After menopause, when your periods have stopped, your body doesn’t produce as much estrogen. For many women, the absence of estrogen brings on a host of unpleasant symptoms like hot flashes, vaginal dryness, and painful sex to name a few.
Menopause is a natural phase, and symptoms eventually subside for most women. But for some, symptoms are severe enough that they need hormonal intervention.
Hormone replacement therapy (HRT) is one of the most effective ways to relieve severe menopause symptoms. HRT may even offer protection against heart disease and bone loss from osteoporosis.
But that doesn’t mean HRT is completely risk-free. Whether it’s right for you depends on your age, when you entered menopause, and other risk factors.
Here’s a look at the risks and rewards to help you decide whether HRT is a good option for you.
Hormone replacement therapy involves taking a medication when your hormone levels drop. It contains:
- estrogen (or estradiol, the most common form of the hormone in your body)
- or both of these hormones
HRT has a
Then, in 2002, a study undertaken by the Women’s Health Initiative linked HRT to cancer and cardiovascular disease. After the WHI’s report was published, HRT use in the United States, the UK, and Canada dropped dramatically.
The WHI report has since been called into question. Newer studies have shown that HRT has lower risks and more benefits for women who start treatment before age 60 and within 10 years of menopause.
But many people are still hesitant to use HRT because of concerns about the risks it could pose.
Although there’s still confusion about HRT, many researchers say the benefits outweigh the risks. Let’s look at some of the best-researched benefits of HRT.
Alleviates menopause symptoms
The experience of menopause is different for everyone. Some people have symptoms that are so mild no medical treatment is needed.
For others, the symptoms can be so severe that it interferes with their ability to go about their daily life. In this situation, it’s usually a good idea to talk with a doctor about hormone replacement.
HRT may help ease menopause symptoms in the following ways:
Low-dose estrogencan relieve vasomotor symptoms such as hot flashes and night sweats. Low-dose estrogen(in many forms) relieves genital and urinary symptoms of menopause, including vaginal dryness, painful sex, and urinary problems.
- Prasterone and Ospemifene, two other hormone-based treatments, can also relieve genital and urinary symptoms.
Offers protection against cardiovascular disease
Before starting HRT, it’s important to undergo a physical exam to be sure you don’t already have signs of cardiovascular disease. Your doctor will likely want you to have a check-up every year while you’re on HRT to be sure you’re maintaining good heart health.
Helps ease depression
During the transition into menopause, which can last several years, many women experience some depression.
Estrogen delivered through a skin patch has been
Helps protect your bones
Menopause increases the risk of bone loss, osteoporosis, and fractures.
Prevents loss of muscle mass
As you age, you tend to lose muscle mass. You need muscle mass for mobility, strength, and balance.
May help prevent Alzheimer’s disease and Parkinson’s disease
According to a
Women under the age of 60, or who entered menopause in the last 10 years, stand to benefit most from hormone therapy.
For older women, or women who started menopause more than 10 years ago, the risks could outweigh the benefits.
When the Women’s Health Initiative published its report in 2002, doctors and patients began avoiding HRT out of concern that it could do more harm than good.
Although newer research has allayed some of those fears, there are still some risks to consider when deciding if HRT is right for you.
A higher risk of certain cancers
There is some debate about the risk of ovarian cancer. Some studies suggest that both estrogen-only and combined therapies raise your risk of ovarian cancer. Other
Estrogen-only HRT may also increase the risk of endometrial cancer (also known as uterine cancer). A
- estrogen-only, sequential combination therapy (where you alternate between progesterone and estrogen at different parts of your cycle)
- tibolone (a synthetic steroid)
- micronized progesterone
Because of the risk, these therapies are generally recommended for women who no longer have a uterus.
Can increase the risk of blood clots
Because of this risk, health experts recommend the lowest possible HRT dose for the shortest period of time for people over 60 or who are 10 years past the onset of menopause.
Raises the risk of gallbladder disease
Since estrogen builds up the concentration of cholesterol in the gall bladder, using HRT increases the likelihood of
The risk is highest for women who use HRT longer than 5 years.
- estrogen-only products
- progesterone-only products
- products that combine estrogen and progesterone
- products that combine estrogen with other medications
These hormone medications come in several different forms, such as:
- pills – examples include:
- patches – such as:
- Alora, Climara, Estraderm, Minivelle, Vivelle (estrogen)
- Climara Pro, Combipatch (estrogen and progesterone)
- injections – such as:
- Delestrogen, Premarin (estrogen)
- skin cream/spray – such as:
- Estrasorb, Evamist, Premarin (estrogen)
- vaginal rings or creams – such as:
- Estrace, Femring, Ogen, Premarin (estrogen)
Creams and rings supply hormones to a localized area, which help to limit the amount in your system.
- problems with vaginal bleeding
- breast cancer or uterine cancer
- blood clots
- a heart attack or stroke
- a bleeding disorder
- liver disease
- allergic reactions to medications containing hormones
Talk with your doctor about whether
If you don’t want to use HRT to treat the symptoms of menopause, you might have some success with a
Some options that may help reduce the severity and frequency of hot flashes include:
- medication such as selective serotonin reuptake inhibitors (SSRIs) or gabapentin
- black cohosh supplements
- acupuncture treatment
- foods such as soy milk, edamame, and other soy foods
- purified pollen
Talking about menopause symptoms can be uncomfortable, especially when the symptoms feel personal.
It may help to make a list of your concerns in advance, so you can refer to the list if you forget.
Tell your doctor about:
- any health conditions such as cancer, heart problems, liver disease, or blood clots
- whether or not you’ve ever smoked
- medications you’re taking for other conditions
- side effects you’ve had from other hormonal treatment
While menopause is a natural change, it does involve a drop in your estrogen levels. This can trigger various symptoms which, in some cases, can be severe.
Hormone replacement therapy (HRT) may help ease many symptoms of menopause, including hot flashes and vaginal dryness. It may also lower your risk of heart problems, protect your bones and muscles, and reduce depression.
HRT, however, is not without its risks, especially for women over 60 or who started menopause more than 10 years ago.
Talk with a healthcare professional about whether HRT is right for you and whether the benefits outweigh any potential risks.