Hormone replacement therapy involves prescribing medications that contain female hormones to replace those that the body stops making after menopause. It is sometimes used in the treatment of common menopausal symptoms.
It can also help to prevent bone loss and reduce the chance of fracture in postmenopausal women.
There are also risks associated with hormone replacement therapy. The risks depend on multiple factors including the kind of hormone therapy, the dose, and how long the medication is taken. For optimal results hormone therapy should be tailored to individual people and re-evaluated periodically to ensure that the benefits outweigh the risks.
How beneficial hormone therapy is depends, in part, on what kind of hormone therapy you are taking.
The first kind is systemic hormone therapy. This involves taking systemic estrogen which comes in patch, cream, gel, spray, pill and skin patch. It is the most effective treatment for menopausal symptoms such as hot flashes and night sweats. It also eases the vaginal symptoms including discomfort during intercourse, as well as itching, dryness and burning. If you combine estrogen and progesterone it can lessen the risk of colon cancer. There is also data to suggest that the risk of heart disease can decrease when taking estrogen as well as the risk of osteoporosis.
There are also low-dose vaginal products that come in ring, cream or tablet form. These can most effectively treat vaginal symptoms as well as relieve some urinary symptoms while minimizing absorption into the body. Low-dose vaginal preparations don’t help with night sweats, hot flashes, or protection against osteoporosis.
If you have not had a hysterectomy your doctor will usually prescribe estrogen and progesterone as estrogen alone can stimulate uterine lining growth which increases the risk of cancer of the uterus. If you have had a hysterectomy you do not need to take progesterone.
Even though there are some health risks, systemic estrogen is the most effective menopausal symptom treatment. The benefits will likely outweigh the risks if you are healthy and: you have lost bone mass and aren’t benefitting or can’t tolerate other treatments, experience moderate to severe hot flashes or other symptoms of menopause, or lost ovarian function or stopped having periods before age 40.
If you’ve had early menopause, in particular if you’ve had your ovaries removed and didn’t take estrogen until at least age 45 you may have a higher risk of: Parkinson’s like symptoms, earlier death, anxiety or depression, heart disease, or osteoporosis. For these women the benefits of hormone therapy generally eclipse the risks.
You should avoid hormone therapy if you have or previously had: endometrial cancer, breast cancer, blood clots in the lungs or legs, liver disease, ovarian cancer, unexplained vaginal bleeding, or liver disease.
If you started menopause after age 45 and aren’t bothered by menopausal symptoms you don’t need hormone therapy to stay healthy. Talk to your doctor about strategies that will reduce the risk of conditions like heart disease and osteoporosis which could include medications other than hormone therapy and lifestyle changes.
The risks of hormone therapy include an increased chance of some serious conditions including: blood clots, stroke, breast cancer, heart disease. These risks will vary depending on age, women aged 60 or older who are beginning treatment for menopause are at a greater risk than someone under 60. They also vary depending on whether you’re taking only estrogen or if you’re also taking progestin/progesterone.