Menopause hormone therapy: Is it right for you?

Menopause hormone therapy is medicine with female hormones. It’s taken to replace the estrogen the body stops making after menopause, which is when periods stop for good. This therapy most often is used to treat common menopause symptoms, such as hot flashes and vaginal discomfort. Menopause hormone therapy used to be called hormone replacement therapy.

Menopause hormone therapy also has been shown to prevent bone loss and reduce broken bones after menopause.

But menopause hormone therapy does have risks. These risks depend on:

• The type of hormone therapy.
• Whether the medicine is taken by mouth or applied on the skin.
• The dose of medicine.
• How long the medicine is taken.
• Your age and personal health risks.

For best results, menopause hormone therapy should be tailored to each person. You also should review your use of hormone therapy regularly with your healthcare professional to make sure the benefits still outweigh the risks.

Menopause hormone therapy replaces the estrogen your body no longer makes after menopause. There are two main types of estrogen therapy:

• Whole-body hormone therapy, also called systemic therapy. Systemic estrogen comes as a pill, skin patch, ring, gel, cream or spray. It typically has more estrogen than other hormone therapies. Systemic estrogen is absorbed by the whole body and can be used to treat many common symptoms of menopause.
• Low-dose vaginal estrogen. Low-dose vaginal estrogen comes as a cream, tablet or ring. It usually has less estrogen than systemic therapy, reducing the amount of estrogen absorbed by the body. Because of this, low-dose vaginal estrogen usually is used to treat only the vaginal and urinary symptoms of menopause.

If you still have your uterus, your healthcare professional will likely prescribe estrogen along with a progestogen, which is a group of progesterone-like medicines. This is because taking estrogen without a progestogen can thicken the uterus lining, which can increase the risk of endometrial cancer. If you have had your uterus removed, you may not need to take a progestogen along with estrogen.

Menopause hormone therapy does have risks. For some, menopause hormone therapy may increase the risk of:

• Heart disease.
• Stroke.
• Blood clots.
• Breast cancer.
• Gallbladder disease.
• Endometrial cancer.

Research suggests that these risks vary depending on:

• Age. If you start menopause hormone therapy at age 60 or older, or it has been more than 10 years since menopause, your risk of serious complications increases. But if you start menopause hormone therapy before age 60 or within 10 years of menopause, the benefits may outweigh the risks.
• Type of menopause hormone therapy. The risks of menopause hormone therapy depend on whether you take estrogen alone or with a progestogen. The dose and type of estrogen also can affect risk.
• Health history. Your personal medical history and risk of cancer, heart disease, stroke, blood clots, liver disease and osteoporosis also are factors that can affect the risks of menopause hormone therapy.

Talk with your healthcare professional about these risks when deciding if menopause hormone therapy might be an option for you.

The benefits of menopause hormone therapy may outweigh the risks if you start treatment before age 60, or within 10 years of menopause. You also may benefit from menopause hormone therapy if you’re healthy and you:

• Have moderate to severe hot flashes. Systemic estrogen is the most effective treatment for hot flashes and night sweats.
• Have other symptoms of menopause. Estrogen can ease vaginal symptoms of menopause, such as dryness, itching, burning and pain with intercourse. It also may help bladder symptoms of menopause, such as urinating often, having a strong urge to urinate, leaking, burning and urinary tract infections.
• Need to prevent bone loss or broken bones. Systemic estrogen helps protect against the bone-thinning disease called osteoporosis. But healthcare professionals usually recommend other medicines to treat osteoporosis. Estrogen therapy may help if other treatments don’t work for you or you can’t take them.
• Have early menopause or low estrogen. If you go through menopause or have your ovaries removed before age 45, or your ovaries stop working before age 40, you may benefit from menopause hormone therapy. That’s because you would have low estrogen for a longer time than if you went through menopause at a typical age. Estrogen therapy may help lower your risk of some health conditions caused by low estrogen, such as osteoporosis, heart disease, dementia and mood changes.

Talk to your healthcare professional about these strategies to reduce the risks of menopause hormone therapy:

• Find the best product type for you. You can take estrogen as a pill or use a patch, gel, vaginal cream, or slow-releasing suppository or ring that you place in your vagina. If you have only vaginal menopause symptoms, estrogen in a low-dose vaginal cream, tablet or ring is usually a better choice than an oral pill or a skin patch.
• Reduce the amount of medicine you take. Take the lowest dose of estrogen that helps your symptoms. And take it only for as long as you need it. If you’re younger than age 45, you need enough estrogen to provide protection against the long-term health effects of low estrogen. If you have lasting menopause symptoms that hurt your quality of life, your healthcare professional may recommend longer treatment.
• Get regular follow-up care. See your healthcare professional regularly to make sure the benefits of menopause hormone therapy continue to outweigh the risks. You also should continue to have regular screenings, such as mammograms, blood pressure measurement and cervical cancer screening.
• Make healthy lifestyle choices. Get daily physical activity and exercise, eat a healthy diet, keep a healthy weight, don’t smoke, limit alcohol and manage stress. Be sure to work with your healthcare professional to manage ongoing health conditions, such as high cholesterol or high blood pressure.

If you still have your uterus and are taking estrogen, you’ll also need to take a progestogen. Your healthcare professional can help you choose the best way to take these hormones based on what works for you and has the fewest side effects.

If you can’t take menopause hormone therapy, you may be able to manage hot flashes with:

• Weight loss.
• Cognitive behavioral therapy.
• Clinical hypnosis.

There also are many nonhormone prescription medicines that may help manage hot flashes.

For vaginal concerns such as dryness or painful intercourse, a vaginal moisturizer or lubricant may help. You also might ask your healthcare professional about the prescription medicine ospemifene (Osphena) or prasterone (Intrarosa). These medicines may help with painful intercourse and other vaginal and bladder symptoms of menopause.

To find out if menopause hormone therapy is a good option for you, talk to your healthcare professional about your symptoms and health risks. You also can ask your healthcare professional for help finding a certified menopause expert. Or check with a professional organization such as The Menopause Society. Be sure to keep the conversation going throughout menopause.

As researchers learn more about menopause hormone therapy and other menopause treatments, recommendations may change. But if you have menopause symptoms that disrupt your sleep or get in the way of daily life, it’s worthwhile to talk to your healthcare professional about treatment options.

If you’re already taking menopause hormone therapy, check in with your healthcare professional regularly to reassess your need for treatment.