If you’re looking for relief from menopause symptoms, knowing the pros and cons of hormone replacement therapy (HRT) can help you decide whether it’s right for you.
What Is Hormone Replacement Therapy?
During menopause, your estrogen levels fall. Some women get uncomfortable symptoms like hot flashes and vaginal dryness. HRT (also known as hormone therapy, menopausal hormone therapy, and estrogen replacement therapy) is the most effective treatment for menopause symptoms.
Estrogen Therapy: Doctors generally suggest a low dose of estrogen for women who have had a hysterectomy, the surgery to remove the uterus. Estrogen comes in different forms. The daily pill and patch are the most popular, but the hormone also is available in a vaginal ring, gel, or spray.
- Estrogen pill — Pills are the most common treatment for menopausal symptoms. Among the many forms of pills available are conjugated estrogens (Cenestin, Estrace, Estratab, Femtrace, Ogen, and Premarin) or estrogens-bazedoxifene (Duavee). Follow your doctor's instructions for dosing. Most estrogen pills are taken once a day without food. Some have more complicated dosing schedules. As noted above, estradiol is the same estrogen that the ovary makes before menopause. (note there are also combination pills that include both estrogen and progestin)
- Estrogen patch — the patch is worn on the skin of your abdomen. Depending on the dose, some patches are replaced every few days, while others can be worn for a week. Examples are Alora, Climara, Estraderm, and Vivelle-Dot. Combination estrogen and progestin patches -- like Climara Pro and Combipatch -- are also available. Menostar has a lower dose of estrogen than other patches, and it's only used for reducing the risk of osteoporosis. It doesn't help with other menopause symptoms.
- Topical Estrogen – Creams, gels and sprays offer other ways of getting estrogen into your system. Examples include gels (like Estroge and Divigell), creams (like Estrasorb), and sprays (like Evamist). As with patches, this type of estrogen treatment is absorbed through the skin directly into the bloodstream. The specifics on how to apply these creams vary, although they're usually used once a day. Estrogel is applied on one arm, from the wrist to the shoulder. Estrasorb is applied to the legs. Evamist is applied to the arm.
- Vaginal estrogen — Vaginal estrogen comes in a cream, vaginal ring, or vaginal estrogen tablets. In general, these treatments are for women who are troubled specifically by vaginal dryness, itchiness, and burning or pain during intercourse. Examples are vaginal tablets (Vagifem), creams (Estrace or Premarin), and insertable rings (Estring or Femring). Dosing schedules vary, depending on the product. Most vaginal rings need to be replaced every three months. Vaginal tablets are often used daily for a couple of weeks; after that, you only need to use them twice a week. Creams might be used daily, several times a week, or according to a different schedule.
Estrogen/Progesterone/Progestin Hormone Therapy
This is often called combination therapy, since it combines doses of estrogen and progestin, the synthetic form of progesterone. It’s meant for women who still have their uterus. Taking estrogen with progesterone lowers your risk for cancer of the endometrium, the lining of the uterus.
While generally used as a form of birth control. Progesterone can help treat many menopausal symptoms such as hot flashes
- Oral progestins – Taken in pill form, progestin medications include medroxyprogesterone acetate (Provera) and the synthetic progestin pills (norethindrone, norgestrel). Many experts now treat the majority of their menopausal patients with natural progesterone rather than synthetic progestins. Natural progesterone has no negative effect on lipids and is a good choice for women with high cholesterol levels. In addition, natural progesterone might have other advantages when compared with medroxyprogesterone acetate.
- Intrauterine progestin – Not approved for this use in the United States, the low-dose intrauterine devices (IUD) levonorgestrel are sold under the brand names: Liletta, Kyleena, Mirena and Skyla). If you had one of these IUDs when you enter perimenopause, your doctor may suggest that you keep it in until after menopause is complete.
Who Shouldn’t Take Hormone Replacement Therapy?
If you have these conditions, you may want to avoid HRT:
- Blood clots
- Cancer (such as breast, uterine, or endometrial)
- Heart or liver disease
- Heart attack
- Known or suspected pregnancy
What Are the Side Effects of Hormone Replacement Therapy?
HRT comes with side effects. Call your doctor if you have any of these:
- Breast swelling or tenderness
- Mood changes
- Vaginal bleeding
How Do I Know If Hormone Replacement Therapy Is Right for Me?
Your doctor can help you weigh the pros and cons and suggest choices based on the severity of your symptoms and your medical history.