When to Consider Hormone Therapy for Menopause

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Hormone replacement therapy pills
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When you’re suffering from a dozen hot flashes every day, you just want relief. And if you’ve already tried reducing your stress level, improving your diet, and adjusting your exercise routine without any results, you might be feeling desperate—but there’s more you can do to alleviate your symptoms. In cases of moderate to severe symptoms of menopause, including osteoporosis, hormone therapy might be right for you.

What is hormone therapy?

During menopause, your body gradually decreases its production of estrogen, which leads to a variety of unpleasant biological effects. Menopausal hormone therapy (MHT), which used to be called hormone replacement therapy, involves a treatment of estrogen, or estrogen along with either progesterone or progestin, which helps ease your symptoms. Women who have had a hysterectomy usually receive only estrogen. Women who haven’t had this surgery will likely receive estrogen plus progestin, a synthetic hormone that acts like progesterone, to prevent an overgrowth of cells in the lining of the uterus, which can lead to uterine cancer.

Hormone therapies come in various forms, and you can talk to your doctor about which type would be best for your situation. The different kinds of MHT include:

  • Estrogen and estrogen-plus-progestin pills
  • Vaginal creams, tablets and rings
  • Skin patches, gels and creams

What are the benefits and risks of hormone therapy?

Hormone therapy can reduce many of the unpleasant symptoms that come along with menopause, including:

  • Moderate to severe hot flashes and night sweats: Systemic estrogen—such as pills and skin applications—is usually recommended to treat the widest variety of menopausal symptoms.

  • Vaginal dryness and urologic dysfunction, including urinary tract infections and bladder control problems: Low-dose vaginal treatments can relieve these symptoms, but they don’t help with hot flashes or protect against osteoporosis.

  • Slowing bone loss, or osteoporosis: Your doctor might prescribe systemic MHT to treat osteoporosis if the condition hasn’t responded well to other treatments.

  • Related issues, such as poor sleep, insomnia, irritability, painful intercourse, and mood swings: Systemic or vaginal treatments may relieve these symptoms.

While reducing symptoms of menopause can be a relief, hormone therapy doesn’t come without risks, especially when taken for more than a few years. For this reason, doctors rarely recommend long-term systemic hormone therapy. Several studies have shown the use of an estrogen-progestin pill increased the risk for some serious conditions and other problems, such as:

However, a related study of short-term use of an estrogen-only treatment found no increased risk of breast cancer or heart disease.

Who should—and shouldn’t—consider hormone therapy?

Because of the risks associated with hormone treatments, doctors usually first recommend non-hormonal remedies, such as physical exercise, a healthy diet, relaxation techniques, and cotton clothing. But if your symptoms persist despite other treatments, hormone therapy might be right for you.

For women in general good health, the benefits of systemic hormonal treatment might outweigh the risks. If you suffer moderate to severe symptoms, had premature menopause (before age 40), or lost normal function of your ovaries before age 40, hormone therapy could be the best course of action. Or if you have osteoporosis that isn’t responding to alternative treatments, your doctor might recommend hormone therapy.

However, if you have a history of blood clots; stroke; or breast, ovarian or endometrial cancer, you shouldn’t take hormone therapy.

Bottom line: Talk to your doctor about whether hormone therapy is a good option to treat your menopausal symptoms. If you choose to take hormone therapy, reduce your risk for complications by finding the right treatment for you. For example, a low-dose vaginal cream, tablet or ring will limit absorption into your body and may be a better choice than a pill or patch if you experience vaginal-only symptoms. Use the shortest-term treatment with the lowest dose that effectively eases your symptoms. And don’t smoke, which can increase your risk for other problems associated with MHT.

Researchers continue to study treatment options and their effects, so new information is always on the horizon. Your doctor should be up-to-date on the latest research, so together, you can determine the right course of treatment to address your menopausal symptoms.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Aug 7
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.

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