A Guide to Hormone Replacement Therapy

Having reached the age of perimenopause, I have newfound empathy for my mother. I remember how I used to giggle and poke fun at her when she would lie on the cold bathroom floor trying to cool herself from a hot flash. As a self-centered teenage girl, I honestly thought she was being overly dramatic. I had no idea of what, and how disconcerting, the symptoms of menopause could be. Turns out it can really be intense! Not to mention all the other symptoms that are popping up, like out-of-whack periods, vaginal dryness, and intense mood swings. I was someone who always thought I would go through menopause without any medication, but I am not ashamed to say that I’ve changed my mind. Looking into it, many options don’t seem to be as dangerous as we have been led to believe.  

Hormone Replacement Therapy (HRT) is a treatment option for symptoms of menopause like hot flashes and night sweats. About one in four women experience symptoms that require medication.

HRT involves using hormones like estrogen and progesterone, which are naturally found in the body. Sometimes, testosterone is included as part of the treatment. During perimenopause, many women experience lower testosterone levels, which can cause tiredness, trouble thinking clearly, and a reduced interest in sex. An option that may be prescribed is AndroFeme, a cream applied to the skin that provides the right amount of testosterone without upsetting the body’s hormone balance.

Many menopause symptoms happen because hormone levels like estrogen drop, and these therapies help restore hormone balance. This can reduce symptoms of menopause and improve a person’s overall quality of life. There are both benefits and risks to using HRT, so it’s essential to consult a doctor to decide if it’s the right choice.

What are the different types of HRT?

HRT is a type of hormone therapy. Women who still have their uterus usually take a combination dose of estrogen and progestogen, such as Prempro. HRT often includes progesterone for women who still have a uterus because estrogen on its own can increase the risk of endometrial cancer. Progesterone helps counteract this risk by protecting the uterine lining. Women without a uterus don’t need progesterone since there’s no endometrial lining to protect. The type of progestogen used in HRT plays a big role in the level of risk. Natural-like options, such as micronized progesterone and dydrogesterone, appear to be safer than most synthetic types.

Women who have had their uterus removed (a hysterectomy) typically take estrogen therapy like Premarin on its own. Another option is Livial, a man-made steroid that comes in tablet form and is often used to treat hot flashes and prevent bone loss after menopause. It can also help boost sexual health. However, Livial is not safe for women who have had a medical history of breast cancer.

A newer treatment for menopause called Duavee combines a dose of estrogen with a SERM (selective estrogen receptor modulator). This therapy comes in tablet form and helps reduce symptoms of menopause like hot flashes and night sweats while also preventing osteoporosis. While it’s not as effective as estrogen and progestogen therapy, it causes fewer side effects like breast tenderness and vaginal bleeding. This treatment option is only meant for women who still have their uterus.

What are the benefits of HRT?

Hormone replacement therapy can help with symptoms of menopause like hot flashes and night sweats. It might also improve sleep, mood, sex drive, joint pain, and vaginal dryness. There are additional benefits, like lowering the risk of osteoporosis, heart disease, fractures, type 2 diabetes, and certain cancers. In fact, the US Preventive Services Task Force looked at 18 clinical trials to study the pros and cons of HRT. They found that it can help lower the risk of some health problems. Women who took both estrogen and progesterone had fewer bone fractures, fewer cases of diabetes, and fewer cases of colon cancer compared to women who took a placebo. Women who only used estrogen therapy had even better results. 

HRT does not appear to increase the risk of developing breast cancer in women with a genetic tendency or who are obese. Research also shows that using vaginal estrogen therapy like Vagifem does not raise the risk of breast cancer.

What are the risks of HRT?

Research shows that hormone replacement therapy may slightly raise the risk of breast and endometrial cancer in some cases. 

Some forms of estrogen therapy used in HRT could increase the chance of blood clots, but using an estrogen patch or gel form, or even a vaginal cream like Premarin is unlikely to have the same effect.

According to current global recommendations, the benefits of HRT outweigh the risks for females with serious symptoms of menopause. For most healthy females, HRT is considered both effective and safe, though a thorough medical history and assessment by a doctor should be performed to determine the correct form of HRT for the patient.

For women between the ages of 70 and 79, the risks depend on the type of hormone therapy, how long it’s used, and when it starts.

As for blood clots, the risk of developing one while using oral hormone therapy is low, around two to three cases per 1,000 women per year. For women not using an oral type HRT, the risk is about 1 case per 1,000 women per year. The risk is higher for women who already have other factors like smoking or obesity.

What are the side effects of HRT?

Some possible side effects are nausea, headaches, sore breasts, water retention, bloating, and changes in bleeding patterns. These usually go away after a few months.

How long should I stay on HRT?

Anyone on HRT should have a doctor check-in about six months after starting treatment and continue to have regular follow-ups. Experts usually suggest using HRT for up to five years, but the exact duration depends on individual needs and health risks.

Are there alternatives to HRT?

There are some prescription medicines that can be used instead of HRT for people who may be at risk of breast cancer. These medicines are usually meant for other health conditions but can also help with symptoms of menopause. An example is Catapres, a blood pressure medication that may also alleviate menopause-related hot flushes and night sweats. It works without altering hormone levels.

The risks of each type of HRT should be weighed carefully for each woman, keeping in mind the benefits and how severe her symptoms are, with treatment for menopause personalized to each woman to help manage her symptoms while keeping risks as low as possible. Some women may decide that even a small risk isn’t worth it, while others might feel the benefits are more important than the risks. Both of these choices are valid.

Frequently Asked Questions

Does HRT make you look younger?

Individuals on HRT often notice benefits like smoother, more youthful skin, improved elasticity, and firmer texture. While studies support these effects for women using estrogen HRT during menopause, research on the impact of HRT for other groups is still lacking.

Does HRT reduce belly fat?

While evidence is limited, some research suggests that HRT may aid in weight loss and reducing belly fat. One study indicated that HRT could help prevent weight gain and promote fat loss by boosting lipid oxidation, improving insulin response, and increasing energy expenditure.

Does hormone therapy cause weight gain?

Some people think HRT leads to weight gain, but there isn’t any solid evidence to support this. Similarly, there’s no proof that HRT helps with weight loss either.

Is it better to go through menopause without HRT?

The answer isn’t the same for everyone. For some individuals, HRT can be essential for maintaining their quality of life, while for others, the risks may surpass the advantages.