Estrogen Replacement Therapy (ERT)

Estrogen is a group of hormones present in women that regulate sexual characteristics, including growth, maturation, and reproduction. Estrogen production declines during menopause, when the body moves into a stage in which pregnancy and childbirth are no longer possible, although other functions continue as normal.

This occurs on average between the ages of 45–55 in women in developed countries. The lack of estrogen causes a number of symptoms which can be troublesome to quality of life, including hot flushes, emotional disturbance, and sleeplessness, while also representing an often unwelcome constant reminder to the woman of the change of physical status she is undergoing. Within the woman, the ovaries cease to produce estrogen and the same effect can be produced by surgery, for example as a result of a hysterectomy. In some cases, therefore, medical practitioners may prescribe estrogen replacement therapy (ERT) as a means of controlling these symptoms. ERT is a subset of hormone replacement therapy (HRT), which also includes the replacement of other types of hormones for a variety of medicinal purposes.

Postmenopausal women may suffer from the demineralization of bones and related conditions, including osteoporosis and atrophic vaginitis. Estrogen replacement may be effective in countering these threats and so may be prescribed, either through an orally or dermally administered procedure. The hormone may also be administered through the vagina. Estrogen administered alone (“unopposed”) is effective in treating postmenopausal symptoms, reduces osteoporosis threat, and has other benefits, but it has not been established how quickly this works on an individual basis and in the level of dosage required.

However, there are negative side effects associated with unopposed estrogen replacement, not least of which is the elevated threat of various kinds of cancer, which is a threat that may persist beyond using ERT treatments. More research is necessary to determine which forms of estrogen pose higher risks than others, what is the time scale involved, and which groups of women may be at higher levels of risk than others, as well as explaining why that might be. As a result of this, medical practitioners now generally recommend using estrogen in combination with other substances, in a format known as “opposed.” It is most common for estrogen to be combined with progestin in this way; progestins are another type of hormone which are involved with regulating the maintenance of pregnancy. [Page 627]Estrogen combined with progestin make up the oral contraceptive. Unfortunately, the combination of opposed estrogen also produces often-distressing and uncomfortable side effects, including bloating, bleeding, and depression.

Additionally, the long-term effects of the treatment are not clear and there is research exploring the link between opposed and unopposed ERT and the elevated incidence of breast cancer, coronary disease, and Alzheimer's disease, especially among older women. It seems clear that women do respond differently to different regimes of estrogen and progestin and that important factors include age and the presence of an intact womb or otherwise. Medical advice should be sought to determine what is considered most appropriate in the individual case. Researchers continue to experiment with varied doses and dosage protocol to shed further light on these issues.

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