MANAGEMENT OF HORMONE REPLACEMENT THERAPY SIDE-EFFECTS

Side effects of hormone replacement therapy (HRT) may keep a significant number of women from continuation of therapy. These include breast tenderness; edema or bloating; premenstrual syndrome (PMS)-like symptoms such as headache, irritability, depression, and lethargy; and withdrawal bleeding. With the many different progestogens and regimens available, therapy should be individualized to meet the patient's need. Each has its advantages and disadvantages, but it is sometimes possible to eliminate withdrawal bleeding. The continuous combined method of HRT may not be fully endometrium protective because cases of endometrial cancer are beginning to surface. There is increasing evidence that added progestogen may even protect the bones and the breast. When adequate dosages of estrogen are given, there is no adverse effect of HRT on lipids and lipoproteins over the long term. Side effects from added progestogens may be severe in a small percentage of women. However, by adding a mild diuretic, changing the type, dosage, route of administration, or the regimen, usually a progestogen can be found for symptom-free hormone replacement.