If you’re having bothersome menopause symptoms, you might be wondering if there’s any way to get relief. The answer: Probably. And hormone replacement therapy -- also called HRT, or hormone therapy -- might be able to help.
HRT is female hormones that replace the ones your body no longer makes after menopause. You can get it from medications you take by mouth, patches or gels that go on your skin, or through a cream, ring, or suppository that goes in your vagina. If you still have a uterus, you would take estrogen and progestin. (Progestin helps lower the risk of getting endometrial cancer from estrogen.) If you’ve had a hysterectomy, you take estrogen alone.
HRT used to be the go-to menopause treatment. But after a 2002 study called the Women’s Health Initiative reported that it made you more likely to get breast cancer and heart disease, the number of women using it dropped.
In the past few years, though, follow-up studies have shown that HRT is safe and works for most women who’ve recently started menopause.
“We now know that hormone therapy has more benefits than risks for the majority of women under age 60, or who are within 10 years of menopause,” says JoAnn V. Pinkerton, MD, an obstetrician and gynecologist, and the executive director of the North American Menopause Society.
These five questions can help you and your doctor decide if HRT might be a good choice.
1. How Old Are You -- and When Did You Begin Menopause?
Hormone therapy is most helpful, and least risky, if you’re under 60 and use it just before or soon after you begin menopause. (That’s also when symptoms tend to be worst.)
“For women over 60, or who are further than 10 years from the start of menopause, the risk of [heart disease], blood clots, dementia, and stroke is higher,” Pinkerton says. But if you’re in your 50s and use HRT soon after menopause starts, it may actually lower your chances of heart and brain issues. If you have brittle bones or osteoporosis, the treatment can help prevent bone loss, too.
2. What's Your Health History?
If you have a history of any these conditions, HRT probably isn’t right for you:
- Breast, ovarian, or endometrial cancer
- Blood clots (particularly in your lungs or legs)
- Heart problems
If you smoke, you can’t use HRT. You’ll have a much higher risk of blood clots and other health problems.
3. How Severe Are Your Symptoms?
If you have few or no menopause symptoms, there’s no need to take HRT. “But if you’re uncomfortable, you may want to consider it,” says Mary Jane Minkin, MD, clinical professor in obstetrics, gynecology and reproductive sciences at Yale Medical School.
Along with easing hot flashes, HRT can relieve vaginal dryness too. It also helps some women sleep better and improves their mood. “You should have substantial relief by 4 weeks,” Minkin says. “If you don’t see improvement in 12 weeks, you’ll need to try higher doses.”
Most experts recommend using HRT for no more than 5 years. The longer you use it, the higher the risks.
4. What Else Have You Tried?
“Many women try other remedies before HRT,” Minkin says.
Over-the-counter lubricants treat vaginal dryness, which can make sex painful. Certain antidepressants called SSRIs can help with mood, but they can also cause weight gain and dampen libido. Exercise and good sleep habits can help with symptoms like low mood, insomnia, and weight gain.
“Cognitive behavioral therapy and hypnosis have been shown to be effective for menopause symptoms,” Pinkerton says. But studies show that no supplement works better than placebo, a pill or treatment that doesn’t actually contain medicine.
You may hear a lot about "bioidentical hormone treatments." Not all are FDA-approved. The agency hasn’t given the nod to compounded bioidenticals, which are made by a pharmacist, because doses can vary. (Traditional HRT is FDA-approved.)
“Women have been so afraid to use hormone therapy that they have used unproven or untested supplements, or compounded hormone therapies, which are not FDA regulated or monitored,” Pinkerton says. “The hormones they contain aren’t tested or monitored for safety. You may be getting too little or too much medication.”
5. Are You OK With the Risks?
Like all medications, it isn’t risk-free. HRT containing estrogen and progestin can slightly raise your risk for breast cancer, stroke, and deep-vein thrombosis.
“However, we have learned about which women are more likely to have those risks, and how to minimize risks so that women can receive the benefits of hormone therapy,” Pinkerton says.
The safest way to use HRT is by working with a doctor who's experienced in prescribing it. That doctor should also closely watch your health with regular checkups while you’re using it. To find one who's certified in menopause treatment, visit menopause.org.