Hormone therapy: Is it right for you? – Mayo Clinic

Hormone therapy: Is it right for you?

Hormone therapy was once routinely used to treat menopausal symptoms and protect long-term health. Then large clinical trials showed health risks. What does this mean for you?

Hormone replacement therapy medications containing female hormones to replace the ones the body no longer makes after menopause is sometimes used to treat common menopausal symptoms, including hot flashes and vaginal discomfort.

Hormone therapy has also been proved to prevent bone loss and reduce fracture in postmenopausal women.

Along with the benefits, there are risks associated with using hormone therapy. These risks depend on a few factors, including the type of hormone therapy, the dose and how long the medication is taken. For best results, hormone therapy should be tailored to each person and re-evaluated every so often to be sure its benefits still outweigh the risks.

The benefits of hormone therapy depend, in part, on whether you take systemic hormone therapy or low-dose vaginal preparations of estrogen.

Systemic hormone therapy. Systemic estrogen which comes in pill, skin patch, gel, cream or spray form remains the most effective treatment for the relief of troublesome menopausal hot flashes and night sweats. Estrogen can also ease vaginal symptoms of menopause, such as dryness, itching, burning and discomfort with intercourse.

Combined estrogen and progesterone therapy may reduce the risk of colon cancer. Some data also suggest that estrogen can decrease the risk of heart disease when taken early in the postmenopausal years. Systemic estrogen helps protect against the bone-thinning disease called osteoporosis. However, doctors usually recommend medications called bisphosphonates to treat osteoporosis.

If you haven't had your uterus removed, your doctor will typically prescribe estrogen along with progesterone or progestin (progesterone-like medication). This is because estrogen alone, when not balanced by progesterone, can stimulate growth of the lining of the uterus, increasing the risk of uterine cancer. If you have had your uterus removed (hysterectomy), you don't need to take progestin.

In the largest clinical trial to date, a combination estrogen-progestin pill (Prempro) increased the risk of certain serious conditions, including:

Subsequent studies have suggested that these risks vary, depending on age. For example, women who begin hormone therapy more than 10 or 20 years from the onset of menopause or at age 60 or older are at greater risk of the above conditions. But if hormone therapy is started before the age of 60 or within 10 years of menopause, the benefits appear to outweigh the risks.

The risks of hormone therapy may also vary depending on whether estrogen is given alone or with progestin, the dose and type of estrogen, and other health factors such as your risks of heart and blood vessel (cardiovascular) disease, cancer risks, and family medical history.

All of these risks should be considered in deciding whether hormone therapy might be an option for you.

Despite its health risks, systemic estrogen is still the most effective treatment for menopausal symptoms. The benefits of hormone therapy may outweigh the risks if you're healthy and you:

Women who experience early menopause, particularly those who had their ovaries removed and don't take estrogen therapy until at least age 45, have a higher risk of:

For women who reach menopause prematurely, the protective benefits of hormone therapy usually outweigh the risks.

Your age, type of menopause and time since menopause play significant roles in the risks associated with hormone therapy. Talk with your doctor about your personal risks.

Women who have or previously had breast cancer, ovarian cancer, endometrial cancer, blood clots in the legs or lungs, stroke, liver disease, or unexplained vaginal bleeding should usually not take hormone therapy.

If you aren't bothered by menopausal symptoms and started menopause after age 45, you do not need hormone therapy to stay healthy. Instead, talk to your doctor about strategies to reduce the risk of conditions such as osteoporosis and heart disease. These strategies might include lifestyle changes and medications other than hormone therapy for long-term protection.

Talk to your doctor about these strategies:

If you haven't had a hysterectomy and are using systemic estrogen therapy, you'll also need progestin. Your doctor can help you find the delivery method that offers the most benefits and convenience with the least risks and cost.

You may be able to manage menopausal hot flashes with healthy-lifestyle approaches, such as keeping cool, limiting caffeinated beverages and alcohol, and practicing paced relaxed breathing or other relaxation techniques. For vaginal concerns, such as dryness or painful intercourse, a vaginal moisturizer or lubricant may provide relief. You might also ask your doctor about the prescription medication ospemifene (Osphena), which may help with episodes of painful intercourse.

To determine if hormone therapy is a good treatment option for you, talk to your doctor about your individual symptoms and health risks. Be sure to keep the conversation going throughout your menopausal years.

As researchers learn more about hormone therapy and other menopausal treatments, recommendations may change. If you continue to have bothersome menopausal symptoms, review treatment options with your doctor on a regular basis.

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Hormone therapy: Is it right for you? - Mayo Clinic