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Hormone therapy (HT)
Hormone therapy has been shown to reduce bone loss, increase bone density in both the spine and hip, and reduce the risk of hip and spine fractures in post-menopausal women. HT is approved for the prevention of post-menopausal osteoporosis and is most commonly administered in the form of a pill or skin patch. When estrogen is taken alone, it can increase a woman's risk of developing cancer of the uterine lining (endometrial cancer). To eliminate this risk, physicians prescribe the hormone progestin in combination with estrogen (both estrogen alone and the combination fall under the umbrella of hormone therapy, or HT) for those women who have not had a hysterectomy. Side effects of HT include vaginal bleeding, breast tenderness, mood disturbances, venous blood clots, and gallbladder disease.
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The Women's Health Initiative (WHI), a large government-funded research study, recently demonstrated that HT with Prempro, a combination of supplemental estrogen and progesterone, is associated with a modest increase in the risk of stroke and heart attack. After five years, it is also associated with a small increased risk of breast cancer. The WHI also demonstrated that estrogen alone is associated with an increase in the risk of stroke. Another large study from the National Cancer Institute (NCI) indicated that long-term use of estrogen therapy may be associated with an increase in the risk of ovarian cancer. It is not yet clear whether HT carries a similar risk. Any estrogen therapy should be prescribed for the shortest period of time possible. When used solely for the prevention of post-menopausal osteoporosis, any hormone regimen should only be considered for women at significant risk of osteoporosis, and nonestrogen medications should be carefully considered.
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