Estrogen Replacement Therapy

What is estrogen replacement therapy?

Estrogen replacement therapy is a form of hormone replacement therapy (HRT). Women use estrogen replacement therapy to help control the symptoms of menopause. Menopause is the stage in a woman’s life when sex hormone levels fall and her menstrual period stops. Symptoms of menopause include hot flashes, night sweats, sleep problems, vaginal dryness, mood swings, anxiety, decreased sexual desire, fatigue, and headaches. Menopause can also cause changes that your doctor can detect with screening tests, such as thinning bones (osteoporosis).

The two main sex hormones that a woman’s body makes are estrogen and progesterone. Progesterone is primarily produced by the ovaries and, in pregnant women, the placenta. The ovaries produce estrogen. Estrogen is responsible for the female sexual characteristics. It is also important for many body processes, such as maintaining a healthy heart and bones.

A woman who has had her uterus removed by hysterectomy may receive estrogen alone for HRT. A menopausal woman who wants to minimize symptoms of menopause with HRT and still has her uterus must receive progesterone in addition to estrogen. Progesterone signals the uterus to shed its lining similar to a menstrual period. This decreases the risk of developing uterine cancer.

HRT is only one method of controlling the symptoms of menopause.You should discuss different treatment options with your doctor or healthcare provider to best understand which option is right for you.

Types of estrogen replacement therapy

Your doctor can prescribe estrogen in different forms. The choice of which form to use depends on your individual symptoms and circumstances. The forms of estrogen replacement therapy approved by the U.S. Food and Drug Administration (FDA) include:

• Oral tablets taken by mouth. Examples include conjugated estrogens (Premarin), esterified estrogens (Estratab, Menest), estropipate (Ogen), and estradiol (Estrace).
• Skin creams and gels applied to clean, dry, unbroken skin on your arms or legs. Never apply estrogen skin preparations to your breasts because breast tissue can change in response to estrogen. Estradiol (Estrasorb, Estrogel) is available in this form.
• Skin patches, or transdermal patches, applied to clean, dry, unbroken skin on your stomach, lower back, or buttocks. Estradiol is available as a skin patch under a variety of brand names, including Climara, Estraderm and Vivelle.
• Skin spray, or transdermal spray, applied to clean, dry, unbroken skin on your forearm. Estradiol (Evamist) is available as a spray.
• Vaginal creams applied directly into your vagina. Examples include conjugated estrogens (Premarin cream), estradiol (Estrace cream), and estropipate (Ogen cream).
• Vaginal rings inserted into the uppermost part of your vagina. They remain in place for 90 days at a time. Estradiol (Estring, Femring) is available as a vaginal ring.
• Vaginal tablets inserted into your vagina. Estradiol (Vagifem) is available in this form.

Other products

A variety of alternative products are available to treat menopause symptoms. It is important to know how these products differ from FDA-approved HRT.

• Bioidentical hormones. The term, bioidentical, means that they have exactly the same chemical structure as hormones made by your body. Bioidentical hormones are synthetic, or made in a laboratory. They look exactly like your body’s hormones, but they are man-made. Your body cannot tell the difference between a bioidentical hormone product and its own hormones. Proponents of bioidentical hormones believe this makes them safer and more superior than other forms of synthetic estrogen. However, there is not enough scientific evidence to support these claims.
• Herbal products. Herbal products also claim to be useful for treating the symptoms of menopause. However, the FDA does not regulate herbal products in the same way that it controls over-the-counter and prescription medications. The FDA regulates herbal products as foods, not drugs. As such, manufacturers do not have to prove that they work or that they are safe. In addition, their purity is not regulated and some products have been found to be contaminated with toxic substances. Always consult your doctor and pharmacist before using herbal products.