Menopause Health Center

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Estrogen replacement therapy (ERT) is used to prevent weakening bones and the severe symptoms that come with sudden, early menopause. Early menopause usually happens after surgery to remove the uterus and ovaries (hysterectomy and oophorectomy) or from ovary failure after cancer treatment. But ERT is known to slightly increase the risks of stroke and blood clots during the first year of use.¹⁶ Long-term ERT may slightly increase breast and ovarian cancer risks.^{17, 12}

Taking estrogen by itself (ERT) can lead to uterine (endometrial) cancer. Taking progestin with estrogen protects against uterine cancer. This is why ERT is only recommended if you have no uterus. If you have not had your uterus removed and want hormone therapy, you take progestin with the estrogen (HRT).

Hysterectomy and Oophorectomy: Should I Use Estrogen Replacement Therapy (ERT)?

Short-term, low-dose HRT or ERT is hoped to offer a balance between HRT benefits and risks. It can be taken for up to 4 to 5 years, with regular checkups. This may work well for many women, who will find that their menopause symptoms have subsided within this period of time. As more women use low-dose hormones for shorter periods of time after menopause, researchers will be able to learn about the actual benefits and risks.

Progesterone creams. "Natural" progesterone creams (available in health food stores or through mail order) or prescription progestin creams, which are made by a compounding pharmacist, are marketed to correct low progesterone levels. While some women report finding relief with progesterone cream, many experts are concerned about whether these products increase the body's progesterone levels. This raises the following concerns about over-the-counter progesterone cream use.

• If it is absorbing well. Progesterone treatment has risks. It has been linked to breast cancer, headaches, and dangerous blood clots in a small number of women.¹⁸ This is why progesterone is usually a prescription hormone and is not safe for women with certain health risks.
• If it is not absorbing well. If you are taking estrogen (and have an intact uterus), you also need to have enough progesterone to prevent the estrogen from causing uterine (endometrial) cancer.

Talk to your doctor before using an over-the-counter progesterone cream.

Testosterone. Testosterone-estrogen is sometimes used for menopausal symptoms that don't improve with estrogen therapy. But it is not FDA-approved because its risks are not yet fully known. Testosterone-estrogen carries the same risks as estrogen treatment (blood clots, stroke, breast cancer) as well as testosterone risks and side effects.

Testosterone is sometimes used to increase sexual desire in postmenopausal women who have low testosterone. But, no form of testosterone is approved for women. Studies have not shown a benefit for longer than 12 weeks of use, and long-term testosterone risks for women are not yet known.⁹ If you have a problem with low sexual desire, see the topic Sexual Problems in Women.