What hormone replacement medicine is recommended?

What hormone replacement I recommend really depends on the patient.  If my patient is a menopausal woman who has a strong family history of breast cancer I do not recommend systemic hormones.  However, if I have patients with severe hot flashes, insomnia and moodiness I often will put them on hormones. 

I do recommend bioidentical hormones that are either applied to the skin or taken under the tongue.  When I prescribe these treatments I monitor the patient's hormone levels closely and I make sure that they have yearly mammograms and pap tests and pelvic exams.

Doctors have gone back and forth on whether to recommend hormone replacement medications to women in menopause. Several years ago a very large study of women on hormone replacement therapy showed an unexpected increase in risk of stroke and heart attack in patients who took conjugated estrogens and medroxyprogesterone. There have been other studies whose results have been different, and some studies have shown that hormone replacement can benefit a woman's heart health. The main estrogen/progesterone product being prescribed at the time that the damaging study results were released was "prempro" which was a combination of the popular conjugated estrogen product "premarin" with a small daily dose of medroxyprogesterone. Many physicians immediately stopped using that product and started using natural progesterones and different varieties of estrogen, including "bioidentical" estrogens which contain a mixture of types of estrogen. Unfortunately there are no good studies to say that other estrogen or progesterone products are safer than others. 

I evaluate my patients to see if they have good reason to take a hormone replacement product, such as sleeplessness, hot flashes, bone loss or mood and thinking problems at menopause. We then discuss their individual risks for using HRT and try a product based on cost, convenience and patient preference. We then re-evaluate to see if the medicine is helpful, and continue a dialog about how long to take the medication and when to try stopping it. If a woman has had a hysterectomy, we use estrogen alone, but if her uterus is intact, it is safer to use progesterone as well since that appears to reduce the risk of developing cancer of the lining of the uterus due to buildup of tissue caused by estrogen.