As you get close to menopause, your ovaries make less estrogen and progesterone, the two hormones that control your monthly cycle. These hormones also affect the health of your bones, your heart, and your vagina.
Replacing these hormones with versions made in a lab (called hormone replacement therapy, or HRT) can ease some symptoms of menopause, but it's important to understand both the benefits and risks -- and discuss them with your doctor -- before deciding if HRT is right for you.
Benefits of HRT
- Relieve hot flashes and night sweats
- Help you sleep better
- Ease vaginal dryness and itching
- Make sex less painful
Its effects on your health after menopause may be even more important. Studies show that HRT can:
- Help prevent fractures caused by osteoporosis (thinning bones)
- Make some women less likely to have heart disease
- Lower your chances of dementia
Risks of HRT
In 2002, early findings of the Women’s Health Initiative seemed to show that HRT could slightly raise the odds of heart disease, breast cancer, and stroke in women who had gone through menopause and were taking a combination estrogen and progestin (a form of progesterone).
But many of the women in the study were over 60, and the results weren’t clear. Still, publicity caused many women to stop or not start HRT.
Since then, research has shown that the benefits can be greater than the risks for many women. But HRT may still raise your chances of:
- Endometrial cancer, if you take estrogen without progestin and you still have your uterus
- Blood clots
- Breast cancer
These are man-made versions of estrogen and progesterone. They’re the same, chemically, as your hormones.
Some are made by drug companies and have been approved by the FDA. Others are made by pharmacists following a doctor’s orders. These are called “compounded,” and they aren’t tested by the FDA for safety.
If bioidentical hormones are “natural,” that means they come from sources like plants or animals, but they still have to be processed.
Research hasn’t shown that bioidentical or natural hormones are any safer or work better than traditional HRT.
Lower Your Chances of Problems
Talk to your doctor about things you can do to make HRT less likely to cause issues:
- Start HRT within 10 years of menopause or before age 60.
- Take the lowest dose that works for you for the shortest possible time.
- Take progesterone or progestin if you still have your uterus.
- Ask about other forms of HRT besides pills, like patches, gels, mists, vaginal creams, vaginal suppositories, or vaginal rings.
- Get regular mammograms and pelvic exams.
Who Shouldn’t Use HRT
You and your doctor may decide HRT isn’t right for you if you have or have had:
- Breast cancer
- Endometrial (uterine) cancer
- Ovarian cancer
- Unexplained vaginal bleeding
- Blood clots
- Liver disease
You also shouldn’t use HRT if there’s any chance you might be pregnant.
Questions for Your Doctor
If you’re thinking about using HRT, you might take this list with you to your next appointment:
- Based on my medical history, is there any reason I shouldn’t use HRT?
- Do you think it could help my symptoms, especially hot flashes, sleep issues, and vaginal dryness?
- Are there other treatments I should consider? (Vaginal moisturizers may help vaginal dryness, for example.)
- Do you think I’ll have side effects from HRT? (Be sure to tell your doctor if you had any issues with taking birth control pills.)
- Does my family medical history make me a good or bad candidate for HRT? (If your mom had osteoporosis, HRT will help lower your chances of it. But if your mom had breast cancer, you’ll want to talk about that with your doctor.)
- What type of HRT might be best for me?