What to Know About HRT

Reviewed by Dan Brennan, MD on March 17, 2021

Hormone replacement therapy (HRT), also called hormone therapy or menopausal hormone therapy (MHT) has become a heavily debated treatment option for symptoms of menopause. It can be helpful for some women, but it can be risky for others. Is HRT for you?

Age is a major risk factor for hormone therapy. Generally, women over the age of 60 who begin HRT are at greater risk. Starting hormone therapy earlier than 60 and continuing treatment doesn’t pose as much of a risk, but long-term HRT has greater risks the longer you continue with treatment. Talk to your doctor when considering hormone therapy to determine if the benefits outweigh the risks for you.

What Is HRT?

HRT is a treatment used to relieve the common symptoms of menopause. HRT medicines contain female hormones that replace those your body no longer produces during menopause.

HRT is used to treat hot flashes, bone loss, vaginal dryness and atrophy, and low estrogen levels. The type of hormone therapy you need, the dosage, and the risks will vary from person to person. 

There are several types of hormone therapy depending on your preference and needs:

  • Estrogen pills 
  • Estrogen patches applied to the skin
  • Estrogen cream inserted vaginally or used locally around the vagina

Women with a uterus receive combination therapy. Instead of estrogen-only treatments, women who have not had their uterus removed (a procedure known as a hysterectomy) will also receive progestin, a type of synthetic progesterone. It prevents the growth of the uterine lining to decrease the risk of uterine cancer.

Treatments are typically divided into two categories: systemic hormone therapy and low-dose vaginal products. 

Systemic HRT. Systemic hormone therapy usually comes in the form of pills, patches, and creams. They contain higher doses of estrogen that are absorbed by the body and treat common symptoms of menopause.

Low-dose vaginal products. These products are used to treat vaginal and urinary symptoms caused by menopause. They usually come as creams, tablets, or rings that give the minimum amount of estrogen needed. 

Benefits and Risks

The benefits and risks of HRT are frequently being researched and addressed. Short-term treatment can treat symptoms of menopause, osteoporosis, and reduce the risk of colon cancer. 

You may benefit from hormone therapy if you:

  • Experience moderate to severe hot flashes or other symptoms of menopause.
  • Have had your ovaries removed.
  • Were diagnosed with “early menopause” before the age of 40.
  • Cannot treat your osteoporosis through other means. 

Some of the risks of HRT are:

  • Increased chance of endometrial cancer for women taking only estrogen (not progestin).
  • Increased chance of breast cancer for long-term hormone therapy.
  • Higher chance of heart disease, heart attacks, blood clots, and stroke.

Women who smoke are at a higher risk for complications from HRT. Additionally, women who start hormone therapy when they are older than 60 are at risk, as well as women who have not had symptoms of menopause for 10 years or more. They can still benefit from HRT, but the risks usually outweigh the benefits. 

There are several health conditions that may put you at risk for complications from hormone therapy. Talk with your doctor to see if you have inherited health risks. These include: 

  • History of heart attacks or strokes
  • At risk for blood clots and vascular disease
  • Breast cancer
  • Gallbladder disease
  • Active liver disease
  • Endometrial cancer

Reducing the risk. There’s no “one size fits all” HRT treatment plan. Your hormone therapy will be tailored to you — your health and your lifestyle. Speak with your doctor about the following topics when considering hormone therapy:

  • Determine which HRT method (pills, patches, creams, etc.) works best for you. 
  • Take the smallest dose of HRT needed for the least amount of time that you can.
  • Receive follow-up care regularly to make sure your treatment is still working.
  • Lead a healthy lifestyle, including exercise, a healthy diet, no smoking, limited alcohol, and stress management.

Alternatives to HRT

Aside from severe symptoms, some symptoms of menopause can be managed through lifestyle changes or alternative medications. 

  • Get enough calcium and vitamin D to help with your bone health.
  • Exercise for general health and for your bone health
  • Use water-based vaginal lubricant or a vaginal estrogen cream to relieve discomfort. 
  • Keep track of when your hot flashes occur so you can figure out what triggers them.
  • Sleep in a cool room with breathable sheets and clothing. 
  • Keep a cold drink on hand for when a hot flash starts.
  • Medicines can be used to manage hot flashes, such as certain antidepressants. 

Show Sources

SOURCES: “North American Menopause Society Updates Position Statement on Hormone Therapy, Says Benefits Outweigh Risks for Some Women.”

Cleveland Clinic: “Estrogen & Hormones.”

Johns Hopkins Medicine: “Menopausal Hormone Therapy.”

Mayo Clinic: “Hormone therapy: Is it right for you?”

National Institute on Aging: “Menopause.”

Texas Heart Institute: “Is Hormone Replacement Therapy for Me?”

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