Hormone therapy (HT) refers to
the use of
progestin for the treatment of
Estrogen and progestin combinations (pills or tablets)
Transdermal combination preparations (a patch placed on the skin that continuously releases estrogen and progestin)
Oral progestin (pills or tablets; used along with an estrogen-only preparation)
Progestin intrauterine device (IUD; used along with an estrogen-only preparation)
Estrogen-progestin hormone therapy, or HT, is recommended
for all women with a uterus who choose to take estrogen. Using estrogen without
progestin greatly increases your risk of
endometrial cancer. Taking progestin with estrogen
eliminates this increased risk.1
How It Works
HT increases the estrogen and progestin
levels in your body. There are several ways to take HT,
including continuous and cyclic along with higher-dose and low-dose.
Combining progestin with estrogen:
- Protects against endometrial cancer (which can
develop with estrogen-only therapy).
- Is not needed for women who
have no uterus.
- May trigger monthly withdrawal bleeding when
progestin is used periodically (such as in cyclic HT).
Why It Is Used
The estrogen in hormone therapy is
used by some postmenopausal women to increase estrogen levels. This helps
osteoporosis and perimenopausal symptoms, such as hot
flashes and sleep problems.
But HT slightly increases risks of
some serious health problems. In a small number of women, HT
may increase the risk of blood clots, stroke,
heart disease, breast cancer, ovarian cancer, or dementia. Risk varies based on when you start HT in menopause and how long you take it. Short-term use of hormone therapy in early menopause has less risk than when it is started later in menopause.2
Because of the risks from HT, many experts recommend that HT be used for:
- Short-term treatment of menopause symptoms. HT effectively relieves menopause symptoms for most women. Women who decide that HT benefits outweigh their risks are advised to use the lowest effective dose for as short a time as possible.2 For most women, menopause symptoms naturally improve within a few years' time, making long-term symptom treatment unnecessary.
- Osteoporosis prevention and treatment, in select cases. Most experts recommend that long-term HT only be considered for women with a high osteoporosis risk. In this case, estrogen's bone-protecting benefit may outweigh the risks from taking HT. Women are now encouraged to consider all possible osteoporosis treatments and to compare their risks and benefits.
Who should not use HT
You should not use HT if you:
- Could be pregnant.
- Have a personal
breast cancer or
- Have a personal history of
certain endometrial cancers.
- Have a personal history of
deep vein thrombosis,
heart attack, or
vaginal bleeding from an unknown cause.
- Have active liver disease.
You may be able to use an alternative to oral estrogen that bypasses the liver,
such as estrogen delivered from a skin patch (transdermal) or vaginal cream.
How Well It Works
HT increases estrogen levels,
- Reduce the
frequency and severity of
- Improve moodiness and sleep problems related to hormone changes.4
- Maintain the lining of the
vagina, which in turn reduces irritation.
- Increase skin
collagen levels, which decline as estrogen levels
decline. Collagen is responsible for the stretch in skin and
- Help prevent postmenopausal
osteoporosis by slowing bone loss and promoting some
increase in bone density.3
- Reduce the risk of dental problems, such as tooth loss and
Estrogen side effects
Side effects that can occur
with all forms of estrogen but are more frequent with oral estrogen
- Irregular vaginal
- Fluid retention.
- Spotting or darkening of the
skin, particularly on the face.
Gallstones. Women who use estrogen therapy (ET)
are more likely to have gallstones that cause symptoms than women who do not
use ET. (High estrogen levels are linked to gallbladder
- In rare cases, an increased growth of preexisting
uterine fibroids or a worsening of
In addition, the estrogen patch (transdermal estrogen)
may cause skin irritation.
Some of these side effects, such as
headaches, nausea, fluid retention, weight gain, and breast tenderness, may go
away after a few weeks of use.
Progestin side effects
The side effects of
progestin often cause women to stop using hormone therapy (HT).
Adjusting the progestin dose, changing the dosing schedule, or changing the
type of progestin may reduce side effects. The progestin
intrauterine device (IUD) reduces or eliminates side
effects that are common with oral progestin.1
Progestin side effects include:
Cyclic progestin (taken 10 to 14
days a month) is more likely to cause:
- Premenstrual-like symptoms, such as bloating,
cramping, breast tenderness, nausea, and depression.
The combination transdermal patch may cause skin irritation.
See Drug Reference for a
full list of side effects. (Drug Reference is not available in all
What To Think About
Risks from hormone therapy
Risk varies based on when you start HT in menopause and how long you take it. Hormone
therapy (HT) may increase the risk of health problems in a small number of women. Using HT may increase your risk of:
If you have been taking HT, talk with your doctor about your reasons for
taking it. Are you taking it to help with perimenopausal symptoms or for
long-term health reasons? Consider changing to another treatment, depending on
the problem you are using HT to treat. If HT seems like the best choice for
you, plan to use the lowest possible effective dose.
If you are
unable to tolerate the side effects of progestin in hormone therapy
and you have not had a
hysterectomy, try nonhormonal treatment options.
When given with a skin patch, estrogen-progestin
enters the bloodstream directly, without passing through the liver. The
estrogen and progestin in pills must be processed by the liver before entering
the bloodstream. This is why women with liver or gallbladder disease can
usually use a patch form of HT.
Direct sunlight or
high heat can increase, then decrease, the amount of hormone released from a
patch. This can give you a big dose at the time and leave less hormone for the
patch to release later in the week. Avoid direct
sunlight on the hormone patch. Also avoid using a tanning bed, heating pad,
electric blanket, hot tub, or sauna while you are using a hormone patch.
Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.
Fritz MA, Speroff L (2011). Postmenopausal hormone therapy. In Clinical Gynecologic Endocrinology and Infertility, 8th ed., pp. 749–857. Philadelphia: Lippincott Williams and Wilkins.
North American Menopause Society (2012). The 2012 hormone therapy position statement of
the North American Menopause Society. Menopause, 19(3): 257–271. Also
available online: http://www.menopause.org/PSht12.pdf.
Fritz MA, Speroff L (2011). Menopause and perimenopausal transition. In Clinical Gynecologic Endocrinology and Infertility, 8th ed., pp. 673–748. Philadelphia: Lippincott Williams and Wilkins.
North American Menopause Society (2010). Estrogen and
progestogen use in postmenopausal women: 2010 position statement of the
North American Menopause Society. Menopause, 17(2):
242–255. Also available online: http://www.menopause.org/PSht10.pdf.
Other Works Consulted
Primary Medical Reviewer
||Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer
||Carla J. Herman, MD, MPH - Geriatric Medicine
Current as of
||March 12, 2014