Deciding about hormone therapy
Hormone therapy (HT) uses one or more hormones to treat symptoms of menopause.
HRT - deciding; Estrogen replacement therapy - deciding; ERT- deciding; Hormone replacement therapy - deciding; Menopause - deciding; HT - deciding; Menopausal hormone therapy - deciding; MHT - deciding
Menopause and Hormones
- A woman's ovaries stop making eggs. They also produce less estrogen and progesterone.
- Menstrual periods slowly stop over time.
- Periods may become more closely or more widely spaced. This pattern may last for 1 to 3 years once you start skipping periods.
Menstrual flow may come to a sudden halt after surgery to remove the ovaries, chemotherapy, or certain hormone treatments for breast cancer.
Menopause symptoms may last 5 or more years, including:
- Hot flashes and sweats, usually at their worst for the first 1 to 2 years after your last period
- Vaginal dryness
- Mood swings
- Sleep problems
- Less interest in sex
HT can be used to treat menopause symptoms. HT uses the hormones estrogen and progestin, a type of progesterone. Sometimes testosterone is also added.
Some symptoms of menopause can be managed without HT. Low-dose vaginal estrogen and vaginal lubricants may help vaginal dryness.
HT comes in the form of a pill, patch, injection, vaginal cream or tablet, or ring.
Taking hormones can have some risks. When considering HT, learn about how it can help you.
Benefits of Hormone Therapy
When taking hormones, hot flashes and night sweats tend to occur less often and can even go away over time. Slowly reducing HT may make these symptoms less bothersome.
Hormone therapy can also be very helpful in relieving:
- Problems sleeping
- Vaginal dryness
- Moodiness and irritability
At one time, HT was used to help prevent thinning bones (osteoporosis). That is no longer the case. Your doctor can prescribe other medicines to treat osteoporosis.
Studies show that HT does not help treat:
- Heart disease
- Urinary incontinence
- Alzheimer disease
Risks of Hormone Therapy
Be sure to talk with your doctor about the risks for HT. These risks may be different depending on your age, medical history, and other factors.
Taking HT may increase your risk for blood clots. Your risk for blood clots is also higher if you are obese or if you smoke.
Your risk for blood clots may be lower if you use estrogen skin patches instead of pills.
Your risk is lower if you use vaginal creams and tablets and the low-dose estrogen ring.
- Most experts believe that taking HT for up to 5 years does not increase your risk for breast cancer.
- Taking estrogen and progestin together for longer than 3 to 5 years may increase your risk for breast cancer, depending on the type of progestin you are prescribed.
- Taking HT can make the mammogram image of your breasts look cloudy. This can make it hard to find breast cancer early.
- Taking estrogen alone is associated with a reduction in risk of breast cancer. However, if you take estrogen and progestin together, your risk of breast cancer may be higher, depending on the type of progesterone you take.
ENDOMETRIAL (UTERINE) CANCER
- Taking estrogen alone increases your risk for endometrial cancer.
- Taking progestin with estrogen protects against this cancer. If you have a uterus, you should take HT with both estrogen and progestin.
- You cannot get endometrial cancer if you do not have a uterus. It is safe and recommended to use estrogen alone in this case.
HT is safest when taken before age 60 or within 10 years after starting menopause. If you decide to take estrogen, studies show that it's safest to begin the estrogen shortly after being diagnosed with menopause. Beginning estrogen more than 10 years after the onset of menopause does increase the risk of heart disease.
- HT may increase the risk of developing heart disease in older women.
- HT may increase the risk in women who began using estrogen more than 10 years after their last period.
Women who take only estrogen and who take estrogen with progestin have an increased risk for stroke. Using the estrogen patch instead of an oral pill decreases this risk. However, risk may still be increased compared to not taking any hormones at all. Lower HT dosage also reduces the risk for stroke.
Taking HT may increase your risk of developing gallstones.
RISK OF DYING (MORTALITY)
Overall mortality is reduced in women who begin HT in their 50s. The protection lasts for about 10 years.
Making a Decision
Every woman is different. Some women aren't bothered by menopause symptoms. For others, symptoms are severe and affect their lives significantly.
If menopause symptoms bother you, talk to your doctor about the benefits and risks for HT. You and your doctor can decide if HT is right for you. Your doctor should know your medical history before prescribing HT.
You should not take HT if you:
- Have had a stroke or heart attack
- Have a history of blood clots in your veins or lungs
- Have had breast or endometrial cancer
- Have liver disease
However, for many women, taking HT is a safe way to treat menopause symptoms.
Currently, experts are unclear on how long you should take HT. Some professional groups suggest that you can take HT for menopause symptoms for longer periods if there is no medical reason to discontinue the medicine. For many women, low doses of HT may be enough to control troublesome symptoms. Low doses of HT tend to have few side effects.
These are all issues to discuss with your health care provider.
When to Call the Doctor
If you have vaginal bleeding or other unusual symptoms during HT, call your doctor.
Be sure to continue seeing your doctor for regular checkups.
ACOG Committee Opinion No. 565: Hormone therapy and heart disease. Obstet Gynecol. 2013;121(6):1407-1410. PMID: 23812486 pubmed.ncbi.nlm.nih.gov/23812486/.
Cosman F, de Beur SJ, LeBoff MS, et al. Clinician's guide to prevention and treatment of osteoporosis. Osteoporosis Int. 2014;25(10):2359-2381. PMID: 25182228 pubmed.ncbi.nlm.nih.gov/25182228/.
de Villiers TJ, Hall JE, Pinkerton JV, et al. Revised Global Consensus Statement on menopausal hormone therapy. Climacteric. 2016;19(4):313-315. PMID: 27322027 pubmed.ncbi.nlm.nih.gov/27322027/.
Lobo RA. Menopause and care of the mature woman: endocrinology, consequences of estrogen deficiency, effects of hormone therapy, and other treatment options. In: Lobo RA, Gershenson DM, Lentz GM, Valea FA, eds. Comprehensive Gynecology. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 14.
Magowan BA, Owen P, Thomson A. The menopause and hormone replacement therapy. In: Magowan BA, Owen P, Thomson A, eds. Clinical Obstetrics and Gynaecology. 4th ed. Elsevier; 2019:chap 9.
Stuenkel CA, Davis SR, Gompel A, et al. Treatment of symptoms of the menopause: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2015;100(11):3975-4011. PMID: 26444994 pubmed.ncbi.nlm.nih.gov/26444994/.
Reviewed By: John D. Jacobson, MD, Professor of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda Center for Fertility, Loma Linda, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.