Estrogen Replacement Therapy (ERT) and Hormone Replacement Therapy (HRT)

Estrogen is the oldest and most commonly used therapy for osteoporosis. By replacing lost estrogen, women can prevent the bone loss that occurs during menopause.

Estrogen is most effective if you start taking it right after menopause begins and use it continuously. It can also build bone density well past menopause. Many women who are on estrogen must also take an additional osteoporosis drug to build up the bone density.

Many types of HRT are available. Because estrogen alone can increase the risk of cancer of the endometrium (uterus lining), women who have not had a hysterectomy should take a combination therapy, which pairs estrogen and progestin.

If you have had a hysterectomy (removal of the uterus), you can take estrogen alone since there is no danger of endometrial cancer. Many women prefer the skin patch because they don’t have to remember to take a pill and sometimes there are fewer side effects.

Pros:

ERT/HRT can increase bone density in the hip and the spine and reduces fractures in postmenopausal women. You can take ERT/HRT as a pill or convenient skin patch.
ERT/HRT can be effective at building bone density even if started later in life
ERT/HRT relieves menopausal symptoms such as hot flashes, difficulty sleeping, dry skin, and vaginal dryness
ERT/HRT increases HDLs (good cholesterol carriers) and reduces LDLs (bad cholesterol carriers).
Some studies show that ERT/HRT may help maintain thought function and reduce the risk of colorectal cancer.
ERT/HRT is economical since generic brands are available.

Cons:

Some studies indicate a possible relationship between HRT/ERT and breast cancer.
Some women experience weight gain, headaches, breast tenderness, and high blood pressure
Women at risk for deep vein thrombosis (blood clots in the lower legs) should not take ERT/HRT.
Some studies have shown that the risk of heart attack goes up within the first two years of starting ERT/HRT.
ERT/HRT is not guaranteed protection against bone loss. Many women on estrogen must also take an additional osteoporosis drug to build bone density.

When considering ERT/HRT, it is very important that your doctor spends time with you discussing the potential benefits and risks, taking into account your medical history and your feelings about hormone replacement therapy.