What Are The Benefits And Risks Of Menopause Hormone Therapy?
Menopausal hormone therapy (MHT), previously known as hormone replacement therapy (HRT), involves taking a medication when your hormone levels drop. It contains:
- estrogen (or estradiol, the most common form of the hormone in your body)
- progesterone
- or both of these hormones
MHT has a controversial historyTrusted Source. Popularized in the 1960s as a way to stay youthful after menopause, MHT use peaked in the 1990s.
Then, in 2002, a study undertaken by the Women’s Health Initiative (WHI) linked MHT to cancer and cardiovascular disease. After the WHI’s report was published, MHT use in the United States, the UK, and Canada dropped dramatically.
However, the WHI report has since been called into question. Newer studiesTrusted Source have shown that MHT has lower risks and more benefits for women who start treatment before age 60 and within 10 years of menopause.
However, many people are still hesitant to use MHT because of concerns about the risks it could pose.
What are the benefits of menopausal hormone therapy?
Although there’s still confusion about MHT, many researchers say its benefits outweigh the risks. Let’s look at some of MHT’s best-researched benefits.
Eases menopause symptoms
The experience of menopause is different for everyone. Some people have symptoms that are so mild that no medical treatment is needed.
For others, the symptoms can be so severe that they interfere with their ability to go about their daily life. In this situation, it’s usually a good idea to talk with a doctor about hormone replacement.
MHT may help ease menopause symptoms in the following ways:
Low dose estrogen
- relieves vasomotor symptomsTrusted Source, such as hot flashes and night sweats
- relieves genital and urinary symptomsTrusted Source, such as vaginal dryness, painful sex, and urinary problems.
Prasterone and ospemifene
Offers protection against cardiovascular disease
Numerous studiesTrusted Source have confirmed that when MHT is started early, within 10 years of menopause, it can help protect your heart and vascular system from disease.
Before starting MHT, it’s important to undergo a physical exam to be sure you don’t already have signs of cardiovascular disease.
Helps ease depression
During the transition into menopause, which can last several years, many people experience depression.
Although depression is most commonly treated with antidepressants, researchTrusted Source has found that hormone therapy with estrogen may work as a second-line therapy for managing depressive symptoms in premenopausal women.
Helps protect your bones
Menopause increases the risk of bone loss, osteoporosis, and fractures.
ResearchTrusted Source shows that 1 to 2 years of estrogen-based MHT in the form of a skin patch may help improve bone density and protect the structure of your bones as you age.
Prevents loss of muscle mass
As you age, you tend to lose muscle mass, which you need for mobility, strength, and balance.
MHTTrusted Source can help prevent the loss of muscle. When combined with exercise, MHT may help increase muscle mass and strengthen your muscles.
May help prevent Alzheimer’s disease and Parkinson’s disease
According to a 2020 meta-analysisTrusted Source, estrogen-based MHT may have a protective effect against some neurological conditions.
In particular, it may play a role in decreasing the risk of Parkinson’s disease and Alzheimer’s disease. However, if you start MHT when you’re 65 years or older or after 10 years from starting menopause, this treatment may increase the risk of developing dementia.
Who does it benefit the most?
Those assigned female at birth who are under the age of 60 or who entered menopause in the last 10 years stand to benefit most from hormone therapy.
For those older than 60 years or who started menopause more than 10 years ago, the risks could outweigh the benefits.
What are the risks?
When the WHI published its report in 2002, doctors and patients began avoiding MHT out of concern that it could do more harm than good.
Although newer research has eased some of those fears, there are still some risks to consider when deciding if MHT is right for you.
A higher risk of certain cancers
A 2020 studyTrusted Source found that past use of a specific type of MHT was linked to a higher risk of breast cancer.
A 2017 study also found that hormone therapy, particularly oestrogen plus progestin MHT (EP-MHT), may increase ovarian and endometrial cancer, but decrease the risk of all gastrointestinal cancers.
More research is needed to understand the link between MHT and cancer risk.
Can increase the risk of blood clots
StudiesTrusted Source have shown that MHT (in pill and patch forms) may raise your risk of blood clots and stroke. This risk may be highest for people over 60 or who started menopause over a decade ago. The longer you take MHT, the greater the increase in your risk.
Because of this risk, health experts recommend the lowest possible MHT dose for the shortest period of time for people over 60 or who are 10 years past the onset of menopause.
Raises the risk of gallbladder disease
Since estrogen builds up the concentration of cholesterol in the gall bladder, using MHT increases the likelihood of gallstonesTrusted Source.
The risk is highest for those who use MHT longer than 5 years. However, this risk is not seen in those who use transdermal estrogen.
The Food and Drug Administration (FDA)Trusted Source has approved several categories of MHT. They include:
- estrogen-only products
- progesterone-only products
- products that combine estrogen and progesterone
- products that combine estrogen with other medications
These hormone medications come in several different forms, such as:
- pills, such as:
- Cenestin, Enjuvia, Estrace, Femtrace, Menest, Ortho-Est, Premarin (estrogen)
- Prometrium, Provera (progesterone)
- Activella, Femhrt, Prefest, Prempro (estrogen and progesterone)
- Duavee (combination estrogen and hormone medicine)
- patches, such as:
- Alora, Climara, Estraderm, Minivelle, Vivelle (estrogen)
- Climara Pro, Combipatch (estrogen and progesterone)
- injections, such as:
- Delestrogen, Premarin (estrogen)
- skin cream or sprays, such as:
- Estrasorb, Evamist, Premarin (estrogen)
- vaginal rings or creams, such as:
- Estrace, Femring, Ogen, Premarin (estrogen)
Creams and rings supply hormones to a localized area, which help limit the amount in your system.
Who should avoid hormone replacement therapy?
According to the FDATrusted Source, you may want to avoid taking MHT if you’ve had:
- problems with vaginal bleeding
- breast cancer or uterine cancer
- blood clots
- a heart attack or stroke
- a bleeding disorder
- liver disease
- allergic reactions to medications containing hormones
Talk with your doctor about whether estrogenTrusted Source is right for you if you have:
- a history of smoking
- gallbladder disease
- ovarian cancer
- migraine headache
- seizure disorder
- high blood pressure
- endometriosis
- hyperlipidemia, or excess fat in your blood
- uterine fibroids
- What about nonhormonal alternatives?
If you don’t want to use MHT to treat the symptoms of menopause, you might have some success with a nonhormonal treatmentTrusted Source.
Some options that may help reduce the severity and frequency of hot flashes include options such as:
- selective serotonin reuptake inhibitors (SSRIs)
- gabapentin
- fezolinetant
- oxybutynin
- stellate ganglion block
- Talking with your doctor
Talking about menopause symptoms can be uncomfortable, especially when the symptoms feel personal.
It may help to make a list of your concerns in advance, so you can refer to the list if you forget.
Tell your doctor about:
- any health conditions such as cancer, heart problems, liver disease, or blood clots
- whether or not you’ve ever smoked
- medications you’re taking for other conditions
- allergies
- side effects you’ve had from other hormonal treatments
While menopause is a natural change, it does involve a drop in your estrogen levels. This can trigger various symptoms which, in some cases, can be severe.
MHT may help ease many symptoms of menopause, including hot flashes and vaginal dryness. It may also lower your risk of heart problems, protect your bones and muscles, and reduce depression.
However, MHT is not without its risks, especially for those over 60 or who started menopause more than 10 years ago.
Talk with a healthcare professional about whether MHT is right for you and whether the benefits outweigh any potential risks.
