The following are frequently asked questions of healthcare providers.

If you have questions that are not addressed here, please e-mail them to communications@arhp.org

Q: Should I stop taking HRT?

A: The recently published research from the Women's Health Initiative (WHI) found a small but real increased risk for a number of serious health conditions among women who used combination hormone therapy (CHT), and this increased risk became evident after one year of use. This was a very large study that compared a group of postmenopausal women who were using CHT with another group of similar women who were not using CHT. More cases of coronary artery disease, stroke, breast cancer, blood clots, and dementia occurred in the women using CHT than in the women who were not. We still have much to learn before we fully understand what produced these findings or what they mean for a specific woman. Questions have also been raised about whether hormone therapy offers some protection against osteoporosis. Recent studies confirm that it does reduce the risk of osteoporosis by about one third in healthy postmenopausal women.

Hormone therapy remains an effective treatment for hot flashes, night sweats, and insomnia associated with menopause, and a decision about whether to use it may depend on how distressing those symptoms are to you. You may want to consider a new formulation of CHT that contains lower doses of estrogen and progestin than the one used in the WHI, or try tapering off therapy to lessen the chance of sudden or severe recurrence of hot flashes or other symptoms.

You should remain on hormone therapy only as long as necessary to manage severe menopausal symptoms. We can discuss alternative approaches to lessening these symptoms and protecting you against osteoporosis. \

Q: Does hormone therapy cause cardiovascular disease and/or breast cancer?

A: The results of the WHI study clearly showed a small, but real increased risk among users of combination hormone therapy. This increased risk was greatest following one year of use. It is not known if hormone therapy alone can cause cardiovascular disease or breast cancer, or if it is only one factor that can contribute to the development of these conditions. Some women may be at greater risk than others but at this point we do not know how to identify those women.

Q: I am on an estrogen only hormone therapy. Am I at risk?

A: The WHI study has not found an increased risk of breast cancer or other serious health problems in women taking estrogen alone.

Q: What can I do to prevent osteoporosis if I quit taking hormone therapy?

A: There are a number of things you can do to help maintain bone health, and alternatives to hormone therapy that are very effective in protecting against bone loss:

• Make sure you have adequate calcium and vitamin D intake. Women ages 19-50 should receive at least 1500mg of calcium and 400 IU of vitamin D every day.
• Don't smoke.
• Engage in regular weight-bearing exercise.
• For the patient who is 65 or otherwise at risk for osteoporosis:
• Monitor height.
• Order a bone density test. The National Osteoporosis Foundation recommends that all women aged 65 and older have a bone density test, as well as younger postmenopausal women who may be at high risk and any postmenopausal woman who breaks a bone, since osteoporosis may be the cause.
• Prescribe drug treatment as appropriate.

Keeping Your Heart Healthy

• Don't smoke; if you do, seek medical advice and treatment to help you quit
• Know your blood pressure and seek medical advice and treatment for elevated blood pressure
• Know your cholesterol profile and seek medical advice and treatment if your cholesterol profile is not normal
• Exercise regularly
• Maintain a healthy weight

Preventing Osteoporotic Fractures

• Make sure you have adequate calcium and vitamin D intake - for women ages 19-50, at least 1500mg of calcium and 400 IU of vitamin D every day
• Don't smoke; if you do, seek medical advice and treatment to help you quit
• Engage in regular weight-bearing exercise
• Talk to your healthcare provider about testing bone density at your spine and hip
• Ask if those performing and reviewing your bone density scans are certified

If Your Bone Density is Low (Osteoporosis or Osteopenia) Ask Your Healthcare Provider About the Following:

• Calcium carbonate (such as Tums or OsCal)
• Calcium citrate (such as Citracal)
• Calcium phosphate (such as Posture)
• Alendronate/Risedronate sodium (Fosamax or Actonel tablets)
• Estrogen/Progestin therapy
• Raloxifene (Evista tablets)
• Calcitonin (Miacalcin shot or nasal spray)

If You Are Experiencing Vaginal Dryness/Discomfort

• Use lubricants (e.g. KY-Jelly, Astroglide) every time you have sex
• Talk with your healthcare provider about the Estrogen Ring (Estring), tablets (Vagifem) and Creams (Premarin, Estrace) to help treat this condition without causing high estrogen levels in your circulation

If you are experiencing Hot Flashes, Night Sweats, or Insomnia Related to Menopause

Even with the recent study findings, menopausal hormone tablets and patches continue to represent the most effective treatment for these symptoms. Use of hormones for menopausal symptoms continues to make sense for many women.