Ask An Expert: Hormone Replacement Therapy

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Ask An Expert: Hormone Replacement Therapy

Question:

What is the oldest age a woman can still take low-dose birth control pills as a form of HRT if no problems exist?

Answer:

Hormone treatment after menopause is controversial. Decisions regarding its use should be made with a doctor after a thorough review of your risks and benefits.

Estrogen treatment can relieve uncomfortable symptoms associated with menopause, but it has also been linked to an increase in the risk of breast cancer, especially with prolonged use.

Menopause is a natural transition marking the end of the reproductive years. It does not require treatment unless disruptive symptoms occur. Hot flashes, insomnia, mood swings and vaginal dryness from decreased levels of estrogen occur in many women. All these symptoms usually improve with estrogen therapy. Hormone treatment should be given in the lowest dose required to relieve the symptoms in order to minimize the risks.

Birth control pills contain estrogen, but in a much higher dose than is usually needed to relieve menopausal symptoms. The higher dose is necessary for contraception to suppress the premenopausal ovaries from releasing an egg. Because pregnancy prevention is not necessary after menopause, the lower dose of estrogen in replacement therapy is much safer. Unless a woman has had a hysterectomy, I recommend that she take progesterone with estrogen to avoid the risk of uterine cancer, which increases when estrogen is taken alone.

Joan Bengtson, M.D., is assistant professor of obstetrics, gynecology and reproductive biology at Harvard Medical School and a member of the Department of Obstetrics, Gynecology & Reproduction at Brigham and Women's Hospital.

Last updated:	June 07, 2007