What to consider about menopausal hormone therapy

January 24, 2018 | by Karen Druzak, MD

If you’re suffering from symptoms of menopause, like hot flashes, night sweats, bone loss and sleep disturbances, your doctor may suggest menopausal hormone therapy (MHT).

MHT is one of the government-approved treatments to relieve menopause systems that are caused by lower levels of estrogen. Premenopausal symptoms can last four years on average, as they gradually ease during menopause.

A woman is a good candidate for hormone therapy if she:

  • Is close to menopause (typically ages 50-59) and is in good health
  • Does not have certain health conditions such as cancer, liver disease, unexplained uterine bleeding, or a history of blood clots or cardiovascular disease that may increase the risks

To help relieve your symptoms and regulate your menstrual cycle, doctors recommend one of two types of MHT:

  • Estrogen-only therapy (ET)
  • Estrogen plus progestin therapy (EPT)

Since ET can raise the risk of uterine cancer, ET is only used by women who have had a hysterectomy and no longer have a uterus. Women who still have a uterus usually take EPT.

How you take hormone therapy depends on where you need it. Hormone therapy can be taken:

  • Through the bloodstream, which enables the hormones to circulate to reach all parts of the body. This type of hormone is called systemic hormone therapy and includes pills, skin patches, injections and a vaginal ring.
  • As a topical, which is placed on or near the place that needs treatment. If small doses are used, a minimal amount of the hormone is absorbed into the bloodstream, so it has little (if any) effect on the rest of the body.

There have been hundreds of clinical studies that have provided evidence that systemic HT (estrogen with or without progestogen) effectively helps such conditions as hot flashes, vaginal dryness, night sweats and bone loss. Benefits can lead to improved sleep, sexual relations and quality of life.

Like any medication, hormone therapy can cause side effects like bleeding, bloating, breast tenderness or enlargement, headaches, mood changes and nausea.

The biggest risk with taking MHT is the length of time the therapy is taken. MHT is approved by the U.S. Food and Drug Administration (FDA) for the short-term relief of menopause symptoms. The FDA recommends women use the lowest dose that eases your symptoms for the shortest time needed since long-term use can increase breast cancer risk, stroke and blood clots.

As a result of the Women’s Health Initiative (WHI) trial in 2002, the FDA requires all estrogen-containing prescription therapies to carry a “black box” warning in their prescribing information about the adverse risks of HT.

For many women, the benefits of MHT outweigh the risks. Your doctor can help you determine whether hormone therapy is right for you based on your symptoms and your medical history.

Related blogs:

Hot flashes anyone? Answers to your questions about menopause

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