Hormone Replacement Therapy: A Look at the Options
Estrogen Only (ERT)
Estrogen Plus Progesterone (HRT)
- Cyclic HRT —This treatment provides estrogen for 25 days each month, adding progesterone on the last 10-14 days out of 25, followed by 3-6 days of no therapy. This way, both hormones are "cycled." Cyclic HRT may cause uterine bleeding (a menstrual period) when the progesterone cycle ends. Hot flashes are also more likely to return on the days when no hormones are taken.
- Continuous-Cyclic HRT —This treatment provides estrogen every day, with progesterone added 10–14 days of each month. Like cyclic HRT, the main side effect is uterine bleeding (in the form of a period).
- Continuous-Combined HRT —This treatment provides both estrogen and progesterone every day. The daily dose of progesterone is much lower than the daily dose in cyclic therapy, which may result in a lower total dose over the course of the month. Breakthrough uterine bleeding occurs in some women on this schedule, but usually stops within the first year of therapy.
- Intermittent-Combined HRT —This treatment provides estrogen every day, with progesterone added intermittently in "on-off" cycles. The cumulative monthly dose of progestogen is about half of that of a continuous-combined pattern. .
Weighing Your Options
American Congress of Obstetricians and Gynecologists http://www.acog.org/
Menopausal Hormone Therapy Information http://www.nih.gov/PHTindex.htm/
The Canadian Women's Health Network http://www.cwhn.ca
The Society of Obstetricians and Gynaecologists of Canada http://www.sogc.org/
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FAQs: Hormone therapy basics. North American Menopause Society website. Available at: http://www.menopause.org/for-women/expert-answers/faqs-hormone-therapy-basics . Accessed August 16, 2012.
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Hormone replacement therapy. WomensGuide.org website. Available at: http://womensguide.org/menopause/hrt.html. Accessed August 16, 2012.
Hormones and menopause. National Institute on Aging website. Available at: http://www.nia.nih.gov/health/publication/hormones-and-menopause . Updated April 25, 2012. Accessed August 16, 2012.
Progestins. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated May 16, 2011. Accessed August 16, 2012.
9/16/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Huang A, Yaffe K, Vittinghoff E, et al. The effect of ultralow-dose transdermal estradiol on sexual function in postmenopausal women. Am J Obstet Gynecol. 2008;198:265.e1-7.
11/19/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Buster JE, Koltun WD, Pascual ML, Day WW, Peterson C. Low-dose estradiol spray to treat vasomotor symptoms: a randomized controlled trial. Obstet Gynecol. 2008;111:1343-1351.
- Reviewer: Brian Randall, MD
- Review Date: 08/2012 -
- Update Date: 08/16/2012 -
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