Hormone Replacement Therapy: What to Know

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Hormone replacement therapy (HRT) is a treatment that can help ease some of the symptoms associated with menopause—the point in time when a person’s menstrual cycle has stopped for 12 straight months and permanently ends. During the transition into menopause, the body gradually makes less of the hormones estrogen and progesterone, causing bothersome symptoms like night sweats, hot flashes, and vaginal dryness.

For many healthy adults, replacing these levels of hormones in the body through HRT can provide relief during the menopausal phase. HRT is prescribed with caution, as risks may include an increased chance of developing serious conditions like breast cancer and heart disease in certain people.

This article discusses the different types of HRT available for treating menopause symptoms and outlines the potential benefits and risks.

Menopausal woman outdoors

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Types of Hormone Replacement Therapy

Hormone replacement therapy is made with either one or two types of hormones:

  • Estrogen only, which helps reduce night sweats, hot flashes, vaginal dryness, and urinary discomfort, in addition to bone loss that's associated with aging, and is recommended for people who have had their uterus removed (hysterectomy)
  • Estrogen with added progesterone, which helps protect against the risk of endometrial cancer in people who still have a uterus

Each is available in different formulas and dosages.

Systemic Hormone Therapy

Systemic therapies allow the hormones—whether estrogen alone or with added progesterone—to circulate throughout the body via the bloodstream. This method impacts the vasomotor symptoms (night sweats and hot flashes) of menopause.

Systemic HRT is provided in the following ways:

  • Pill formulas that are taken orally (by mouth)
  • Topical formulas that absorb through the skin via a patch, gel, or spray
  • Vaginal rings that are inserted into the vagina every few months

Low-Dose Vaginal Products

Low-dose vaginal therapies release smaller amounts of hormones to the affected area through placement into the vagina.

Because they work locally instead of systemically, these products are typically used to just treat menopause symptoms that affect the vagina or urinary tract, such as vaginal dryness. They do this by helping to thicken vaginal tissues and boost moisture.

Low-dose HRT is available in the form of a vaginal cream, ring, or tablet. They most often contain estrogen alone.

Benefits of Hormone Replacement Therapy

For many healthy adults who are experiencing moderate or severe menopausal symptoms, there are benefits to using hormone replacement therapy that may override potential risks of this treatment.

Medical experts note that the benefits of HRT can include:

  • Relief from moderate to severe hot flashes
  • Relief from vaginal dryness and discomfort
  • Prevention of bone loss (osteoporosis) and bone fractures
  • Protection against colorectal cancer

In addition, the American College of Obstetrics and Gynecologists (ACOG) notes that otherwise healthy people who are experiencing early menopause or estrogen deficiency may find HRT beneficial.

Hormone replacement therapy is recommended on an individual basis. It's important to speak with a healthcare provider about the potential benefits and risks of HRT based on factors like your symptoms, medical history, and overall health.

Risks of Hormone Replacement Therapy

Many medical experts agree that hormone replacement therapy is an option worth considering for healthy adults under 60 seeking to manage certain menopausal symptoms. But it's important to point out that research has highlighted several potentially serious risks of using HRT.

In particular, research that began in 2002 raised significant concerns, including that some participants on HRT had a higher risk of breast cancer, heart disease, stroke, blood clots, urinary incontinence, gallbladder disease, and dementia. The affected participants were mostly over the age of 60 and past the menopausal stage.

Since then, researchers have continued to analyze these findings as they explore the long-term safety of HRT. Experts have clarified that the potential risks may be more likely in people who:

  • Begin HRT at age 60 or older
  • Begin HRT more than 10 years after the start of menopause
  • Have a personal or family history of conditions like cancer and heart disease

Anyone with these risk factors will not be considered a candidate for hormone replacement therapy.

To help avoid further risks in people who are prescribed HRT, the U.S. Food and Drug Administration (FDA) recommends using HRT at the lowest working dose for the shortest period of time possible, which is typically no longer than five years.

When HRT Is Not Recommended

Hormone replacement therapy is not recommended for people who:

  • May be pregnant
  • Have issues with abnormal vaginal bleeding
  • Have a family or personal history of breast cancer
  • Have a personal history of heart disease, stroke, blood clots, or liver disease
  • Have a family history of gallbladder disease
  • Are allergic to estrogen or progesterone

What to Expect

Just as the transition to menopause is unique for every individual, the experience of taking hormone replacement therapy will be, too.

Like most medications, there are some common side effects that may occur with HRT, including:

Note that potential side effects can vary based on the type of hormone replacement therapy and dosage. If side effects become bothersome, talk to your healthcare provider before stopping medication.

Summary

Hormone replacement therapy (HRT) is a medical treatment that boosts declining levels of estrogen and progesterone in a person approaching menopause. It helps ease some menopausal symptoms, such as hot flashes, night sweats, and vaginal dryness. HRT can be used orally, topically, or vaginally.

While the benefits of HRT can be worthwhile for people looking for moderate to severe symptom relief, studies have shown that it comes with an increased chance of breast cancer, heart disease, and other serious health conditions. It's important to talk to a healthcare provider about your medical history and personal risks before deciding whether HRT is right for you.

A Word From Verywell

The transition to menopause often comes with physical and emotional challenges, but your quality of life does not have to suffer. Whether or not you decide to try hormone replacement therapy, know that there are other options to help you cope with the menopausal transition, including non-hormonal medications that can help with hot flashes and vaginal discomfort.

Frequently Asked Questions

  • What are the signs that you need hormone replacement therapy?

    Symptoms of menopause—such as night sweats, hot flashes, and vaginal dryness—can be relieved with hormone replacement therapy. Check with a healthcare provider for more information on HRT if you're approaching menopause and experiencing these symptoms.

  • Do you gain weight on hormone replacement therapy?

    There's no solid evidence that taking hormone replacement therapy directly causes weight gain. However, hormonal changes that happen naturally during menopause in addition to lifestyle or physical activity factors often contribute to weight gain during this time.

  • What are the side effects of hormone replacement therapy?

    Common side effects may include spotting, bloating, headaches, and breast soreness.

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