Recent studies have changed how health professionals use hormone therapy after menopause. For a long time, hormone replacement therapy (HRT) was thought to protect against heart disease and dementia. However, studies now show that HRT use can cause serious health problems. One large study done by the Women's Health Initiative (WHI) has shown that HRT does not protect against heart disease. In fact, in a small number of women who are 10 or more years past menopause, it causes heart disease, including heart attacks.¹¹ In the WHI study, short-term use of HRT was also linked to an increase in the numbers of strokes and blood clots. Using HRT for several years was linked to increased cases of breast cancer and dementia. Overall, most women using HRT in the WHI study had no serious side effects, but they also had no long-term benefits.

ERT may also cause breast cancer in a small number of women.⁹

Experts do not yet know whether hormone therapy risks are the same for older and younger postmenopausal women. Researchers are now exploring HRT use by women who use short-term, low-dose hormone therapy starting at menopause.

Average HRT- and ERT-related risks are low among the general population of women. Your personal risks that hormone therapy may stimulate breast cancer, cardiovascular problems, blood clots, or neurological changes may be lower or higher, depending on your risk factors.

Many health professionals now suggest trying nonhormonal treatment for bothersome menopause symptoms before considering hormone therapy (birth control pills, estrogen alone [ERT], or estrogen-progestin [HRT]). There are several nonhormonal prescription treatments that can relieve or reduce hot flashes and other menopause symptoms. You can also try using black cohosh or dietary soy.

Medication Choices

Prescription medication without hormones

• Selective serotonin reuptake inhibitors (SSRIs), which are a type of antidepressant medicine such as Paxil or Prozac, can reduce the number and severity of hot flashes. Some women have side effects.¹² The safety of very long-term use has yet to be studied.
• Clonidine, a high blood pressure medication, can reduce the number and severity of hot flashes.¹³ Some women have side effects related to low blood pressure.
• Gabapentin (Neurontin), an antiseizure medication, can reduce the number and severity of hot flashes.²⁸ Possible side effects include sleepiness, dizziness, and swelling.

Prescription medication with hormones

• Birth control pills (estrogen and progestin) regulate menstrual bleeding and can relieve symptoms until menopause. Birth control pills are not used after menopause. You should not use birth control pills if you smoke or have diabetes, untreated high blood pressure, cardiovascular disease, or a history of breast cancer. Low-dose formulations are recommended for women older than 35. Some women have side effects.
• Progestin pills or the levonorgestrel IUD, which releases a form of progesterone into the uterus, reduce heavy, irregular menstrual periods during perimenopause. Some women have side effects.
• Low-dose vaginal estrogen (cream, tablet, or ring) reduces vaginal and urethral dryness and weakening without introducing high levels of estrogen into the body.
• Hormone replacement therapy (estrogen and progestin), in pill, patch, or vaginal ring form, can be used to treat menopause symptoms. Because recent studies have found that HRT increases some health risks for some women, health professionals have changed the way HRT is used. For menopause symptom relief, experts now recommend that HRT only be used at the lowest effective dose for the shortest possible period of time.¹
• Bioidentical hormone replacement therapy is made from plants and is thought to be more similar to human-produced hormones than synthetic HRT. However, bioidentical HRT is not well-researched and may carry the same health risks that traditional HRT does.¹ Any form of hormone therapy is best taken for as short a period as possible.

Should I use hormone replacement therapy (HRT)?