Hormone Therapy (HT) or estrogen/progesterone, is commonly used to relieve the symptoms of menopause. However, because estrogen plays such an important role in maintaining bone, HT is another option to consider to treat osteoporosis if you are also seeking relief from symptoms of menopause.
How Does Hormone Therapy Work?
Following menopause, the body produces much less of the sex hormones estrogen and progesterone, resulting in a loss of bone density. Estrogen/progesterone treatment is not intended to “replace” the loss of these hormones, but to supplement these hormones to the lowest level required to prevent bone loss. Treatment can consist of estrogen alone or estrogen and progesterone in combination.
How Effective is it?
Estrogen/progesterone treatment increases bone density and prevents spine and hip fractures.
Who Can Take It?
Estrogen/progesterone is used to treat osteoporosis in postmenopausal women who are also experiencing menopausal symptoms such as hot flashes and night sweats.
How is it Taken?
A dose of 0.625 mg of oral conjugated equine estrogen (or its equivalent) is taken each day. Unless you have had a hysterectomy, progesterone is also taken to reduce the risk of developing uterine cancer. Estrogen/progesterone are available in both pill and patch form and in a variety of regimens.
Are There Side Effects?
Side effects can include depression, headaches, breast tenderness, premenstrual syndrome, skin irritation and weight gain. Menstrual bleeding may also occur. Experimenting with doses, types (pills, patches) and regimens may help to eliminate (or minimize) these side effects.
There is an increased risk for breast cancer, stroke and cardiovascular disease in women who take estrogen/progesterone for more than five years. Women using estrogen/progesterone are encouraged to establish regular cardiovascular and breast health monitoring programs with their doctor. There is also an increased risk of venous thromboembolism (blood clots), similar to that for women using raloxifene. The risk of endometrial cancer is increased if estrogen is used without progesterone; however, this risk is minimized by the addition of progesterone for women with an intact uterus.
The substantial risks for cardiovascular disease, stroke and invasive breast cancer may lead to an unfavorable risk/benefit ratio with prolonged use of HT when taken only for the treatment of postmenopausal osteoporosis. Other options for treatment should be explored first.