Hormone Replacement Therapy

What is hormone replacement therapy?

Hormone replacement therapy (HRT) usually refers to the replacement of sex hormones in menopausal women. Women use HRT to help control the symptoms of menopause. Menopause is the stage in a woman’s life when sex hormone levels fall and her menstrual period stops. Symptoms of menopause include hot flashes, night sweats, sleep problems, vaginal dryness, mood swings, anxiety, decreased sexual desire, fatigue, and headaches. Menopause can also cause changes, such as thinning bones (osteoporosis), that your doctor can detect with tests.

The two main sex hormones that a woman’s body makes are estrogen and progesterone. Progesterone is primarily produced by the ovaries and, in pregnant women, the placenta. The ovaries also produce estrogen. Estrogen is responsible for the female sexual characteristics. It is also important for many body processes, such as maintaining a healthy heart and bones.

A woman who has had her uterus removed by hysterectomy may receive estrogen alone for HRT. However, a woman who still has her uterus must receive progesterone in addition to estrogen for HRT. Progesterone signals the uterus to shed its lining similar to a menstrual period. This decreases the risk of developing uterine cancer.

HRT is only one method of controlling the symptoms of menopause. HRT involves some health risks. You may have other treatment options available that involve less risk, depending on your specific circumstances. You should discuss different treatment options with your doctor or healthcare provider to understand which option is right for you. 

Types of hormone replacement therapy

Your doctor can prescribe HRT in different forms. The choice of which form to use depends on your individual symptoms and circumstances. The forms ofestrogen replacement therapy approved by the United States Food and Drug Administration (FDA) include:

• Intrauterine devices (IUDs) placed inside your uterus by your doctor. A progesterone product, levonorgestrel (Mirena), is available in this form.
• Combination tablets taken by mouth. Examples include medications containing conjugated (mixed) estrogens and medroxyprogesterone acetate (Premphase, Prempro) and medications containing ethinylestradiol and norethindrone acetate (Femhrt).
• Estrogen tablets taken by mouth. Examples include conjugated  (mixed) estrogens (Premarin), esterified estrogens (Estratab, Menest), estropipate (Ogen), and estradiol (Estrace).
• Progesterone tablets taken by mouth. Examples include medroxyprogesterone acetate (Cycrin, Provera), norethindrone acetate (Aygestin, Norlutate), and progesterone USP (Prometrium).
• Skin creams and gels applied to clean, dry, unbroken skin on your arms or legs. Never apply estrogen skin preparations to your breasts because breast tissue can change in response to estrogen. Estradiol (Estrasorb, Estrogel) is available in this form.
• Skin patches, or transdermal patches, applied to clean, dry, unbroken skin on your stomach, lower back, or buttocks. Estradiol is available as a skin patch under a variety of brand names, including Climara, Estraderm and Vivelle. Combination products are also available as a skin patch. Examples include medications containing estradiol and norethindrone acetate (Combipatch) and medications containing estradiol and norgestimate (Ortho-Prefest).
• Skin spray, or transdermal spray, applied to clean, dry, unbroken skin on your forearm. Estradiol (Evamist) is available as a spray.
• Vaginal creams applied by placing the cream directly into your vagina. Estrogen examples include conjugated (mixed) estrogens (Premarin cream), estradiol (Estrace cream), and estropipate (Ogen cream). Progesterone (Crinone) is also available in this form.
• Vaginal rings inserted into the uppermost part of your vagina. They remain in place for 90 days at a time. Estradiol (Estring, Femring) is available as a vaginal ring.
• Vaginal tablets inserted into your vagina. Estradiol (Vagifem) is available in this form.