Hormone Replacement Therapy

Menopause is a natural part of life for women, usually between 45 and 55. It’s the time when your ovaries stop releasing eggs and your menstrual periods come to an end, meaning pregnancy is no longer possible.

Menopause, however, doesn’t happen all at once; it’s a gradual process that begins with perimenopause, a phase that can start several years before your periods stop completely.

During perimenopause, you might notice changes like:

Hot flashes
Night sweats
Mood swings
Trouble sleeping
Vaginal dryness

These symptoms are linked to fluctuations in your hormones, especially estrogen.

What Are Hormones?

Hormones are chemical messengers in your body that regulate many functions, including mood, sleep, and reproductive health.

The hormone estrogen, in particular, plays a key role in:

The menstrual cycle
Maintaining bone density
Keeping your skin and tissues healthy

As you get closer to menopause, your ovaries produce much less estrogen—over 90% less—which can make symptoms such as dry eyes, increased anxiety or depression, and sleep disturbances more noticeable.

The good news is that there are ways to manage bothersome symptoms. Hormone replacement therapy (HRT) is one option that can help you feel more comfortable during this transition.

What is Hormone Replacement Therapy?

HRT is a treatment used to relieve the symptoms of menopause by supplementing your body with two key hormones—estrogen and progesterone.

Estrogen is the primary hormone that helps ease symptoms like hot flashes and night sweats.

Progesterone is a hormone that your ovaries naturally produce. Progestin is an artificial version of progesterone. It is created in a laboratory to work like progesterone in your body.

If you still have your uterus, progestin will likely be added to your therapy. This is important because taking estrogen alone can cause the lining of your uterus to grow too much, which could increase the risk of uterine cancer.

If you’ve had a hysterectomy and no longer have a uterus, you can be treated with estrogen alone.

How HRT is Administered

When it comes to taking hormone therapy, you have two main options: systemic and local.

With systemic therapy, the hormone enters your bloodstream and travels to the different parts of your body where it’s needed. You might take it as a pill, use a patch, or apply a spray or gel.

This approach is excellent for managing symptoms like hot flashes, night sweats, and other common menopause-related issues.

Local therapy is applied directly to a specific area, like your vagina. You might use a vaginal cream, ring, or a tablet that melts inside. This method is beneficial if you’re dealing with vaginal dryness. Local therapy usually involves a much lower dose of hormones since it targets a specific area.

Examples of Estrogen HRT

There are several types of estrogen therapies available, allowing for options that can be customized to your needs. If you’ve had surgery to remove your uterus, your doctor will usually recommend estrogen-only therapy. Taking estrogen by itself generally has fewer long-term risks compared to hormone therapy that combines estrogen and progesterone. Some examples include:

1. Estrogen patch

You wear the patch on your skin; you replace it every few days or weekly, depending on the type. It’s effective at relieving menopausal symptoms and increasing bone density. Patches are a popular choice because this formulation has a lower risk of blood clots compared to estrogen pills.

2. Estrogen pill

This is another common option for hormone therapy. Typically, you take the estrogen pill once a day. However, it’s important to note that it carries a higher risk of blood clots than the patch.

3. Estrogen pellets

Estrogen pellets, which are smaller than a grain of rice, are implanted under the skin. They release estrogen slowly over time. Typically, the pellets last several months before new ones need to be placed. One popular brand is BioTe.

4. Vaginal estrogen

If vaginal dryness is your main concern, low-dose vaginal estrogen can be very effective. It comes in a cream, ring, or tablet form and usually doesn’t require progestin because the dose is low and stays localized, not affecting the uterus.

Combination Estrogen-Progesterone Therapy

During your menstrual years, the lining of your uterus sheds each month with your period. After menopause, when periods stop, estrogen can cause the lining to thicken too much, which can lead to cancer.

If you still have your uterus, it’s important to take progesterone or progestin along with estrogen. Progestins help protect you from uterine cancer.

Combination therapy is usually available in a pill or a skin patch.

Hormone Therapy Risks

Hormone therapy has its benefits, but it’s also associated with certain risks.
Hormone therapy, particularly when it involves a combination of estrogen and progestin, has been linked to an increased risk of certain serious health conditions. These risks include:

Heart disease
Stroke
Blood clots
Breast cancer

It’s important to note that these risks are not the same for everyone. In fact, they can be influenced by several factors:

1. Age
Women who start hormone therapy at age 60 or older, or more than ten years after menopause begins, may have a higher risk of developing these conditions. However, starting hormone therapy before age 60 or within ten years of menopause appears to offer more benefits than risks.

2. Type of hormone therapy
The risk associated with hormone therapy can vary depending on whether estrogen is taken alone or combined with progestin, as well as the specific dose and type of estrogen used.

3. Health history
Your personal and family health history plays a significant role in determining whether hormone therapy is a safe and suitable option for you, including your risk for:

Cancer
Heart disease
Stroke
Blood clots
Liver disease
Osteoporosis

For this reason, these risks should be carefully considered by both you and your doctor when deciding if hormone therapy is the right choice.

Who is a Candidate for Hormone Therapy?

Hormone therapy can be considered for healthy women within ten years of menopause who are experiencing bothersome symptoms like hot flashes or vaginal dryness. However, it’s usually advised to taper off hormone therapy after four or five years to minimize the risk of breast cancer.

Who Should Avoid Hormone Therapy?

HRT is not recommended if you have a history of:

Breast cancer
Heart disease
Blood clots
Stroke