Hormone Therapy for Menopause

If you are considering hormone therapy, or hormone replacement therapy, to manage menopause symptoms, you may be feeling anxious about the risks associated with this treatment. It is completely normal to feel this way. There is a lot of misinformation and confusion about the pros and cons of using hormones to manage menopause.

This article explains what studies have found regarding the safety and effectiveness of hormone therapy for menopause and the different types of hormone therapy.

Regarding the benefits and risks of hormone therapy, the 2017 position statement from the North American Menopause Society notes:

• The benefits may outweigh the risks for individuals who begin hormone therapy before age 60 or within 10 years of the onset of menopause.
• The decision to use hormone therapy should be individualized, taking into account treatment goals, health risks, and the individual's preferences.
• The type of hormone therapy and specific regimen should also be individualized, factoring in risks, preferences, and safety.

There are many different types, dosages, and formulations of hormone therapy depending on your specific needs.

The National Institutes of Health's Women's Health Initiative hormone therapy trial suggested that there may be an increased risk of cancer with the use of certain hormones and hormone combinations in hormone therapy for menopause. However, certain types do not increase risk of cancer. Be sure to speak to a healthcare provider about these combinations and your risk of cancer.

Oral Estrogen

This type of hormone therapy comes in pill form and is taken by mouth. Although the original conjugated equine estrogen formulation, which is made from horse urine, is still used, several other synthetic estrogens are also available. These synthetic estrogens are considered bioidentical (the same chemical structure of estrogen made by the human body).

There are several different strengths available, which allows for a range of dosing options. If you have a uterus, you will also need to take some form of a progesterone. This protects your endometrium, or uterine lining, from the effects of estrogen, which is linked to an increased risk of endometrial cancer.

Transdermal Estrogen

Transdermal estrogen is a type of hormone therapy that is absorbed through the skin. This has a few benefits:

• It doesn't have to be absorbed by your intestines, so it can be prescribed in lower doses.
• It maintains a more stable hormone level in your body, which can be especially helpful if you tend to have migraine headaches.
• It doesn't need to pass through your liver. This means it doesn't cause an increase in triglycerides, an unhealthy cholesterol, which minimizes the risk of gallbladder-related issues.

Types of transdermal options include patches, gels, topical emulsions, and sprays. How well each type absorbs can vary. If you have a uterus, you will also need to take some form of a progesterone.

Vaginal Estrogen

This type of hormone therapy typically results in lower levels of estrogen in your bloodstream. Because of this, it is usually only used to treat concerns like vaginal dryness, painful sex, and pain or difficulty peeing. The one exception is the higher dose vaginal ring Femring, which may be used to also treat hot flashes.

Vaginal estrogens are available in creams, which are applied on the inside of the vagina. They are also available as rings and tablets, which are inserted into the vagina.

Except for the higher dose ring, these vaginal preparations can be used safely without progesterone, even if you have a uterus.

Progestin-Progesterone

If you are starting hormone therapy and you have a uterus, you will need to use some type of a progestin or progesterone to protect the lining of your uterus. Over time, estrogen that isn't balanced out with progesterone can lead to endometrial hyperplasia, a condition that causes abnormal uterine bleeding. It can also lead to endometrial cancer.

You can either use a synthetic progestin or one that is identical to the progesterone produced by the ovaries.

These progestin/progesterone options are available as:

• Pills
• Vaginal gels
• Vaginal inserts
• Progestin-containing intrauterine device, or a small medical device that is inserted into the uterus

Combination Estrogen and Progestin

For some individuals, it may be preferable to use a product that contains both hormones. This can help with menopause-related symptoms, including hot flashes, and may also reduce the risk of colon cancer.

This type of hormone therapy is available in pill form and as a transdermal patch.

A Word From Verywell

The hormone changes associated with menopause can cause very uncomfortable symptoms. These may be improved with the use of hormone therapy. If you are considering hormone therapy, discuss your options with a healthcare provider, so you have plenty of information to make an informed decision.