You’ve probably heard that some people treat the symptoms of menopause with hormone replacement therapy (HRT). HRT can help with the changes that come with lower levels of estrogen at menopause, especially hot flashes, sleep problems, vaginal dryness, and bone loss (osteoporosis).
The nuts and bolts of using HRT
HRT is prescribed by a healthcare provider. Your provider will help you determine the right type of hormones, along with the best way for you to take HRT.
There are two main types of HRT:
- Estrogen only therapy (ET) is prescribed to women who’ve had a hysterectomy.
- Estrogen plus progesterone therapy (EPT) is prescribed to women who have a uterus. Progesterone protects against uterine cancer, which is a risk if you take estrogen alone.
There are also two ways to take HRT:
- Systemic HRT travels through your bloodstream to all the parts of your body. You can take systemic HRT as an oral tablet, patch, gel, emulsion (a cream or lotion), spray, or injection.
- Local HRT works on a specific area of the body. Local HRT medications come in creams, rings, or tablets and are used to treat vaginal symptoms.
What to know about the benefits and risks of HRT
There’s a lot of confusing information out there about HRT, so let’s dig into the facts. There are hundreds of clinical studies to show that systemic HRT is effective for easing hot flashes, vaginal dryness, and night sweats, and preventing bone loss. People who’ve used HRT report better sleep, benefits for their sex lives, and overall improvements to their quality of life.
But HRT got a lot of negative press back in 2002 when a long-term study, called the Women’s Health Initiative (WHI), showed that post-menopausal women using HRT had increased risks of breast cancer, heart disease, stroke, blood clots, and urinary incontinence.
It’s important to know that the early WHI findings included post-menopausal women across a wide range of ages. As researchers broke down the data, they discovered that younger women (those in their 50s, as opposed to women in their 70s) were far less likely to have health complications, and that shorter-term use of hormones (about three to five years) reduces risks.
Further research showed that women with early menopause (before 40), and no history of breast cancer or other risk factors, have low risks from taking HRT until the typical age of menopause (51). And women without a uterus who take estrogen alone also have lower risks, especially if they are younger.
All of this research has shaped how doctors prescribe HRT so they can maximize the benefits and keep risks low. Doctors now consider the age of the patient, begin with the lowest effective dose of HRT, and make a plan for patients to take HRT for only a few years.
Reviewed by the Ovia Health Clinical Team
Sources
- The North American Menopause Society: https://www.menopause.org/for-women/menopauseflashes/menopause-symptoms-and-treatments/hormone-therapy-benefits-risks (accessed 11/30/21).
- Office on Women’s Health (US Department of Health and Human Services): https://www.womenshealth.gov/30-achievements/25
- Manson, JoAnn E. et al. JAMA Network:
- https://jamanetwork.com/journals/jama/fullarticle/1745676
