HRT and Dementia

By: Rachel Calderon
By: Rachel Calderon

A study published in the Journal of the American Medical Association is once again putting Hormone Replacement Therapy (HRT) in the spotlight. Last summer, women participating in a study on HRT were told to stop taking it after researchers found it was linked to heart diseases, stroke and cancer. Now a study found it could be linked to Alzheimer's disease or other forms of dementia. One local doctor says this should not be a reason for women to stop HRT.

"If you're on HRT, you should see your doctor to make sure you're only using it for a short period of time: less than 5 years. It can treat symptoms like hot flashes, night sweats and vaginal dryness, but you need to see your doctor to find out if you're on the lowest possible dose." Dr. Thomas Petroff, D.O., DeWitt Women's Health.

Some experts say the number of women that faced the probable risk was so small (60 in a study of 4,500), women are highly encouraged to see their physicians before they stop HRT completely.

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What Is Hormone Replacement Therapy?

Doctors usually prescribe HRT, which combines estrogen and progestin (a form of progesterone). Estrogen can and should be used alone (estrogen replacement therapy or ERT) for women who have had their uterus, including the cervix, removed (by hysterectomy).

Estrogen alone comes in many forms. You can use the pill or tablet form, vaginal creams, vaginal ring insert, implants, or shots. There are also patches that stick to the skin.

The body absorbs estrogen from the patch through the skin. Progestin usually is taken in pill form, sometimes in the same pill as the estrogen. It is also available as an IUD (intrauterine device), a vaginal gel, and shots.

The form your doctor suggests may depend on your symptoms. For instance, estrogen creams are used for vaginal dryness.

The vaginal ring insert treats vaginal dryness and may help urinary tract symptoms, such as problems holding urine. Pills or patches, however, are used to provide additional relief from menopause symptoms such as hot flashes or to prevent bone loss.

There are different schedules for taking HRT in pill form. You could take estrogen every day for a set number of days, add progestin for 10-14 days, and then stop taking one or both for a specific period of time.

You would repeat the same pattern every month. This cyclic schedule often causes regular monthly bleeding like a light menstrual period.

Or you could take estrogen and progestin together every day of the month without any break. This continuous pattern can stop monthly bleeding after about six months of treatment. However, problem spotting may continue for longer. Talk with your doctor about the schedule that is best for you.

The Pros and Cons

Pros

  • Reduce the risk of osteoporosis.
  • Relieve hot flashes and night sweats.
  • May reduce the risk of heart disease.
  • May improve mood and psychological wellbeing.

Cons

  • Increases the risk of cancer of the uterus (endometrial cancer).
  • Can have unpleasant side effects, such as bloating or irritability.
  • HRT and ERT may increase risk of breast cancer; long-term use may pose the greatest risk.
  • In women at risk of blood clots, HRT and ERT may be dangerous.

Source: http://www.aoa.dhhs.gov/aoa/pages/agepages/hormone.html (National Institute on Aging).


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