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Menopause 101

How to Choose Estrogen

©2006 Publications International, Ltd.
Estrogen pills are the most common method for taking replacement estrogen.

Most women are confused about which form of estrogen is best--and with good reason. There are many forms of estrogen and progesterone -- pills, patches, injections, suppositories, and implants. Furthermore, there are many different brands and chemical formulas of both hormones, and more brands and forms will become available in the future. There is no way of making this subject, or the choice, simple. First, we will consider the different delivery methods. 

  • Estrogen pills: Most American women on HRT take estrogen in pill form. Most pills are taken more or less daily. They are convenient for most women and are usually less expensive than some of the other forms of estrogen. Some women experience side effects (spotting, flashes, headaches) from the "peak" blood level of estrogen, which usually occurs several hours after a pill is taken, and from the "trough," which occurs before the next pill is absorbed. The peaks and troughs and duration of action vary with different pills.

  • Estrogen patches: Estrogen is also available in patch form. Estrogen patches can make the rise and fall in blood levels of estrogen more gradual; hence, they may be better for women who get headaches or flashes from daily fluctuations in hormone levels. They are normally used every few days (once or twice weekly) and are nice for women who forget to take pills, since the presence of a patch serves as a reminder to change the patch. Skin irritation from the patch can be a problem, and sometimes the patch may fall off when you sweat.

  • Estrogen gels and creams: Estrogen is available in gel and cream form both over the counter and by prescription. Over-the-counter gels and creams are not regulated by the FDA and have not been tested for safety. These products are usually used once or twice daily.

  • Estrogen injections: Injections are not widely used or widely available in the United States, but they may become more popular in the future. Injections, usually weekly or monthly, provide more even blood levels of the hormones. They also eliminate the problem of having to remember your pill or keep track of your patch. However, they can require a visit to the doctor's office and may provide higher hormone levels than necessary.

  • Estrogen vaginal creams: Estrogen vaginal cream can help with sexual lubrication, bladder irritation, and infection brought on by the thinning of the bladder wall. In theory, all of the potential side effects of estrogen can apply to vaginal use. In practice, however, the amount absorbed is a fraction of what would be absorbed through standard HRT.

  • Estrogen pellets: A health care practitioner inserts these small pellets of long-acting estrogen under the skin. They are not widely used because they require an office visit for insertion, and there are concerns about the safety of potentially high estrogen levels.

Another consideration is whether you want your HRT regimen to be "cyclic" or "continuous." Combination estrogen/progestin therapy, used by women who have a uterus, can be taken in several ways. The most popular method is called "continuous combined hormone therapy," in which estrogen and progestin are put into a single product -- pill, patch, gel, or cream. This method is simple, ensures an appropriate balance of hormones, and minimizes the risk of endometrial cancer; breakthrough bleeding (spotting) is a common side effect.

Many estrogen products, however, do not contain progesterone; hence, women must take two different products cyclically. Many women and their doctors prefer to use less frequent progestin at regular intervals -- also called a pulsed regimen -- for 12 to 14 days. This counteracts any uterine lining buildup stimulated by the estrogen. Depending on the estrogen dose and your risk factors for endometrial cancer, doses of progestin may be cycled as often as once a month or as infrequently as every six months. Talk with your doctor about the different methods -- and benefits and risks associated with each -- of taking HRT.

Reevaluate the Decision

Once you have made a decision about HRT, don't just continue indefinitely on autopilot! New information becomes available all the time about the pros and cons of HRT. New doses and routes of administration will arise that may be favorable for your lifestyle or risk factors. Also, a new health condition may increase the risks of either taking or not taking HRT.

Ask your doctor about your situation at annual visits. Some doctors, if you don't ask, will not raise the issue and will either automatically refill your existing prescription or not mention the possibility of starting HRT if you aren't already taking it. A woman who was not previously sexually active but is now may benefit from the vaginal lubricating effects of estrogen.

At five-year intervals, women should very thoroughly take stock of their hormone therapy. Update your family and personal history with your doctor, and see if there is new information that may be significant for you.

Hormone therapy is not the only treatment for menopause. On the next page, we'll take a look at some nonhormonal treatments for menopause.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.