Hormone replacement therapy (HRT) can relieve unpleasant symptoms of menopause, but there are some side effects and health risks that should be considered.
HRT can help to ease symptoms of menopause.
As a woman approaches her mid-40s to early 50s, levels of the hormones estrogen and progesterone start to decline and overall hormonal imbalance occurs. The menstrual cycle becomes irregular. Menopause is the point when a woman hasn’t had a period for a year due to the declining levels of hormones.
Common symptoms of menopause include hot flashes, sleep disturbances, and vaginal discomfort. For many women, symptoms of menopause are mild, and no treatment is necessary. When symptoms do become troublesome, HRT may help.
Another reason to take HRT is early menopause due to primary ovarian insufficiency (POI) or other diseases. Cancer treatment, including surgery, radiation, and chemotherapy, may trigger early menopause. Removal of the ovaries (oophorectomy) causes immediate menopause. However, if the uterus is removed (hysterectomy) but the ovaries are kept, it does not cause menopause right away.
There are several treatment options for HRT:
- estrogen only (ET)
- combined estrogen and progesterone (EPT)
- combined estrogen and methyltestosterone
These treatments can come in the form of pills, injections, and skin patches. They can also be dispensed in easy-to-use vaginal creams, suppositories, or vaginal rings.
While HRT can ease symptoms of menopause, there are also some health risks to consider. To minimize the risk, your doctor may start with a very low dose to see if your symptoms improve. The most current recommendation by experts is to use the lowest dose of hormones necessary for the shortest period of time. However, there is ongoing controversy on the dose, duration, and source of hormone used.
Hormones considered to be “bioidentical,” such as 17β-estradiol, have the same molecular and chemical structure as hormones produced by your body and are readily available from retail pharmacies. Custom-compounded hormone therapy products have been highly advertised but currently lack well-controlled studies to support the safety of long-term use.
Side effects vary from woman to woman and depend on the dosage and combination of hormones. For women who still have a uterus, estrogen is combined with progesterone to decrease the risk of cancer of the uterus.
Studies show that oral EPT increases the chances of developing heart disease, blood clots, and stroke when compared to not taking hormones. However, these risks seem to be lowest in otherwise healthy women between the ages of 50 and 59. The longer you take hormones after menopause, the greater the risk.
HRT is generally not recommended for women who have previously had blood clots or stroke. The risk of stroke is greater in smokers who are also overweight.
There’s no increased risk of lung cancer associated with HRT, but combination EPT may increase the risk of dying from lung cancer.
When estrogen levels drop, you may experience vaginal dryness, burning, and itching. That can make intercourse painful and interfere with intimacy. HRT can relieve those symptoms and make sex pleasurable again. If vaginal discomfort is your main problem, you can use vaginal creams, a vaginal ring, or suppositories instead of oral HRT.
HRT may cause vaginal spotting or bleeding.
Combination EPT may offer some protection from uterine cancer. When progestin is added to estrogen, it helps to block an overgrowth of cells of the uterine lining (which may lead to uterine cancer).
HRT can cause swelling or tenderness of the breasts. It can also make your breasts appear denser on mammograms, which can make it harder to find cancerous cells. HRT may increase your risk of developing breast cancer.
Estrogen therapy without progesterone can raise your risk of endometrial (uterine) cancer. HRT is usually not recommended for women who have had endometrial, ovarian, or breast cancer.
HRT may cause bloating, fluid retention, and nausea. You may have a higher risk of developing gallstones or other gallbladder problems.
For some women, an unpleasant symptom of menopause is urinary incontinence. You may lose a few drops of urine when you laugh, sneeze, or cough. Low-dose estrogen vaginal creams and suppositories may improve symptoms.
HRT is generally not recommended for women who have had liver disease.
Persistent hot flashes can become a problem in menopause. Night sweats can keep you from getting a good night’s sleep. HRT can be quite effective in relieving these symptoms. It may also relive anxiety and irritability. In some women, it can cause mood changes and headaches.
Currently, the role HRT plays in dementia is unclear. The Women’s Health Initiative, a 15-year study, found that women who take menopausal HRT may have a higher risk of dementia. In 2017, a different study, 20 years long, showed a decreased risk of Alzheimer’s disease in those who used HRT.
HRT may relieve skin itchiness caused by menopause, but it can also cause some mild skin discoloration. If you use an estrogen patch, you may get skin irritation at the site of the patch.