Why is estrogen replacement therapy used? 

Your doctor may recommend estrogen replacement therapy (ERT) to treat menopause symptoms. Menopause symptoms most likely to respond to ERT include:

  • Anxiety and mood swings, which can interfere with your daily life and become debilitating
  • Hot flashes, which are often described as a sudden sensation of warmth, flushing and sweating
  • Night sweats, which are the nighttime version of hot flashes
  • Osteoporosis, or thinning bones, which is a complication of menopause. You may not know you have thinning bones unless your doctor finds it on a screening test.
  • Sleep problems, including insomnia or sleeplessness
  • Vaginal dryness, which cause burning, irritation, and painful sexual intercourse

Who prescribes estrogen replacement therapy?

The following specialists prescribe estrogen replacement therapy:

  • Family practitioners (family medicine doctors) provide comprehensive healthcare to adults and children. 
  • Internists provide comprehensive healthcare to adults.
  • Midwives, including certified nurse-midwives (CNMs) and certified midwives (CMs). These types of midwives are healthcare professionals who provide prenatal, labor, and delivery care, and some gynecologic care, including menopause treatments. The ability of a midwife to prescribe estrogen replacement therapy varies by state.
  • Obstetricians-gynecologists (Ob/Gyns) specialize in women's health, including pregnancy and labor and delivery.

How is estrogen replacement therapy delivered?

You will take estrogen continuously for estrogen replacement therapy (ERT) after a hysterectomy. This means that you take it every day without any breaks. 

This differs from estrogen combined with progesterone, which you take cyclically to mimic your menstrual cycle. This is typical for women who still have their uterus and are having menopause symptoms.

What are the risks and potential complications of estrogen replacement therapy? 

Estrogen replacement therapy (ERT) is effective for treating many of the symptoms of menopause. However, it is not right for every woman because there are risks. Some risks are serious and even life threatening. Your healthcare provider is the best person to guide your treatment decisions based on your specific circumstances.

The Women’s Health Initiative (WHI) is a major study supported by the National Institutes of Health (NIH). WHI looked at the risks and benefits of hormone replacement therapy (HRT). In general, the results from this study showed that women should use HRT in the lowest possible dose for the shortest amount of time. Long-term use of HRT was associated with significant risks. 

Risks of estrogen-alone replacement therapy include: 

  • Blood clots, in the form of a deep vein thrombosis (DVT). A blood clot can travel to the lungs and cause a pulmonary embolism (PE).
  • Stroke

Reducing your risk of complications

You can reduce your risks by: 

  • Avoiding ERT if you have a personal or family history of blood clots or stroke
  • Exercising regularly
  • Maintaining a healthy weight
  • Not drinking alcohol or limiting alcohol intake to one drink per day for women
  • Quitting smoking
  • Treating high blood pressure, high cholesterol levels, and diabetes as recommended by your healthcare provider

Questions to ask your doctor

It is common for patients to forget to ask about some of their concerns during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor or healthcare provider with concerns and questions before starting ERT and between appointments. 

It is also a good idea to bring a list of questions to your appointments. Questions can include:

  • What form of ERT is best for me?
  • How long should I take ERT? 
  • When should I stop ERT? What’s the best way to stop?
  • Will my symptoms come back after stopping therapy?
  • What are the other options for treating my symptoms?
  • What are my risks of heart disease, breast cancer, colorectal cancer, stroke, and osteoporosis?
  • What other options can help me prevent osteoporosis and other risks or menopause?
  • When should I follow up with you?
  • How should I contact you? Ask for numbers to call during and after regular hours.