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Even after you've decided to take estrogen replacement therapy (ERT), the decision-making isn't over. There are many types of estrogen therapy in many different forms -- pills, patches, suppositories, and more. The best type of hormone replacement therapy (HRT) depends on your health, your symptoms, personal preference, and what you need to get out of treatment. For example, if you still have your uterus, then estrogen will be given in combination with the hormone progestin.
Because the estrogen is absorbed right through the skin, don't let other people in your family touch these creams or gels. If they do, they could get dosed with estrogen themselves. For the same reason, make sure your hands are clean and dry after applying the medication.
When deciding what type of estrogen therapy to get, work closely with your doctor. While oral estrogen has been around for a long time and is well studied, some modes of taking hormone therapy are not. They may have lower risks or different risks that we don't know about yet. Your doctor should be up to date on the latest research.
Hormone replacement therapy is medication that contains female hormones. You take the medication to replace the estrogen that your body stops making during menopause. Hormone therapy is most often used to treat common menopausal symptoms, including hot flashes and vaginal discomfort.
If you haven't had your uterus removed, your doctor will typically prescribe estrogen along with progesterone or progestin (progesterone-like medication). This is because estrogen alone, when not balanced by progesterone, can stimulate growth of the lining of the uterus, increasing the risk of endometrial cancer. If you have had your uterus removed (hysterectomy), you may not need to take progestin.
If you haven't had a hysterectomy and are using systemic estrogen therapy, you'll also need progestin. Your doctor can help you find the delivery method that offers the most benefits and convenience with the least risks and cost.
Oral contraceptives (birth-control pills) are used to prevent pregnancy. Estrogen and progestin are two female sex hormones. Combinations of estrogen and progestin work by preventing ovulation (the release of eggs from the ovaries). They also change the lining of the uterus (womb) to prevent pregnancy from developing and change the mucus at the cervix (opening of the uterus) to prevent sperm (male reproductive cells) from entering. Oral contraceptives are a very effective method of birth control, but they do not prevent the spread of human immunodeficiency virus (HIV, the virus that causes acquired immunodeficiency syndrome [AIDS]) and other sexually transmitted diseases.
If you have a 28-tablet packet, take 1 tablet daily for 28 days in a row in the order specified in your packet. Start a new packet the day after you take your 28th tablet. The tablets in most 28-tablet packets may have different colors. Many 28-tablet packets have certain color tablets that contain different amounts of estrogen and progestin, but also may have other color tablets which contain an inactive ingredient or a folate supplement.
If you have a 91-day tablet packet, take 1 tablet daily for 91 days. Your packet will contain three trays of tablets. Start with the first tablet on the first tray and continue taking 1 tablet every day in the order specified on the packet until you have taken all of the tablets on all of the trays. The last set of tablets are a different color. These tablets may contain an inactive ingredient, or they may contain a very low dose of estrogen. Start your new packet the day after you take your 91st tablet.
You will probably experience withdrawal bleeding similar to a menstrual period while you are taking the inactive tablets or the low dose estrogen tablets or during the week that you do not take your oral contraceptive. If you are taking the type of packet that only contains active tablets, you will not experience any scheduled bleeding, but you may experience unexpected bleeding and spotting, especially at the beginning of your treatment. Be sure to start taking your new packet on schedule even if you are still bleeding.
Vaginal atrophy is caused when a drop in the estrogen levels during and after menopause causes thinning of the tissues in and around the vulva and vagina. This leads to decreased flexibility and elasticity of the vagina and a decrease in the mucus production that lubricates the area.
This will include questions to identify if women may have a candida fungal infection of the vagina, which can be worsened by vaginal estrogen. Women who have a vaginal infection should not start treatment with Gina until the infection has been sorted.
Women with a history of endometriosis, where tissue similar to the lining of the womb grows elsewhere in the body, can buy Gina if they have previously had a prescription for vaginal estrogen and they have had no recent symptoms of endometriosis.
The ovaries stop releasing eggs and making the female hormones, estrogen and progesterone. In the months or years leading up to natural menopause, menstrual periods may become less frequent and irregular, and hormone levels may go up and down. This time is called perimenopause or the menopausal transition. Since periods can become less frequent during this time, it can be hard to know when they have actually stopped (and you have gone through menopause) until you look back at a later time.
There are also many progestins available, but medroxyprogesterone acetate (MPA or Provera), is often used with an estrogen to treat menopausal symptoms. Some preparations contain both an estrogen and a progestin.
Treating menopausal symptoms with estrogen and progestin together is known as estrogen-progestin therapy (EPT) or combined hormone therapy. Although estrogen alone improves the symptoms of menopause, it increases the risk of cancer of the uterus ( endometrial cancer). Adding a progestin to the estrogen lowers the risk of endometrial cancer back to normal. Because of this, EPT is given to women who still have a uterus (those who have not had a hysterectomy). EPT can be given 2 ways:
Hormones, most often estrogen, can also be placed in or near the place that needs treatment. This is called topical hormone therapy. If small doses are used, little of the hormone is absorbed into the bloodstream, so it has little if any effect on the rest of the body.
However, a recent analysis combined the results of more than 50 studies, including randomized controlled trials and observational studies. This analysis found that women who took estrogen and progestin (progesterone) after menopause did have an increased risk of getting ovarian cancer. The risk was highest for women taking hormones, and decreased over time after the hormones were stopped.
In women who still have a uterus, using systemic ET has been shown to increase the risk of endometrial cancer (cancer of the lining of the uterus). The risk remains higher than average even after ET is no longer used. Although most studies that showed an increased risk were of women taking estrogen as a pill, women using a patch or high-dose vaginal ring can also expect to have an increased risk of endometrial cancer.
Because of this increased cancer risk, women who have gone through menopause and who still have a uterus are given a progestin along with estrogen. Studies have shown that EPT does not increase the risk for endometrial cancer.
However, a recent analysis combined the results of more than 50 studies, including randomized controlled trials and observational studies. This analysis found that women who took estrogen after menopause did have an increased risk of getting ovarian cancer. The risk was highest for women currently taking estrogen, and decreased over time after estrogen was stopped.
The decision to use estrogen, alone (ET) or with a progestin therapy (EPT), after menopause should be made by each woman and her doctor after weighing the possible risks and benefits. Things to think about include:
Ritenbaugh C, Stanford JL, Wu L, et al. Conjugated equine estrogens and colorectal cancer incidence and survival: the Women's Health Initiative randomized clinical trial. Cancer Epidemiol Biomarkers Prev. 2008 Oct;17(10):2609-18. Epub 2008 Sep 30.
Progestin is a form of progesterone, the hormone that plays a role in the menstrual cycle and pregnancy. Progestin is used in several birth control methods. This page discusses progestin-only pills and the birth control injection. Other progestin-only birth control methods are discussed in Long-Acting Reversible Contraception (LARC): Intrauterine Device (IUD) and Implant.
If you have trouble remembering pills, use an alarm or a smartphone app to remind you. Do not skip pills for any reason. Missing pills or taking pills at different times each day makes the birth control less effective.
If you are switching from another form of birth control, simply stop using the other method at the same time you start the progestin-only pills. If it has been more than 5 days since your period started, use an additional birth control method or avoid sex for the next 2 days.
If you are switching from an intrauterine device (IUD), you have a few options. You can wait until you have been taking the pills for at least 2 days to have the IUD removed. Or you can use another form of birth control or avoid sex for the 2 days before removing the IUD and starting the pills.
With most progestin-only pills, if you miss a pill by more than 3 hours, you should take it as soon as possible and use a backup method of birth control (such as condoms) or avoid having vaginal sex for the next 2 days.
Also, if you have vomiting or severe diarrhea within 3 hours after taking a pill, the progestin may not be absorbed completely by your body. Keep taking your pills but use a backup method until 2 days after your vomiting or diarrhea stops. 781b155fdc
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