Hormone replacement therapy (HRT) 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 HRT, 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.5
How It Works
HRT increases the estrogen and progestin
levels in your body. There are several
standard hormone replacement therapy schedules,
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 HRT).
Patch warning. 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.
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 HRT slightly increases risks of
some serious health problems. In a small number of women, HRT
may increase the risk of blood clots, stroke,
heart disease, breast cancer, ovarian cancer, or dementia.2, 1 In
women who are 10 or more years past menopause, using HRT slightly raises the
Because of the risks of HRT, many experts recommend that HRT be used for:
Short-term treatment of menopause symptoms. HRT effectively relieves menopause symptoms for most women. Women who decide that HRT 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 HRT only be considered for women with a high osteoporosis risk. In this case, estrogen's bone-protecting benefit may outweigh the risks of taking HRT. Women are now encouraged to consider all possible osteoporosis treatments and to compare their risks and benefits.
Who should not use HRT
You should not use HRT if you:
How Well It Works
HRT increases estrogen levels,
- Reduce the
frequency and severity of
- Improve moodiness and sleep problems related to hormone changes.2
- 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.4
- Reduce the risk of dental problems, such as tooth loss and
Risks of hormone replacement therapy
replacement therapy (HRT) may increase the risk of health problems in a small number of women. This
increase in risk depends on your age, your personal risk, and when HRT is started.2 Talk with
your doctor about these risks. Using HRT may increase your risk of:
- Blood clots.
- Heart disease.
- Breast cancer.
- Uterine (endometrial) cancer.
- Ovarian cancer.
Experts do not yet know whether lower-dose, shorter-term
HRT reduces or eliminates these risks.
Estrogen side effects
Side effects that can occur
with all forms of estrogen but are more frequent with oral estrogen
- Irregular vaginal
- Fluid retention.
- Breast tenderness.
- Spotting or darkening of the
skin, particularly on the face.
Gallstones. Women who use estrogen replacement therapy
are more likely to have gallstones that cause symptoms than women who do not
use ERT. (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 replacement therapy (HRT).
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.5
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
If you have been taking HRT, 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 HRT to treat. If HRT 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 replacement therapy
and you have not had a
hysterectomy, try nonhormonal treatment options.
The British Million Women Study has confirmed the Women's Health
Initiative findings and has provided
more information about estrogen, progestin, and breast and endometrial cancers.3 This is important
information for women deciding whether to take estrogen without progestin, as
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 HRT.
Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.
Practice Committee, American Society for Reproductive Medicine (2008). Estrogen and progestogen therapy in postmenopausal women. Educational Bulletin. Fertility and Sterility, 90(Suppl 3): S88-S102.
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.
Million Women Study Collaborators (2003). Breast
cancer and hormone-replacement therapy in the Million Women Study.
Lancet, 362(9382): 419-427.
Speroff L, Fritz MA (2005). Menopause and the
perimenopausal transition. In Clinical Gynecologic Endocrinology and Infertility, 7th ed., pp. 621-688. Philadelphia:
Lippincott Williams and Wilkins.
Speroff L, Fritz MA (2005). Postmenopausal hormone
therapy. In Clinical Gynecologic Endocrinology and Infertility, 7th ed., pp. 689-777. Philadelphia: Lippincott Williams and
Rossouw JE, et al. (2007). Postmenopausal hormone
therapy and risk of cardiovascular disease by age and years since menopause.
JAMA, 297(13): 1465-1477.