The Pros and Cons of Hormone Replacement Therapy

Trying to keep up with the latest on hormone replacement therapy (or HRT) can be tough.

"Women don't know what to believe anymore," says Shelley R. Salpeter, MD, director of medicine consultation services at Santa Clara Valley Medical Center in San Jose, Calif.

Experts debate the risks and benefits of hormone replacement therapy, but everyone, including the FDA, agrees that it definitely helps with two conditions: the symptoms of menopause and osteoporosis.

Here are the pros and cons of using hormone replacement therapy, as well as some alternatives:

Medical Condition Pros Cons Alternatives to Hormone Replacement Therapy
Menopausal symptoms Considered the best treatment for these symptoms (when severe), in women who are perimenopausal or postmenopausal. Slight increased risk of breast or uterine cancer (risk is decreased for breast cancer if estrogen is used alone and for uterine cancer if both estrogen AND progesterone are used or if the woman has had a hysterectomy), and heart attack or stroke, in some women. May not be recommended for women who have a family or personal history of heart disease, stroke, blood clots, or breast cancer.

Some antidepressants can help with mood changes, sleep problems, and reduce hot flashes and night sweats.

Vaginal moisturizers, lubricants, vaginal estrogen

Treating each symptom directly.

Some women use herbal remedies like black cohosh, but studies have not shown that they help. With time, most women's menopausal symptoms will subside.

Osteoporosis (thinning bones) Highly effective in reducing the risk of osteoporosis. May be good for women who cannot use other medicines that protect bone health. Same as above.

Using hormone replacement therapy for prevention of osteoporosis alone -- not to treat menopausal symptoms -- is not recommended by the FDA. However, some women and their doctors may choose to use it for this reason.

Bisphosphonates, which reduce the breakdown of bone.

SERMs, a new class of synthetic estrogen that does not have the same negative effects as estrogen.
Calcium and vitamin D supplements, and weight bearing exercise.

Synthetic parathyroid hormone, which stimulates growth of bone.

RANKL inhibitor (Prolia), which reduces bone turnover and resorption.


Hormone Replacement Therapy & Disease Prevention

Hormone replacement therapy was once used to prevent heart disease, dementia, Alzheimer's disease, and other conditions. But it is rarely used that way now. In at least some women, it may increase the risks of these conditions.

Some doctors use HRT in cases where a woman has a combination of symptoms that hormone replacement therapy can relieve. For instance, while using HRT for osteoporosis alone is not generally recommended, it may be used in a woman for that reason.

"If a woman in early menopause has low bone density, high cholesterol, mood changes, and sleep problems, she could just take one medicine -- estrogen -- instead of four," says Lynne T. Shuster, MD, director of the Women's Health Clinic at the Mayo Clinic in Rochester, Minn.

The key is to work closely with your doctor. Before deciding on hormone replacement therapy, go over the specific risks and benefits in your case. Keep in mind your age, lifestyle, and risk for disease. Then get regular checkups to make sure that you should continue with HRT.

WebMD Medical Reference Reviewed by Nivin Todd, MD on July 13, 2017


American College of Obstetricians and Gynecologists web site, "Frequently Asked Questions about Hormone Therapy."
News release: ''ACOG Issues State-of-the-Art Guide to Hormone Therapy."
Shelley R. Salpeter, MD, clinical professor of medicine at Stanford University's School of Medicine; director of medicine consultation services at Santa Clara Valley Medical Center in San Jose, CA. Isaac Schiff, MD, chief of obstetrics and gynecology at Massachusetts General Hospital in Boston; chair of the American College if Obstetricians and Gynecologists Task Force on Hormone Therapy. Lynne T. Shuster, MD, director of the Women's Health Clinic at the Mayo Clinic in Rochester, Minn. U.S. Food and Drug Administration web site, "Questions and Answers for Estrogen and Estrogen with Progestin Therapies for Postmenopausal Women."

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