Should You Use Hormone Therapy During Menopause?

When a woman begins having menopause symptoms like hot flashes, irregular periods or mood changes, she will probably wonder at some point whether she should take some type of menopause hormone therapy (HRT). Sometimes called “hormone replacement therapy,” or HRT, it usually refers to a combination of the female hormones estrogen and/or progesterone.

Research is beginning to show what the risks and benefits of menopause hormone therapy are, but there is still a lot to learn about the effects of estrogen and progesterone on our bodies and our health. While it is a very effective treatment for many menopause symptoms, hormone therapy can increase the chances of other conditions, and the decision to use it is a balancing act of determining whether the pros outweigh the cons.

The Women’s Health Initiative (WHI) study is the largest study done on menopausal women and focused on heart disease, bone fractures, and breast and colorectal cancers. One of the preventive strategies studied was the effect of hormone therapy on these conditions.

Originally it was assumed that hormone therapy would prevent heart disease and stroke in postmenopausal women. When it was shown that not only did estrogen not protect women from heart disease and stroke but women on hormone therapy actually had an increase in these conditions, the trials were stopped early. Researchers are still sorting through the information to determine which women were at most risk and which actually benefited from the hormone therapy.

The current recommendation for menopause hormone therapy suggests if hormone therapy is used to treat menopausal symptoms, it should be used in the smallest doses that are effective, for the shortest time necessary.

Benefits

There are some proven benefits to at least a short course of estrogen and/or progesterone. Among the reasons you might consider using hormone therapy are:

• Hormone therapy is the most effective treatment for hot flashes and vaginal dryness
• HRT is often effective in treating mood-related symptoms including mood swings and depression
• HRT can improve sleep quality for women who suffer from insomnia during menopause
• HRT slows bone loss, preventing or delaying osteoporosis. Other medications, such as the bisphosphonates or raloxifene, are usually the first choice for preventing bone loss, but if you are using hormone therapy for other reasons an added benefit will be some protection from osteoporosis.

For women who have seriously disruptive symptoms during menopause, MHT can improve their quality of life, help them weather the changes and still maintain their health and emotional equilibrium.

Risks

As the WHI and other research has shown, there are serious risks to consider with HRT. The risks are higher for some women, depending on their personal health history and their family health history. The most well-known risks are:

• Blood clots
• Cardiovascular events, including stroke and heart attack
• Certain types of breast cancer
• Gallbladder disease

Since your risk depends on your personal combination of risk factors, it’s important to discuss this decision carefully with your medical provider.

When MHT Is Not an Option

For some women, the risks in using hormone therapy are definitely very high. HRT would not be recommended for women who:

• Have irregular or unexplained vaginal bleeding
• Have (or have had) breast cancer or uterine cancer
• Have a history of heart attack or stroke
• Have a history of getting blood clots
• Have liver disease

Side Effects

In addition to the risks, hormone therapy can also cause some side effects. When thinking about whether this is a good treatment for you, it is important to realize that you may experience any of the following when taking estrogen and/or progesterone:

• Breast tenderness or swelling
• Irregular bleeding
• Bloating
• Headaches
• Queasiness
• Mood disturbance
• Local irritation or allergic reactions to delivery method (vaginal ring, skin patch, cream)

Depending on how disruptive your menopause symptoms are, the hormone side effects may dissuade you from HRT

Questions to Ask

For many women, the decision about whether to take hormones before and after menopause is a major one. You may never have been on any medication in your life or you may be philosophically opposed to treating a normal transition with medications.

Whatever your concerns, when menopause symptoms start to affect you, and you think you might want to try hormone therapy, here are some questions to ask yourself:

• How bad are your symptoms? Symptoms are extremely variable from one woman to the next, ranging from almost nonexistent to truly intolerable. Think about how disruptive your symptoms are on a scale of one to 10, where one is “hardly bothers me at all” and 10 is, “I don’t think I can stand this another moment.” List each symptom out and rate it one to 10. Take these ratings with you when you talk to your healthcare provider.
• What are your personal health risks? Do you have any medical conditions? Do you take medications now? Have you had serious illnesses such as cancer? How is your cholesterol? Your weight? Write down all the health risks that you know you have and be prepared to talk about them when you discuss hormone therapy with your medical provider.
• What is your family history? Are there any health conditions that seem to run in your family? Heart disease? Cancer? High cholesterol? Clotting disorders? Diabetes? Osteoporosis? Depression? Be sure you find out as much as you can about the health histories of your parents and siblings.
• What sort of menopause experience did your mother have? You may not know the answer to this one, but your mother’s experience with menopause may give you some clues about what to expect from your own.
• How do you feel about taking medication and hormones in particular? Think about how you really feel about taking a daily medication. Some women don’t give it a second thought and some find it to be a violation of their values or jarring to their self-image. If you have a hard time remembering to take a pill every day, would you be okay with a patch or vaginal ring to treat your symptoms?

Finding a balance between ongoing health and physical comfort is an important midlife assignment and deciding whether to take hormones during menopause is not an exact science. Even once you decide, you may adjust your decision as your symptoms change. It’s not so much a one-time choice as it is an ongoing dialogue between you and your healthcare provider. Learning what you can about hormone therapy and then asking yourself the central questions prepares you for that dialogue.