1. What happens if you have irregular bleeding while on HRT? A biopsy is performed: it's a relatively simple outpatient procedure in which a tissue sample is removed and checked for cancer. It may cause some cramping. Irregular bleeding always should be reported to a doctor.
2. What is the patch?
The patch is a silver-dollar-sized bandage that contains estrogen only, so women who use it must take progesterone or progestin if they have not had a hysterectomy and ovary removal. The patch usually is changed twice a week, but some doctors recommend changing it every three days if a woman has hot flashes or other symptoms.
About 25 percent of women can't use the patch because of severe skin irritation.
3. Is the patch as effective as pills?
The patch is as effective as estrogen pills for preventing osteoporosis, but its heart disease benefits aren't as well proven. Some leading researchers say women who need to raise their HDL, or so called "good cholesterol," should choose other forms of HRT.
4. What is known about natural progesterone?
It is not widely used and has been available only since 1988 for HRT. The PEPI study found that taking 200 milligrams of micronized, or natural, progesterone plus conjugated estrogen (see next question) daily more than doubled the heart-disease benefits of synthetic progestin and estrogen.
The drawbacks: It costs more, may require more frequent doses and may not be reimbursed by insurers unless you insist.
5. What are the usual doses and forms of hormone replacement drugs?
Pills containing 0.625 milligrams of conjugated estrogen, or 1 milligram estradiol, are most commonly prescribed because they are the minimum amounts needed to protect against osteoporosis.
Conjugated estrogen is a form obtained from the urine of pregnant mares: estradiol pronounced ess-trah-dile, is made in a laboratory and most closely resembles the type women make during their reproductive years.
There are no significant differences between the two when used for hormone replacement. For short-term control of symptoms, some women take as much as 1.25 mg. of conjugated estrogen daily. There are concerns about long term use of such higher doses.
Progestin and progesterone doses vary, depending on whether they are taken in continuous or cyclic patterns and whether they are causing side effects. If you still have a period and want to avoid it certain months, some doctors allow women occasionally to skip progestin doses.
