Hormone Therapy for Menopause

If you are considering hormone therapy, or hormone replacement therapy, to manage menopause symptoms, you may be feeling a bit anxious about the risks associated with this treatment.

Know that 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. It also discusses different types of hormone therapy.

Older patient talking with doctor while sitting on exam table.
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The Women's Health Initiative hormone therapy trial suggested an increased risk of cancer, especially breast cancer, associated with hormone therapy for menopause.

As of 2017, in regards to hormone therapy, 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.

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, or very similar to the estrogen made by the human body in the ovary, the organ where eggs form.

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

This type of hormone therapy 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 a 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.

Summary

While research suggests there is an increased risk of cancer associated with hormone replacement therapy, in many cases the pros of using this treatment may outweigh the cons.

Hormone therapy is available as estrogen therapy or combination estrogen and progestin therapy. There are many different ways this type of therapy may be delivered.

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. Hormone therapy may also be recommended to help prevent osteoporosis, a condition that weakens the bones, especially if you are at an increased risk.

Whatever your reasons are for considering hormone therapy, a healthcare provider should give you plenty of information so you can make an informed decision.

Frequently Asked Questions

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8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. American College of Obstetricians and Gynecologists. Hormone therapy for menopause.

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  4. US. National Library of Medicine. Estrogen vaginal.

  5. Lindahl SH. Reviewing the options for local estrogen treatment of vaginal atrophyInt J Womens Health. 2014;6:307-312. doi:10.2147/IJWH.S52555

  6. Liang Y, Jiao H, Qu L, Liu H. Association between hormone replacement therapy and development of endometrial cancer: results from a prospective us cohort studyFront Med. 2022;8:802959. doi:10.3389/fmed.2021.802959

  7. Endocrine Society. Osteoporosis treatment.

  8. The North American Menopause Society. Changes in weight and fat distribution.