Hormone replacement therapy (HRT) is a common treatment used to relieve a wide variety of menopausal symptoms, such as hot flashes, night sweats, and mood changes. In addition to symptom relief, hormone replacement therapy also helps protect against osteoporosis and may lower the risk of heart disease in some women.
Most healthcare providers recommend hormone therapy for up to five years. It’s important to tell your doctor about all prescription and nonprescription medications, vitamins and supplements you take.
What is HRT?
Hormone replacement therapy (HRT) replaces the oestrogen and progesterone levels that decrease during menopause. This balances the body’s hormones, easing symptoms like hot flushes and mood swings. HRT is taken orally and can be prescribed as a patch, gel, spray or tablet.
Depending on the type of HRT you choose, it can be continuous or cyclical. Continuous HRT delivers both oestrogen and progesterone every day, either as a gel or tablet. Cyclic HRT provides the same amount of oestrogen each day but with a smaller dose of progesterone. You can also use a low-dose intrauterine device (IUD) with levonorgestrel for bleeding control and pregnancy prevention – this is known as off-label cyclic HRT.
There are also bioidentical hormones available that more closely match your natural hormones and may have fewer long-term risks. However, these are not well-studied. It’s a good idea to talk to your doctor before you decide on this option. Your doctor will work with you to develop a treatment plan that’s right for your needs.
What are the benefits of HRT?
Hormone replacement therapy can relieve many menopause symptoms, including hot flashes and night sweats. It also protects bones and reduces the risk of heart disease, type 2 diabetes, depression and dementia. It’s important to use HRT only under the guidance of a healthcare professional, and to take the lowest dose for the shortest time possible.
HRT is available in different forms, from pills to patches and sprays. It can contain either oestrogen or progestogen, or both. If you have had a hysterectomy, you can still take combined HRT or oestrogen-only HRT. Your doctor will advise you on what form to choose based on your symptoms and medical history. People who have a high risk of blood clots or gall bladder problems may need to be careful with certain forms of hormone treatment. They might need to use a gel or implant instead of tablets. This includes women who have a rare type of breast cancer or have had an operation to remove the womb (a subtotal hysterectomy). They should also talk to their doctor about using bioidentical hormones, which are made from plant sources and are similar to the hormones produced by your body.
What are the risks of HRT?
Women on long-term HRT have been linked to an increased risk of blood clots, breast cancer and endometrial cancer. But your doctor can help you decide if the benefits outweigh the risks for you.
As you approach menopause, your ovaries stop producing estrogen and progesterone. HRT replaces these hormones and reduces your menopause symptoms. You can take it in the form of pills, creams, gels and patches. HRT can also relieve hot flashes and night sweats, and improve vaginal problems such as pain during sex.
It’s best to use the lowest dose of hormones for the shortest time possible. Your doctor may recommend nonhormonal treatments instead. Women with a history of blood clots, stroke, heart disease or liver disease should not use HRT. Those who have had breast, ovarian or endometrial cancer should not use it either. You should also avoid HRT if you have a family history of these diseases. It is not recommended for women under 60 or those who are within 10 years of menopause.
How do I take HRT?
As you near or enter menopause, your ovaries decrease the hormones estrogen and progesterone. HRT replenishes these hormones, which balance your reproductive system and reduce menopause symptoms. You can take estrogen alone, or you can take a combination of estrogen and progestin (progesterone) in pills, skin patches or gels. University of Utah Health Midlife Women’s and Menopause Program providers can help you decide if HRT is right for you.
HRT can be “systemic,” which means it travels through your bloodstream, or it can be “local,” which means it only affects a specific area of the body. Local HRT is available in the form of a vaginal cream, ring or tablet (tablets that melt inside your uterus). HRT usually causes mild side effects such as hot flashes, night sweats and vaginal dryness. However, you may also experience bloating, breast soreness or spotting. You should tell your doctor about any serious side effects, such as a clot in the leg or lungs; liver, kidney or gallbladder disease; or a history of breast cancer, high blood pressure or heart attack.