Menopausal Hormone Therapy | Johns Hopkins Medicine

When a woman's body no longer makes estrogen, hormone therapy may be an option. But, hormone therapy (HT), in which estrogen and progestin (a synthetic progesterone) are used in combination, has been controversial over the years.

To learn more about women's health, and specifically hormone therapy, theNational Institutes of Health (NIH) did a study called the Women's Health Initiative (WHI)beginning in 1991. The studyinvolved more than 161,000 generally healthy postmenopausal women.

The study was designed to test the effects of postmenopausal hormone therapy, diet modification, and calcium and vitamin D supplements on heart disease, fractures, and breast and colorectal cancer in women.

The study had 2 arms:

Women with a uterus were given progestin in combination with estrogen, which is known to prevent endometrial cancer. All women were randomly assigned to either the hormone medicine being studied or to placebo (inactive substance).Compared with placebo, the estrogen plus progestin treatmentresulted in:

Small increase inrisk of heart attack (in women younger than 60 when combined hormone therapy is started in perimenopause, it may reduce risk of heart attack)

Small increase inrisk of stroke

Small increase inrisk of blood clots

Small increase in risk of breast cancer

Reduced risk of colorectal cancer

Fewer fractures

No protection against mild cognitive impairment and increased risk of dementia (study included only women 65 and older)

Compared with the placebo, treatment with estrogen alone resulted in:

No difference in risk for heart attack

Increased risk of stroke

Increased risk of blood clots

Reduced risk of breast cancer

No difference in risk for colorectal cancer

Reduced risk of fracture

The WHI recommends that women follow the FDA advice on hormone (estrogen-alone or estrogen-plus-progestin) therapy. It says that hormone therapy should not be taken to prevent heart disease.

These products are approved therapies for relief from moderate to severe hot flashes and symptoms of vaginal dryness. Although hormone therapy may be effective in preventing fractures, it should only be considered for women at high risk of osteoporosis who cannot take other medicines. The FDA recommends that hormone therapy be used at the lowest doses for the shortest time needed to achieve treatment goals. Postmenopausal women who use or are considering using hormone therapy should discuss the possible benefits and risks to them with their healthcare providers.

The National Heart, Lung, and Blood Institute offers the following suggestions for women who are deciding whether or not to use hormone therapy:

The most important thing a woman can do in deciding to continue hormone therapy is discuss the current research with her healthcare provider.

Women need to be aware that taking a combined progesterone and estrogen regimen or estrogen alone is no longer recommended to prevent heart disease. A woman should discuss other ways of protecting the heart with her healthcare provider.

Women should discuss with their healthcare providers the value of taking combined progesterone and estrogen therapy or estrogen to prevent osteoporosis. There may be other treatments based on a woman's health profile.

Always consult your healthcare provider for more information.

Asa woman approaches menopause, the production of estrogen and progesterone fluctuates and then decreases significantly. Symptoms such as hot flashes often result from the changing hormone levels. After a woman's last menstrual period, when her ovaries make much less estrogen and progesterone, some symptoms of menopause might disappear, but others may continue.

To help relieve these symptoms, some women use hormones. This is called menopausal hormone therapy (MHT). This approach used to be called hormone replacement therapy or HRT. MHT describes several different hormone combinations available in a variety of forms and doses.

Hormone therapycan be given in a variety of methods, including the following:

For women who are appropriate candidates, this type of therapy can often be customized to provide the most benefits with the least side effects. It is important for women to talk with their healthcare providers about any discomfort or menstrual symptoms experienced with hormone treatment, as treatment approaches and dosages can be adjusted.

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Menopausal Hormone Therapy | Johns Hopkins Medicine