Hormone Replacement Therapy for Menopause

If you’re looking for relief from menopause symptoms, knowing the pros and cons of hormone replacement therapy (HRT) can help you decide whether it’s right for you.

What Is Hormone Replacement Therapy?

HRT (also known as hormone therapy, menopausal hormone therapy, and estrogen replacement therapy) uses female hormones -- estrogen and progesterone -- to treat common symptoms of menopause and aging. Doctors can prescribe it during or after menopause.

After your period stops, your hormone levels fall, causing uncomfortable symptoms like hot flashes and vaginal dryness, and sometimes conditions like osteoporosis. HRT replaces hormones your body no longer makes. It’s the most effective treatment for menopause symptoms.

Why Does Your Body Need Estrogen?

You might think of pregnancy when you think of estrogen. In women of child-bearing age, it gets the uterus ready to receive a fertilized egg. It has other roles, too -- it controls how your body uses calcium, which strengthens bones, and raises good cholesterol in the blood.

When Should You Take Progesterone?

If you still have your uterus, taking estrogen without progesterone raises your risk for cancer of the endometrium, the lining of the uterus. Since the cells from the endometrium aren’t leaving your body during your period any more, they may build up in your uterus and lead to cancer. Progesterone lowers that risk by thinning the lining.

Once you know the hormones that make up HRT, think about which type of HRT you should get:

Estrogen Therapy: Doctors generally suggest a low dose of estrogen for women who have had a hysterectomy, the surgery to remove the uterus. Estrogen comes in different forms. The daily pill and patch are the most popular, but the hormone also is available in a vaginal ring, gel, or spray.

Estrogen/Progesterone/Progestin Hormone Therapy: This is often called combination therapy, since it combines doses of estrogen and progestin, the synthetic form of progesterone. It’s meant for women who still have their uterus.

The biggest debate about HRT is whether its risks outweigh its benefits.

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What Are the Risks of Taking Hormone Replacement Therapy?

In recent years, several studies showed that women taking HRT have a higher risk of breast cancer, heart disease, stroke, and blood clots. The largest study was the Women’s Health Initiative (WHI), a 15-year study tracking over 161,800 healthy, postmenopausal women. The study found that women who took the combination therapy had an increased risk of heart disease. The overall risks of long-term use outweighed the benefits, the study showed.

But after that, a handful of studies based on WHI research have focused on the type of therapy, the way it’s taken, and when treatment started. Those factors can produce different results. One recent study by the Fred Hutchinson Cancer Research Center reveals that antidepressants offer benefits similar to low-dose estrogen without the risks.

With all the conflicting research, it’s easy to see why HRT can be confusing.

Who Shouldn’t Take Hormone Replacement Therapy?

If you have these conditions, you may want to avoid HRT:

What Are the Side Effects of Hormone Replacement Therapy?

HRT comes with side effects. Call your doctor if you have any of these:

How Do I Know If Hormone Replacement Therapy Is Right for Me?

Your doctor can help you weigh the pros and cons and suggest choices based on your age, your family's medical history, and your personal medical history.

WebMD Medical Reference Reviewed by Traci C. Johnson, MD on August 12, 2016

Sources

SOURCES:

Garnet Anderson, PhD, director, public health sciences division, Fred Hutchinson Cancer Research Center, Seattle.

Cleveland Clinic: “Hormone Therapy (HT), Understanding Benefits and Risks.”

John Hopkins Medicine: “Hormone Therapy.”

Journal of the American Medical Association, Oct. 2, 2013.

Main Line Health: “Estrogen, Progesterone, and Menopause.”

JoAnn E. Manson, MD, DrPH, chief, preventative medicine division, department of medicine, Brigham and Women’s Hospital, Boston.

National Cancer Institute: “Menopausal Hormone Therapy and Cancer Fact Sheet.”

National Heart, Lung, and Blood Institute: “Women’s Health Initiative.”

National Institutes of Health: “WHI Study Data Confirm Short-Term Heart Disease Risk of Combination Hormone Therapy for Postmenopausal Women.”

National Institute on Aging: “Hormones and Menopause."

North American Menopause Society: “Hormone Therapy for women in 2012.”

Office on Women’s Health, U.S. Department of Health and Human Services: “Menopausal hormone therapy (MHT).”

U.S. Preventative Services Task Force: “Understanding Task Force Recommendations: Menopausal Hormone Therapy for the Primary Prevention of Chronic Conditions.”

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