(Published in the August 2008 issue of Menopause Flashes)
Various terms are used to describe prescription hormone therapies that have been approved in the United States and Canada for the relief of menopause-related symptoms and to decrease long-term health risks across the menopause transition and beyond. The following terms from The North American Menopause Society should help provide consistency and clarity when discussing hormone therapy:
- Estrogen therapy (ET) has been widely studied and used for more than 50 years by millions of women for menopause-related symptoms. A variety of estrogen types, delivery systems, and dosage strengths provide options that enable a woman, in consultation with her healthcare provider, to select the one that is best for her. ET is generally prescribed only for women who do not have a uterus because ET stimulates the uterine lining to thicken and increases risk for uterine cancer (see EPT below).
- Estrogen-progestogen therapy (EPT) is a combination of estrogen and progestogen (either natural progesterone or synthetic progestin). Although evidence suggests that the benefits of EPT are almost entirely due to the estrogen, the addition of progestogen is recommended for women with a uterus. The progestogen counteracts the negative effects of estrogen on the lining of the uterus. Various dosing schedules (often called “regimens”) can be used for menopause-related symptoms. These regimens include taking estrogen and progestogen separately or through convenient combination EPT products. Like ET, they provide an opportunity for each woman to explore different options with her clinician and to determine which is best for her.
- Hormone therapy (HT) is a generic term that encompasses both ET and EPT.
- Progestogen therapy is sometimes used alone during perimenopause to treat symptoms such as hot flashes, to manage abnormal uterine bleeding, or to counter “estrogen dominance” that can occur in some women as estrogen levels fluctuate to high levels or women no longer ovulate. There are various progestogen options that can be tailored to a woman’s unique needs.
- “Systemic” HT refers to hormone therapy administration resulting in blood levels of hormones that are high enough to affect many parts of the body. “Local” HT refers to vaginal estrogen therapy that attempts to deliver only enough estrogen to affect tissue in the vagina and surrounding urogenital area.
ET and EPT are the only pharmacologic therapies approved in the United States and Canada for treating menopause-related symptoms.
Both EPT and ET should definitely be considered when menopause symptoms interfere with a woman’s quality of life. Nothing works as well as hormone therapy to relieve moderate to severe hot flashes, night sweats, and the ensuing sleep disturbances. For these symptoms, prescription systemic HT in the form of pills, skin patches, topical preparations, or a vaginal ring is recommended.
Local ET is also the most effective treatment for moderate to severe vaginal dryness and vaginal atrophy, a condition in which the lining of the vagina becomes thinner, less elastic, and more prone to irritation and/or inflammation. For vaginal symptoms alone, a local ET product, such as a vaginal cream, tablet, or ring, is recommended by NAMS.
Literally hundreds of clinical studies have provided evidence that systemic HT relieves menopause symptoms. Hormone therapy should always be taken at the lowest effective dose and for the shortest amount of time consistent with treatment goals, which are determined individually for each woman. The goal is to provide maximum benefit, including symptom relief, while minimizing the risks associated with hormone therapy.
As with any medical therapy, the decision to use hormone therapy should be made by a woman in consultation with her healthcare provider, based on:
- Underlying cause of her symptoms
- Age
- Disease risk factors with and without hormone therapy
- Preferences
- Cost of treatment options
- Impact of symptoms on her quality of life
An informed decision about menopause-related symptom relief also includes knowledge of the risks and benefits of other prescription therapies, complementary and alternative medicine (CAM) approaches, and lifestyle strategies, as well as awareness of the option to do nothing at all and let the symptoms take their natural course—which for most women means resolution over time.
Read more about perimenopause and menopause symptom relief in the NAMS Menopause Guidebook and Early Menopause Guidebook.
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