Deciding about hormone therapy
Hormone therapy (HT) uses one or more hormones to treat symptoms of menopause.
HRT - deciding; Estrogen replacement therapy - deciding; ERT- deciding; Hormone replacement therapy - deciding; Menopause - deciding; HT - deciding; Menopausal hormone therapy - deciding; MHT - deciding
Menopause and Hormones
Menstrual flow may come to a sudden halt after surgery to remove the ovaries, chemotherapy, or certain hormone treatments for breast cancer.
Menopause symptoms may last 5 or more years, including:
HT can be used to treat menopause symptoms. HT uses the hormones estrogen and progestin, a type of progesterone. Sometimes testosterone is also added.
Some symptoms of menopause can be managed without HT. Low-dose vaginal estrogen and vaginal lubricants may help vaginal dryness.
HT comes in the form of a pill, patch, injection, vaginal cream or tablet, or ring.
Taking hormones can have some risks. When considering HT, learn about how it can help you.
Benefits of Hormone Therapy
When taking hormones, hot flashes and night sweats tend to occur less often and can even go away over time. Slowly reducing HT may make these symptoms less bothersome.
Hormone therapy can also be very helpful in relieving:
At one time, HT was used to help prevent thinning bones (osteoporosis). That is no longer the case. Your doctor can prescribe other medicines to treat osteoporosis.
Studies show that HT does not help treat:
Risks of Hormone Therapy
Be sure to talk with your doctor about the risks for HT. These risks may be different depending on your age, medical history, and other factors.
Taking HT may increase your risk for blood clots. Your risk for blood clots is also higher if you are obese or if you smoke.
Your risk for blood clots may be lower if you use estrogen skin patches instead of pills.
Your risk is lower if you use vaginal creams and tablets and the low-dose estrogen ring.
ENDOMETRIAL (UTERINE) CANCER
HT is safest when taken before age 60 or within 10 years after starting menopause.
Women who take only estrogen and who take estrogen with progestin have an increased risk for stroke. Using the estrogen patch instead of an oral pill decreases this risk. However, risk may still be increased compared to not taking any hormones at all. Lower HT dosage also reduces the risk for stroke.
Taking HT may increase your risk of developing gallstones.
RISK OF DYING (MORTALITY)
Overall mortality is reduced in women who begin HT in their 50s. The protection lasts for about 10 years.
Making a Decision
Every woman is different. Some women aren't bothered by menopause symptoms. For others, symptoms are severe and affect their lives significantly.
If menopause symptoms bother you, talk to your doctor about the benefits and risks for HT. You and your doctor can decide if HT is right for you. Your doctor should know your medical history before prescribing HT.
You should not take HT if you:
However, for many women, taking HT is a safe way to treat menopause symptoms.
Currently, experts are unclear on how long you should take HT. Some professional groups suggest that you can take HT for menopause symptoms for longer periods if there is no medical reason to discontinue the medicine. For many women, low doses of HT may be enough to control troublesome symptoms. Low doses of HT tend to have few side effects.
These are all issues to discuss with your health care provider.
When to Call the Doctor
If you have vaginal bleeding or other unusual symptoms during HT, call your doctor.
Be sure to continue seeing your doctor for regular checkups.
ACOG Committee Opinion No. 565: Hormone therapy and heart disease. Obstet Gynecol. 2013;121(6):1407-1410. PMID: 23812486 www.ncbi.nlm.nih.gov/pubmed/23812486.
Cosman F, de Beur SJ, LeBoff MS, et al. Clinician's guide to prevention and treatment of osteoporosis. Osteoporosis Int. 2014;25(10):2359-2381. PMID: 25182228 www.ncbi.nlm.nih.gov/pubmed/25182228.
de Villiers TJ, Hall JE, Pinkerton JV, et al. Revised Global Consensus Statement on menopausal hormone therapy. Climacteric. 2016;19(4):313-315. PMID: 27322027 www.ncbi.nlm.nih.gov/pubmed/27322027.
Lobo RA. Menopause and care of the mature woman: endocrinology, consequences of estrogen deficiency, effects of hormone therapy, and other treatment options. In: Lobo RA, Gershenson DM, Lentz GM, Valea FA, eds. Comprehensive Gynecology. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 14.
Stuenkel CA, Davis SR, Gompel A, et al. Treatment of symptoms of the menopause: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2015;100(11):3975-4011. PMID: 26444994 www.ncbi.nlm.nih.gov/pubmed/26444994.
Review Date: 1/14/2018
Reviewed By: John D. Jacobson, MD, Professor of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda Center for Fertility, Loma Linda, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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