When women think about hormone replacement therapy (HRT), they may immediately imagine pills taken every morning to curb the worst menopause symptoms. Hormone replacement therapy is available in forms other than pills. With patches and creams, the options are less limited than ever before. Therapies are also available in estrogen only and combination therapies.

Estrogen Only Hormone Replacement Therapy (ERT)
The most common form of hormone replacement therapy is estrogen only. Estrogen can be delivered in pill, patch, and cream. Injections and pellet implants are also available. Pills, patches and pellets are considered “systemic” therapy meaning they work within the body to relieve menopause symptoms. Common names in “systemic” therapy include Premarin, Estratab, Vivelle, Vivelle Dot, and Estraderm.

Local ERT utilizes creams, rings, and tablets inserted into the vagina. Local ERT provides only a small amount of estrogen to the body and are typically used to treat local menopause problems like vaginal dryness.

Potential Side Effects and Risks of “Systemic” ERT
Hormone replacement therapy comes with a long list of potential side effects and risks including uterine bleeding, gallbladder diseases and stones, pancreatitis, blood clots, and heart disease. Other problems associated with HRT can include breast tenderness, nausea, fluid retention, and dizziness.

Combination Estrogen / Progesterone Therapy
When a woman does not find relief from severe menopause symptoms with estrogen alone, progesterone may be added to her HRT. Combining estrogen replacement therapy with progesterone is a trial and error process with several delivery options. Doctors can choose to cycle between progesterone and estrogen, administer progesterone 10 to 14 days a month, or continuously supply progesterone to the body as needed.

Progesterone comes with increased risk of endometrial cancer and thus should not be used by women who have a history of cancer or abnormal pap smears with precancerous or cancerous cells.

To Take HRT or Not Take HRT
Women who enter menopause earlier in life tend to use HRT for the first few years after the change of life. HRT can greatly reduce menopause symptoms and bone loss. The risks associated with HRT and ERT are high, so some doctors are choosing alternative therapy education in patients with mild menopause symptoms.

Many women live in menopause without hot flashes, mood swings, and other common menopause problems without using HRT. The choice is ultimately one a patient and doctor will have to make together. Women should be informed, however, of the higher risk of life threatening conditions associated with the therapies prescribed before taking any ERT or HRT.