The Hormone replacement therapy in Houston technique is one of the treatments approved by the federal government for relief of menopausal symptoms. Menopause symptoms include hot flashes, sleep problems, and vaginal dryness, which are caused by lower levels of estrogen. HT is also approved by the FDA for osteoporosis prevention. Since 2002, clinicians prescribe much lower doses for much shorter periods of time (3-5 years) than in the past.
I will give some background information on menopausal HT before we talk about its benefits and risks.
The natural menopause consists of the following three stages:
- Menopause transition (perimenopause) refers to the period between the start of symptoms (such as irregular periods) and one year after the last menstrual period.
- The first menstrual period following the cessation of menstruation is considered menopause.
- The postmenopausal years are all those following menopause.
HT can be divided into two types:
- Estrogen-only therapy is known as ET. Estrogen is the main hormone responsible for reducing menopausal symptoms. When a woman has had a hysterectomy, she cannot have a uterus.
- A combined estrogen and progestogen therapy is called EPT. Progestogen is added to ET to prevent uterine cancer (endometrial cancer) in women with uteruses.
You can take HT in two ways:
- All parts of the body are reached by systemic products, which circulate through the bloodstream. Oral tablets, patches, gels, emulsions, sprays, and injections can be used to treat hot flashes, night sweats, vaginal symptoms, and osteoporosis.
- A localized (non-systemic) product affects only the affected part of the body. Creams, rings, or tablets are available for the treatment of vaginal symptoms.
Current prescribing practice:
The lowest effective dose should be used for the shortest time consistent with their individual goals. When women begin HT close to menopause (typically ages 50-59), the benefit-risk ratio is favorable, but becomes riskier with time since menopause and advancing age.
If there is no reason not to take HT until the age of menopause at 51 for women with early menopause before age 40, without a history of breast cancer risk.
Each woman will receive an individualized treatment plan from her doctor. Treatments are not standardized.
Hundreds of clinical studies provide evidence that estrogen therapy (estrogen with or without progestogen) provides effective relief from conditions such as hot flashes, vaginal dryness, night sweats, and skeletal degeneration. They can also improve quality of life, sleep, and sexual relations.
HT is primarily used for hot flashes, night sweats, vaginal dryness, and osteoporosis prevention.
It is recommended to use HT at the lowest effective dose for the shortest time period possible in order to minimize serious health risks. The real concern about hormone safety arises from prolonged use of systemic ET or EPT.
Women’s Health Initiative (WHI) trials in 2002 forced the US Food & Drug Administration and Health Canada to mandate that all prescription estrogen-containing products carry a “black box” warning with information about the risk of HT use. Though Premarin and Prempro were the only products studied in the WHI, the risks of all HT products, including “natural” bioidentical and compounded hormones, should be presumed to be similar until further evidence suggests otherwise.
The majority of breast cancer risks are associated with EPT. A stroke as well as an increase in blood clots in the veins have been associated with ET and EPT. Women over 60 are at higher risk for these conditions.
The combination of progesterone and estrogen is needed to protect women with uteri from uterine cancer.
Weighing the risks and benefits
There is no single way to achieve the best possible quality of life during and after menopause. Women must weigh their discomfort against their fear of treatment. The term risk is defined as the possibility or chance of harm; it does not indicate that harm will occur. HT risks are generally lower in younger women than they were originally reported to be in women ages 50 to 70 combined. It is now thought that women who have had their uterus removed by hysterectomy and take estrogen alone have a better benefit-risk profile than those taking EPT. It is especially true for younger menopausal women (in their 50s or within 10 years of menopause) than for older women.
As more research has been conducted, medical professionals have changed their view of hormones. However, much remains to be learned. Even though recent studies such as the WHI have provided some clarity to large populations, they do not necessarily address every issue an individual woman faces. That is up to her, with the help of her healthcare providers.
Women will consider many factors when deciding whether or not to use a particular hormone product, including their age, their risks, their preferences, available treatment options, and the cost. Does the potential benefit outweigh the potential risk? It is only after an in-depth consultation with her clinician and after carefully examining and understanding her own situation that a woman can make the best treatment decision. It is essential to reevaluate and adjust the treatment plan as new therapies and guidelines become available, as well as as the body changes over time.