Hormone Replacement Therapy for Menopause

Hormone replacement therapy (HRT) is a medical treatment that uses estrogen and progestin, a form of progesterone, to help reduce symptoms women may have in perimenopause and menopause, when these hormones naturally decrease.


Perimenopause refers to the four- to eight-year period leading up to menopause, while menopause occurs when a woman hasn’t had a period consecutively for 12 months.

Also referred to as hormone therapy (HT), this treatment can also be used in other circumstances, such as for infertility, cancer or gender transition, says Dr. Kecia Gaither, double board-certified in OB-GYN and maternal fetal medicine and director of perinatal services/maternal fetal medicine at NYC Health + Hospitals/Lincoln in the Bronx, New York.

[At-Home Menopause Tests: Pros and Cons, What They Test and When to See a Provider]

Hormone Therapy: A Relief for Certain Symptoms

Hormone therapy in perimenopausal and menopausal women can help treat several symptoms:

— Hot flashes

— Joint aches

Mood swings

— Night sweats

Bone loss

— Vaginal dryness, which also may lead to painful intercourse

An estimated 75% of women will experience hot flashes during perimenopause, according to the Menopause Society. These will sometimes continue post-menopause.

While some women may have virtually no symptoms going through menopause, others may experience many symptoms. Thankfully, you don’t need to have all of these symptoms to receive hormone therapy. For instance, you may have severe hot flashes and vaginal dryness — but not have other symptoms — that are severe enough for a health care professional to recommend hormone therapy.

Dr. Wen Shen, associate professor of clinical gynecology and obstetrics and director of the Women’s Wellness & Healthy Aging Program at Johns Hopkins Medicine in Baltimore, has treated women who have hot flashes as frequently as six times a day or who wake up several times at night from nighttime hot flashes, both of which can lead to a decreased quality of life.

“You’re going to be irritable, and you’re not going to be a very pleasant person to be around,” she says, pointing to the value of hormone therapy in those scenarios.

The average age for menopause in the U.S. is 51, according to the Menopause Society, but age alone isn’t a qualifier for HRT. Some women go into early menopause due to removal of their reproductive organs, leading to a possible need for hormone therapy. In fact, for women who go into early menopause, hormone therapy is recommended to reduce the risk for heart disease and bone loss, says Dr. Genevieve Neal-Perry, professor and chair of the department of obstetrics and gynecology at the University of North Carolina School of Medicine.

[READ: The Menopause Diet: The best diet plan for mitigating symptoms and weight gain.]

Safety and Risk of Hormone Therapy for Menopause

There’s been a shift in the safety perception of hormone therapy as research evolves. In the 1960s through 1990s, hormone therapy was regularly recommended to treat menopause symptoms and to prevent chronic health conditions, like heart disease and dementia.

Then, a 2002 study from the Women’s Health Initiative, which included 68,000 women between the ages of 50 and 79, focused on the effects of estrogen plus progestin hormone therapy found that it raised the risk for blood clots, breast cancer, dementia, heart attacks and stroke. This led to a marked decrease in the use of HRT.

However, the average age of women in the study was 65, or 14 years beyond the average age for menopause. That represents a long time period when the body may undergo a variety of health changes, including development of a greater risk for blood clots and heart disease.

The decrease in HRT use “was rather unfortunate because we’re still suffering from the consequences of that misinterpreted result,” Shen says. “To this day, I have patients who come to me and say their doctor refused to prescribe hormone therapy for them even though they’re having horrific symptoms.”

Results published in the journal JAMA in 2013, based on a follow-up Women’s Health Initiative study, found that women in the earlier stages of menopause can benefit from hormone therapy to treat menopause-related symptoms. However, the U.S. Preventive Services Task Force still recommends that HRT shouldn’t be used to prevent chronic diseases, such as heart disease in postmenopausal women. Age makes a difference in the benefits and risks associated with HRT.

“For women who are under the age of 60 and within 10 years of menopause onset, the benefits will typically outweigh the risks,” says Dr. Stephanie Faubion, director of the Women’s Health Clinic and the Office of Women’s Health at Mayo Clinic.

Hormone therapy has certain risks, including the potential development of:

— Blood clots

Breast cancer

— Endometrial cancer

— Heart attacks

— Migraines with auras

Ovarian cancer

However, the extent of these risks may vary depending on the HRT preparation, dosage and method of use, Gaither says. For instance, skin and vaginal use of hormone therapy aren’t metabolized through the liver, so the risk associated with blood clots is lower. Plus, the risk of endometrial cancer is lowered when both estrogen and progestin are used versus estrogen alone.

Still, it’s important to consider if hormone therapy is right for you. Your health care professional may advise against HRT if you have a history of:

— Abnormal vaginal bleeding

Blood clots

— Breast, ovarian or uterine cancer

— Heart attack

— Stroke

It’s important to talk to your health care professional, specifically from a doctor who specializes in hormone therapy and menopause, about the benefits and risk factors based on your medical history.

If a woman is having hot flashes or other menopausal symptoms at age 60 or beyond, health care professionals will typically discuss nonhormonal treatments. Some women may choose to continue hormone therapy beyond age 60 despite associated risks, Neal-Perry says.

[READ: Health Questions to Ask Your Doctor]

Side Effects of Hormone Therapy for Menopause

Not everyone using hormone therapy for menopause will have side effects from it, but certain side effects may occur.

Common side effects of hormone therapy include:

— Breast sensitivity


— Irritation on the skin where the hormonal patch is placed

— Mood changes

— Vaginal bleeding

Hormone therapy isn’t associated with weight gain, although weight gain may occur during menopause due to decreasing estrogen levels.

How to Use Hormone Therapy

Hormone therapy for menopause can come in many different forms, including:

— Oral pills

— Patches placed on the skin

— A ring or cream placed in the vagina, used to help with vaginal dryness

— A spray or gel

A health care professional can help review the pros and cons of each form of hormone therapy for your individual needs. For example, if you have psoriasis, you may want to avoid a patch as it’s placed on the skin and instead opt for a pill. For someone who wants to avoid using pills, the patch may be a first choice.

Hormone therapy is available as estrogen-only or use of both estrogen and progestin. Most women will use a combination of both estrogen and progestin to help cut their risk of endometrial cancer. These hormones may be taken together, or they may be used separately, depending on the form of hormone therapy you’re using. If a woman no longer has a uterus, then she can use estrogen-only hormone therapy.

It could take a couple of days to a couple of weeks to notice improvements from the use of hormone therapy.

[READ: Can a Plant-Based Diet Help With Hot Flashes?]

Other Ways to Manage Hot Flashes and Other Menopause Symptoms

If you don’t qualify for hormone therapy, there are other options to help with hot flashes and related menopause symptoms:

— Nonhormonal medication like a low dose of the antidepressant drug paroxetine is approved by the Food and Drug Administration to treat hot flashes. Sometimes, other nonhormonal drugs are used to help with hot flashes. One such drug specifically geared toward menopause hot flashes is fezolinetant.

— In women who are perimenopausal, the use of birth control pills, another type of hormone therapy, is an option. These have the dual purpose of preventing pregnancy.

— Lifestyle changes such as regular exercise, avoiding hot drinks and reducing stress can improve symptoms.

Shen cautions against spending lots of money on herbs and supplements that are said to help with menopause, as their effectiveness is often not based on medical evidence. Plus, they aren’t regulated by the FDA like prescription drugs are.

The following resources provide evidence-based recommendations for managing menopause symptoms:

National Menopause Foundation

Society for Women’s Health Research

The Menopause Society

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Hormone Replacement Therapy for Menopause originally appeared on usnews.com

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