Hormone Replacement Therapy (HRT) or estrogen/progesterone, is commonly used to relieve the symptoms of
menopause. However, because estrogen plays such an important role in maintaining bone, HRT is another option
to consider to prevent and treat osteoporosis, especially if you are also seeking relief from other symptoms
of menopause.
How does HRT work?
Following menopause, the body produces much less of the sex hormones estrogen and progesterone, resulting
in a loss of bone density. Estrogen/progesterone treatment is not intended to "replace" the loss of these
hormones, but to supplement these hormones to the lowest level required to prevent bone loss. Treatment can
consist of estrogen alone or estrogen and progesterone in combination.
How effective is it?
Estrogen/progesterone treatment increases bone density and prevents spine and hip fractures.
Who can take it?
Estrogen/progesterone is used to prevent osteoporosis in postmenopausal women, including women who have
experienced menopause before age 45 (early menopause.) Estrogen/progesterone is used to treat osteoporosis in
postmenopausal women.
How is it taken?
A dose of 0.625 mg of oral conjugated equine estrogen (or its equivalent) is taken each day. Unless you
have had a hysterectomy, progesterone is also taken to reduce the risk of developing uterine cancer.
Estrogen/progesterone are available in both pill and patch form and in a variety of regimens.
Are there side effects?
Side effects can include depression, headaches, breast tenderness, premenstrual syndrome, skin irritation
and weight gain. Menstrual bleeding may also occur. Experimenting with doses, types (pills, patches) and
regimens may help to eliminate (or minimize) these side effects.
There is an increased risk for breast cancer, stroke and cardiovascular disease in women who take
estrogen/progesterone for more than five years. Women using estrogen/progesterone are encouraged to establish
regular cardiovascular and breast health monitoring programs with their doctor. There is also an increased
risk of venous thromboembolism (blood clots), similar to that for women using raloxifene. The risk of
endometrial cancer is increased if estrogen is used without progesterone; however, this risk is minimized by
the addition of progesterone for women with an intact uterus.
The substantial risks for cardiovascular disease, stroke and invasive breast cancer may lead to an
unfavorable risk/benefit ratio with prolonged use of HRT when taken only for the treatment of postmenopausal
osteoporosis. Other options for treatment should be explored first.
