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Therapy Options
A woman who has had a hysterectomy can take estrogen without
the addition of a progestogen, since she is in no danger of
developing endometrial hyperplasia, or overgrowth of the uterine
lining, which may increase the risk of endometrial cancer. For
the majority of women who have not had a hysterectomy, however,
it will be necessary to take a progestogen along with the
estrogen. For convenience, oral products that contain both the
estrogen and progestogen are now being prescribed by many
physicians.
HRT Regimens
Since every women differs in how much oestrogen she may need,
the amount prescribed by her doctor may vary. The number of days
a woman will need to take oestrogen and/or progestogen may also
vary.
Therapy is most commonly taken in tablet form. Several regimens
and dosages are currently available, so treatment can easily be
individualized.
The tablet form can be given in one of two ways - either as a
cyclic-combined regimen or as a continuous-combined regimen. In
both methods, the estrogen portion is taken every day, so the
difference between the two methods is in the progestogen part.
Both methods reduce the risk of endometrial cancer, so the
choice can be made on the basis of each woman's preference.
In a cyclic-combined HRT regimen, the progestogen is taken for
approximately 10 to 14 days of every 28-day cycle. This mimics
the natural premenopausal estrogen-progesterone cycle, so the
lining of the uterus sheds each month, just as it would during a
normal menstrual period. This bleeding is called withdrawal
bleeding, since it occurs during the days when the progestogen
is withdrawn. The bleeding usually occurs at regular,
predictable times. Withdrawal bleeding seems a lot like
menstrual bleeding, but it is not the same. It doesn't mean that
your fertility has been restored. You should be aware that if
your periods had not stopped completely before you started HRT,
it is possible that you could become pregnant. In that case, you
should choose a nonhormonal method of contraception, such as a
diaphragm or a sponge. Your health care professional can give
you more information on what your options are. Withdrawal
bleeding is usually light. If it is heavy, it's probably an
indication that the dose needs to be adjusted, so you should
talk to your doctor.
In a continuous-combined HRT regimen, progestogen is taken every
day along wth the estrogen. Because the progestogen is never
"withdrawn," withdrawal bleeding often does not occur.
Some women do experience mild irregular bleeding when they first
begin a continuous-combined regimen, but this bleeding tends to
decrease with time until, for many women, it stops altogether.
The daily use of a progestogen prevents the uterine lining from
building up in the first place, which also provides a decreased
risk of endometrial hyperplasia and endometrial cancer like a
cyclic HRT regimen does.
If you are taking a continuous-combined regimen and you find
that you still have light bleediing or spotting during the first
few months, it might be a good idea to stay with it a while
longer, because the longer you remain on therapy, the more
likely it is that the bleeding will stop. And once the bleeding
does stop, it very rarely starts again.
Transdermal Estradiol
Patch
Transdermal skin patches are an alternative method of
administering estrogen. The thin patch is adhered to the skin
and releases a small amount of estradiol, a synthetic type of
estrogen, each day for about 4 days. After that time, the patch
is removed, and a new patch is applied. The estradiol is
absorbed by the skin directly into the bloodstream, where it
boosts circulating levels of estrogen to premenopausal levels.
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