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Deciding about hormone therapy

Hormone therapy (HT) uses one or more hormones to treat symptoms of menopause.

Menopause and Hormones

During menopause:

  • 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
  • Anxiety
  • 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
  • Dementia

Risks of Hormone Therapy

Be sure to talk with your doctor about the risks of HT. These risks may be different depending on your age, medical history, and other factors.

BLOOD CLOTS

Taking HT may increase your risk for blood clots. Your risk of blood clots is also higher if you are obese or if you smoke.

Your risk of 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.

BREAST CANCER

  • Most experts believe that taking HT for up to 5 years does not increase your risk of breast cancer.
  • Taking estrogen and progesterone together for longer than 3 to 5 years increases your risk of breast cancer.
  • 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 does not carry as high a risk for breast cancer as estrogen and progesterone together.

ENDOMETRIAL (UTERINE) CANCER

  • Taking estrogen alone increases your risk for endometrial cancer.
  • Taking progestin with estrogen seems to protect against this cancer. So 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. So it is safe and recommended to use estrogen alone in this case.

HEART DISEASE

HT is safest when taken before age 60 or within 10 years after starting menopause.

  • HT may increase the risk of heart disease in older women.
  • HT may increase the risk in women who began using estrogen more than 10 years after their last period.

STROKE

Women who take only estrogen and who take estrogen with progesterone have an increased risk of stroke. Using the estrogen patch instead of an oral pill decreases this risk. However, it is still increased compared to not taking any hormones at all.

GALLSTONES

Taking HT may increase your risk of gallstones.

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 of 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

Certain lifestyle changes can help you adjust to the changes of menopause without taking hormones. They can also help protect your bones, improve your heart health, and help you stay fit.

However, for many women, taking HT is a safe way to treat menopause symptoms, as long as you take it:

  • No longer than 5 years
  • At the lowest possible dose

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.

Alternative Names

HRT - deciding; Estrogen replacement therapy - deciding; ERT- deciding; Hormone replacement therapy - deciding; Menopause - deciding; HT - deciding; Menopausal hormone therapy - deciding; MHT - deciding

References

ACOG Committee Opinion No. 565: Hormone therapy and heart disease. Obstet Gynecol. 2013;121(6):1407-1410. PMID: 23812486 www.ncbi.nlm.nih.gov/pubmed/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 www.ncbi.nlm.nih.gov/pubmed/25182228.

de Villiers TJ, Gass ML, Haines CJ, et al. Global consensus statement on menopausal hormone therapy. Climacteric. 2013;16(2):203-204. PMID: 23488524 www.ncbi.nlm.nih.gov/pubmed/23488524.

North American Menopause Society. The 2012 hormone therapy position statement of The North American Menopause Society. Menopause. 2012;19(3): 257-271. PMID: 22367731 www.ncbi.nlm.nih.gov/pubmed/22367731.

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 www.ncbi.nlm.nih.gov/pubmed/26444994.

Update Date 4/5/2016

Updated by: Irina Burd, MD, PhD, Associate Professor of Gynecology and Obstetrics at Johns Hopkins University School of Medicine, Baltimore, MD. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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