacement therapy for five years or less poses little or no danger. This can be long enough for women who simply want a short-term measure of relieving unpleasant menopause symptoms.

Many experts believe the benefits of hormone replacement therapy may be greater than the risks. The best advice is to discuss potential benefits, risks, and side effects with your doctor.

Many of the questions about hormone replacement therapy address these areas:

• The question about breast cancer
• Other potential concerns

The Question About Breast Cancer

Breast tissue is highly sensitive to estrogen and progesterone. Some experts believe that the longer a woman is exposed to these hormones, the higher her risk for developing breast cancer.

The link between breast cancer and hormone replacement therapy is the subject of intense debate and many clinical studies.

• A report in the February 2000 issue of the New England Journal of Medicine concluded that women whose body-mass index is considered “lean” were at increased risk for breast cancer. The study concluded that breast-cancer risk did not increase for heavier women, however.
• A major 1997 analysis of 51 studies indicated that even one year of HRT could increase the chances of breast cancer.
• Many studies indicate that the danger of breast cancer exists only with long-term hormone replacement therapy (more than five to eight years).
• Studies show an increase in breast cancer among women taking HRT only if they consumed one or more alcoholic drinks a day.
• Studies have shown that any extra risk of developing breast cancer declines quickly once HRT is stopped.
• Other studies have shown no significant increase in breast cancer among women who take HRT.

Some experts point out that even if HRT does increase the risk for breast cancer, tools for early detection of breast cancer (such as mammography) can pinpoint cancer at its earliest and most easily treated stages.

They suggest that if women perform monthly breast self-examinations and have annual mammograms, breast cancer can be identified and successfully treated.

Women with previously diagnosed breast cancer or those with a first-degree relative (such as a mother or sister) with breast cancer need special consultation with their physicians before taking estrogen.

Other Potential Concerns

Other possible negative effects of HRT may include:

• Asthma. Women who take HRT have a slightly higher risk for developing asthma later in life; however, the chances are extremely small.
• Gallstones. Women who take high doses of estrogen are at higher risk for developing gallstones. Low doses of estrogen do not increase risk of developing this common condition, however.
• Changes within the uterus. HRT may aggravate a painful condition called endometriosis or may cause fibroids to grow.

For further information about endometriosis, go to Endometriosis.

For further information about fibroids, go to Fibroids.

Weighing Your Options. Should I take HRT?

Here are some things to consider when deciding whether to begin hormone replacement therapy:

• Who would benefit most from HRT?
• Other medicines for menopause-related concerns
• What about soy?
• Other types of therapies
• The decision is a personal one

Who Would Benefit Most From HRT?

Virtually any woman past menopause may obtain some benefit from hormone replacement therapy, but it may be of particular benefit to women:

• Who have severe menopause symptoms, like hot flashes.
• Who are at increased risk for osteoporosis.
• Who had experienced an early menopause and who need to prevent early onset of osteoporosis. This includes young women who have amenorrhea (a condition in which menstrual periods stop because of severe weight loss, excessive physical training,chemotherapy, radiation therapy, or other causes).
• Who are young but whose ovaries have never developed properly and who need estrogen to develop mature female characteristics.

Alternatives To HRT

A number of other drugs are available that can help the discomforts of menopause and provide protection against certain diseases that can occur as a result of lower estrogen production.

• For hot flashes – Bellurgal is a non-hormonal drug that is approved for the treatment of hot flashes. It relieves symptoms in about half of the women who try it.
• To prevent osteoporosis – Newer medicines that can help prevent osteoporosis include alendronate (Fosamax), raloxifene (EVISTA), and calcitonin (Miacalcin, Calcimar).
• For vaginal dryness – Try moisturizers and non-estrogen lubricants such as KY Jelly or Replens.
• To prevent heart attacks – Aspirin and over-the-counter pain relievers can relieve discomforts. In addition, regularly taking a small dose of aspirin may help prevent colon polyps and heart attacks. Because aspirin can be associated with gastrointestinal problems, women should consult with their doctor before taking aspirin regularly.
• To lower cholesterol – Cholesterol-lowering medications (statins) can be prescribed to bring down high cholesterol levels and have few side effects.

What About Soy?

Recent attention has been turned to the benefits of soy . Soy has been shown to:

• Decrease hot flashes
• Lower cholesterol
• Have some of the same beneficial effects on blood vessels that estrogen has
• Slightly increase bone density

A diet with increased soy protein does seem to have beneficial effects. However, very little data is available on the safety of soy. One small study showed an increase in breast cancer among women who consumed soy.

The estrogen activity of soy is very low, so some of the major benefits of estrogen treatment cannot be obtained with soy alone.

Other Types Of Therapies

Whether they are taking hormone replacement therapy or not, women should pursue a healthy lifestyle for protection against all aging-related conditions. A healthy lifestyle includes:

• Regular weight-bearing exercise such as brisk walking or dancing.
• Not smoking.
• Eating a healthy diet rich in fresh fruits, vegetables, and whole-grain foods.
• Staying active sexually (this helps preserve the lining of the vagina)
• Limiting alcohol use

Some women report great benefit in relieving menopause symptoms from stress-management techniques such as:

• Therapeutic massage
• Acupuncture
• Meditation
• Relaxation therapy

Many women ask about “natural” remedies. Certain herbs are thought to be effective, but few reliable clinical studies have been performed. But it is important to know that herbal and vitamin therapies also may have potentially dangerous side effects.

• Black cohosh, for example, is a plant estrogen that may have an effect on menopause symptoms – but it also may increase cell growth in the uterus, which may be a risk factor for uterine cancer.
• Ginseng has hormonal qualities, and there are some reports of uterine bleeding associated with its use.

How Is HRT Taken?

Hormone replacement therapy is available in the following forms:

• Tablets that are taken by mouth
• Implants
• Skin patches
• Creams

Oral Forms

There are many prescription preparations available that contain estrogen. Some have additional progesterone, which is either incorporated in the same tablet or taken separately.

Estrogen can be taken every day, in 28-day cycles. Typically, a progestin is added for the last 10 to 14 days in each cycle. This combination causes monthly bleeding, similar to a period, even in women who have not had one for years. Bleeding usually begins after the last progestin tablet is taken.

For women who are several years past menopause, estrogen and progesterone can be taken every day continuously. This usually avoids monthly bleeding, which is a common reason why women elect to discontinue HRT. With this option, the lining of the uterus remains healthy because the continuous progesterone keeps it from becoming thickened.

Implants

The estrogen implant is a small pellet containing pure estrogen. It is inserted under the skin of the abdomen or buttock. A woman receives a local anesthetic during insertion.

The implant allows estrogen to gradually be absorbed into the bloodstream. It is effective for four to eight months. Most women with implants also take progestin tablets the first 10 days of each month.

Skin Patches

Transparent adhesive patches containing estrogen, or a combination of estrogen and progestin, can be applied on the skin below the waist, such as on the hip. The patches release the hormones directly into the skin. Patches are usually changed once or twice a week.

Estrogen Creams

Estrogen creams can be used for local treatment of vaginal dryness and irritation. The cream is applied inside the vagina and travels into the bloodstream.

Estrogen Gel

A gel is available that is applied to the skin once or twice daily. It contains estrogen that is readily absorbed by the body. Some women feel that they are more in control of their hormone therapy with a gel, and they find it convenient and easy to use. As with the cream, estrogen gel can relieve menopause symptoms but does not provide protection against osteoporosis.

When Should You Begin HRT?

Once a woman decides to begin hormone replacement therapy, her next big decision is when to begin. Your doctor can help you decide what is best for you. The decision will depend in large part on the reasons why you are taking HRT.

For Controlling Menopause Symptoms

Menopause symptoms such as hot flashes and vaginal dryness can continue on and off for several years, but eventually they will end. Some women decide to take HRT to control these symptoms, and then discontinue HRT when they no longer need it for symptom control. Most experts agree that taking HRT for five years or less poses little or no danger.

To control menopause symptoms, HRT should start when the symptoms begin.

For Its Protective Benefits

If you decide to take HRT for protection against osteoporosis:

• The greatest protection against osteoporosis is obtained when HRT is started soon after menopause.
• HRT should be started within five years of menopause in order to have any significant effect on bone density.

Is It Ever Too Late To Start?

Opinions differ among experts on whether it is ever too late to start HRT. Most agree that in order to have a significant effect in preventing osteoporosis, it should be started within five years of menopause.

What Should You Expect When Beginning HRT?

Hormone replacement therapy can cause some side effects, most of which are temporary. Some forms of combination therapy, in which women take both estrogen and progesterone, can cause monthly bleeding similar to a period.

Minor Side Effects

Some women who begin hormone replacement therapy experience side effects. Most of the side effects are temporary and will go away within several months. They include:

• Bloating and fluid retention
• Nausea
• Breast tenderness (can be relieved with over-the-counter pain relievers)
• Vaginal bleeding (may require ultrasound studies and biopsies of the tissue in the uterus)

Monthly Bleeding

When hormone replacement therapy first started, women were given estrogen alone. This was later shown to increase their risk of certain types of cancer. In response, combination therapy was introduced, with women taking both estrogen and progesterone.

Earlier combination therapy caused women to bleed lightly once a month, in a fashion similar to menstrual periods, although the flow generally is lighter. Today, a new form of HRT is available that combines estrogen and progestin. It eliminates monthly bleeding in the vast majority of women.

The Importance Of Regular Checkups

If you are taking HRT, you should have regular medical checkups. The American College of Obstetricians and Gynecologists recommends that all women taking HRT get a medical checkup every year. The exam should include:

• A check of your blood pressure
• A pelvic exam
• A clinical breast exam
• A mammogram

How Long Should HRT Continue?

Because of possible increased risks for breast cancer with long-time use, some doctors suggest stopping HRT after about 10 years.

The problem with this approach is that the protective benefits from HRT can decline and eventually disappear. For women who take HRT because they are at higher risk for osteoporosis, this may not be the best option.

Hormone Replacement Therapy: Frequently Asked Questions

Here are some frequently asked questions related to hormone replacement therapy.

Q: If I have none of the risk factors, should I still take hormone replacement therapy?

A: A decision that is right for one woman may not be right for another, so the answer is different for each person. The decision would depend on what a woman hopes to get from HRT, such as relief of menopause symptoms. All of the pros and cons have to be balanced against each other.

Q: Will hormone replacement therapy make me gain weight?

A: According to a long-term study reported in the Journal of the American Medical Association, hormone replacement therapy did not result in weight gain. However, regardless of whether they are taking HRT, women are more likely to gain some weight with aging. A good diet and regular exercise can help avoid this.

Q: I’m considering adding soy to my diet. What’s the right amount?

A: Many experts recommend about 40 grams of soy protein a day. Soy protein is available in powdered form as well as in foods such as tofu or soybeans.

Q: Is menopause considered an illness or disease?

A: Menopause is a naturally occurring event and is not an illness or medical condition. There is nothing abnormal about menopause.

Q: My mother and sister both went through menopause in their mid-40s. Will it happen it me, too?

A: Although the average age for menopause is 50, it can occur at any time between the mid-30s to the late 50s. There does seem to be a pattern in families. If your close female relatives have had an earlier menopause, it is more likely that you will, too.

Q: Is contraception necessary if taking HRT?

A: After menopause, when her periods have completely stopped, a woman is no longer fertile. However, some women begin HRT while they are still having periods, in order to relieve menopause symptoms. Those women could become pregnant and will need contraception. Monthly bleeding as a result of HRT does not imply that pregnancy is possible.

Q: Are any tests required before HRT is started?

A: A general medical checkup is recommended to determine if a woman has any risk factors that may contraindicate HRT. A routine exam should include a check of blood pressure, breasts, abdomen, and pelvis.

Hormone Replacement Therapy: Putting It All Together

Here is a summary of the important facts and information related to hormone replacement therapy.

• Hormone replacement therapy (HRT) has been shown to be effective in reducing troublesome symptoms of menopause, such as hot flashes, vaginal dryness, and disrupted sleep.
• A woman’s natural production of estrogen does not usually stop suddenly, but decreases over a period of several years.
• Lack of estrogen contributes to the risk of osteoporosis. HRT reduces the risk of this serious health problems and provides other health benefits.
• HRT has potential risks and is not right for everyone. Women should weigh the benefits against the risks in order to decide if HRT is right for them.
• HRT is available in several different forms, including tablets, skin patches, injections and creams.
• Some women experience side effects when beginning HRT, but they are usually short-lasting and can be managed.

Hormone Replacement Therapy: Glossary

Here are definitions of medical terms related to hormone replacement therapy.

Alzheimer’s disease: A type of dementia that causes confusion, memory failure, speech disturbances, and inability to function.

Androstenedione: One of the male hormones that is produced in small quantities in a woman’s body; the other is testosterone.

Bladder: The sac within the body that stores the urine.

Blood pressure: The pressure that circulating blood places on the walls of the arteries, the veins, and the chambers of the heart.

Breast self-examination: A procedure that women use to examine their breast for lumps, involving feeling breast tissue with the fingers and visually examining the breasts.

Cardiovascular disease: Any abnormal condition caused by problems with the heart and blood vessels; it is the leading cause of death in the U.S.

Chemotherapy: The treatment of cancer with chemical agents.

Cholesterol: A fat-like substance normally present in the bloodstream and needed for the development of body cells. Cholesterol is both produced by the body and found in animal foods. Although it is a necessary substance, if levels of cholesterol are too high, it can be deposited on artery walls, eventually narrowing or blocking blood flow. There are two types of cholesterol, know as “bad cholesterol” (LDL) and “good cholesterol” (HDL).

Clinical breast exam: An examination of the breasts by a health care provider.

Colorectal cancer: Cancer of the large intestine and/or rectum, characterized by a change in bowel habits and passing blood in the stool.

Dementia: A progressive mental disorder characterized by personality changes, confusion, disorientation, diminished intelligence, and impaired memory and judgment.

Endometrial cancer: One of the types of cancer of the uterus, from the lining of the cells of the uterus.

Endometriosis: An abnormal condition in which tissue from the uterus grow in other locations in the body, causing pain and infertility.

Estrogen: A female hormone made by the ovaries that plays an important role in the reproduction process and promotes the development of female sex characteristics.

Fallopian tubes: The tubes that lead from each ovary to the uterus, through which the eggs produced in the ovaries travel.

Fibroids: A noncancerous muscle growth that most often occurs in the wall of the uterus.

Gallstones: A noncancerous stone that forms in the gall bladder, causing pain and sometimes requiring surgery

Hormone replacement therapy (HRT): A treatment for women who have reached or passed menopause that involves taking small doses of the female hormone estrogen.

Hot flashes: A sensation of warmth, particularly in the face and neck, in women during or after menopause.

Hysterectomy: The surgical removal of the uterus; occasionally the ovaries are removed as well.

Incontinence: The involuntary release of urine.

Mammogram: The x-ray image of the breast produced with mammography.

Mammography: A low-dose x-ray examination of the breast that can spot cancers as small as a grain of table pepper.

Menopause: The period in a woman’s life when her menstrual periods end; often referred to as the “change of life.”

Menstrual periods: The periodic discharge of blood and tissue from the uterus in a monthly cycle.

Menstruation: The monthly discharge through the vagina of blood and tissue from the shedding of the lining of a nonpregnant uterus.

Night sweats: Hot flashes that happen at night and can be accompanied by sweating.

Osteoarthritis: A form of arthritis in which the a joint degenerates, usually due to “wear and tear,” causing pain and restricting movement.

Osteoporosis: A disorder in which the bones become porous, fragile, and susceptible to fracture; it is a major cause of pain and disability, particularly in older women.

Ovaries: The pair of reproductive organs in women that produce eggs and the female sex hormones.

Pelvic exam: The examination of a woman’s reproductive system, externally and internally, by a health care provider.

Postmenopausal – After the onset of menopause.

Progesterone: A female hormone made by the ovaries that plays an important role in the reproduction process.

Progestin: The artificial form of progesterone that can be taken by mouth or injection as a hormonal supplement.

Radiation therapy: The use of high-powered x-rays to destroy cancer cells.

Soy: A type of food made from beans and available in various forms in most grocery stores that has high nutritional value.

Testosterone: One of the male hormones that is produced in small quantities in a woman’s body; the other is androsterone.

Thromboembolism: A condition in which a blood clot forms inside a blood vessel.

Urethra: The passageway through which urine passes from the bladder to the outside of the body.

Urinary tract infection: An infection of one or more structures within the urinary tract that can cause frequent urination, burning, and pain.

Uterus: Also called womb, it is the part of a women’s reproductive system where a developing baby grows.

Hormone Replacement Therapy: Additional Sources of Information

Here are some reliable sources that can provide more information about hormone replacement therapy.

The American College of Obstetricians and Gynecologists (ACOG) offers the following pamphlets: “Hormone Replacement Therapy,” “Preventing Osteoporosis,” and “The Menopause Years.” To obtain copies, send a self-address envelope to:

ACOG 
Phone: 1-800-762-2264
http://www.acog.org

The American Association of Retired Persons (AARP) Women’s Initiative has a fact sheet entitled “Hormone Replacement Therapy: Facts to Help You Decide.” 
Phone: 1-800-424-3410

The North American Menopause Society( NAMS) 
Phone: 440-442-7550
http://www.menopause.org

Johns Hopkins Medicine 
http://www.hopkinsmedicine.org

Meriter Hospital in Madison, Wisconsin, publishes a Web page entitled “Plant-based Therapies and Herbal Remedies,” which discusses other options for relief of menopause symptoms. The information can be found at http://www.meriter.com/living/library/women/hormone/menopa.htm.