Are you having symptoms of menopause, including hot flashes, vaginal dryness, or discomfort after intercourse? If so, hormone replacement therapy, or HRT, may be able to help you. Many females take HRT if they are going through severe symptoms of menopause. However, there are risks to using HRT that you should know about before trying the treatment. For some people, the risks of HRT may outweigh its benefits. Read on to learn if HRT is the right treatment for you.
What Is Hormone Replacement Therapy?
Hormone replacement therapy, also called hormone therapy or HRT, is medicine that contains female hormones like estrogen. It can help females manage symptoms of menopause, the year-long stretch after your final menstrual period. When you reach menopause, your ovaries stop making estrogen. Hormone therapy can replace the estrogen that your ovaries no longer produce.
Menopause symptoms can also happen in females treated for cancer with chemotherapy or radiation or in those whose ovaries have been removed.
If you’re going through menopause, you may consider taking hormone therapy if you are experiencing symptoms of menopause, such as:
- Vaginal dryness
- Vaginal itching
- Hot flashes
- Vaginal burning
- Vaginal discomfort after intercourse
Types of Hormone Therapy For Females
There are two major types of hormone therapy:
- Systemic hormone therapy: This is a high dose of estrogen absorbed throughout the body. You can use it to treat any common menopausal symptom. It comes in many forms, such as a pill, skin patch, vaginal ring, gel, cream, or spray.
- Low-dose vaginal products: Some forms of hormone therapy have a low dose of estrogen. They usually only treat the vaginal and urinary symptoms of menopause. They come in cream, tablet, or ring form.
There can be benefits to hormone therapy beyond treating symptoms of menopause, such as decreasing bone loss and fracturing. However, there are risks to using hormone therapy, and you should only take hormone therapy if its benefits outweigh the risks.
Risks of Hormone Therapy For Females
A study found that HRT increases the risk of several conditions, including:
Breast Cancer
Normally, estrogen binds to receptors on breast cells to increase breast growth. If cancerous cells are present in the breasts, medicine that contains estrogen, such as HRT, can cause those cells to multiply.
Heart Disease
Estrogen has both positive and negative effects on heart health. Initially, researchers thought that HRT would decrease the risk of heart disease in females because some evidence suggested estrogen protects females against it.
However, another study showed no lasting decrease in heart disease, heart attack, or stroke in females who used HRT for three years. The study later found that the risk of heart attack increases the longer someone uses HRT.
Their findings showed that HRT could increase the risk for:
- Blood clots: Estrogen stimulates processes in the body that promote blood clot formation.
- Stroke: Your risk of stroke increases with HRT because blood clots that travel to the brain can cause a stroke.
Endometrial Cancer
Endometrial cancer is cancer of the womb (uterus). Taking estrogen medication can stimulate the lining of your womb (endometrium) and increase your risk of getting endometrial cancer. Your doctor will treat you with progesterone, another female hormone produced by the body, or progestin, a synthetic version. This will lower your risk of getting endometrial cancer. If your womb is surgically removed, you may not need progesterone or progestin.
Females with certain risk factors are more likely to have more negative effects of HRT than others. These risk factors include:
- Age: Age 60 or older, or more than 10 years after menopause begins
- Type of hormone therapy: Taking estrogen by itself rather than taking estrogen combined with progesterone/progestin
- Health history: Having a family history of the negative effects of hormone therapy, such as heart disease, stroke, or blood clots
Who Can Benefit from Hormone Therapy?
The benefits of hormone therapy outweigh the risks in females who have:
- Moderate to severe hot flashes: Hot flashes are a sudden feeling of warmth in the upper body, usually over the face, neck, and chest. Systemic estrogen therapy is most effective for relieving hot flashes and night sweats.
- Severe vaginal symptoms of menopause: Estrogen can relieve vaginal symptoms of menopause like dryness, itching, burning, and discomfort with intercourse.
- A high risk of osteoporosis: Though doctors normally prescribe other medications to prevent osteoporosis, estrogen therapy can also strengthen bones and may be helpful in females who cannot tolerate osteoporosis medicines or aren’t benefiting from them.
- Early menopause or estrogen deficiency: Females usually go through menopause between the ages of 45 and 55. Estrogen therapy may be right for you if you went through menopause or had your ovaries removed before age 45. Estrogen therapy may also work for you if you have primary ovarian insufficiency. This happens when you lose the function of your ovaries before age 40.
If any of the above applies to you, you should consider using hormone therapy.
Who Should Not Use HRT?
You shouldn’t use HRT if you have:
- A history of heart attack, stroke, or blood clots
- Increased risk of getting blood clots or vascular disease
- Unexplained vaginal bleeding
- Past or active breast cancer
- Fibrocystic breast disease
- Active liver disease
- Endometrial cancer
- Gallbladder disease
If you have any of the above, the risks of using HRT will likely outweigh the benefits, and you should avoid using HRT. If you are considering HRT, talk to your doctor to learn more or try other options.
Alternatives to Hormone Therapy For Females
HRT isn’t for everyone. If the risks of HRT outweigh the benefits for you, there are some alternatives to HRT that you can use. This includes medications containing bioidentical hormones, like hormone pellets, cream, or shots.
Bioidentical hormones are estrogen and progesterone hormones derived from plants. Though you may consider bioidentical hormones safe because of this, there is little evidence to support their safety. The FDA has not approved this kind of medication. However, they are effective for some people.
Other alternatives to HRT can reduce menopausal symptoms in some people. These include:
- Antidepressants like selective-serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs)
- Tibolone, a synthetic medication that mimics the effects of natural hormones
- Clonidine, a blood pressure medicine taken as a tablet two or three times a day
- Lifestyle changes like eating healthy and exercising regularly
- Herbal therapies, like black cohosh and St. John’s wort
What’s Next
If you think you’re going through menopause and have symptoms that interfere with your daily life, speak to your doctors. They may refer you to an endocrinologist, a doctor who knows all about hormones. An endocrinologist can test your hormone levels to see if you are going through menopause and recommend HRT for severe symptoms. Your doctor will tell you if HRT is the appropriate treatment for you.
Resource Links:
- “Alternatives: Hormone Replacement Therapy (HRT)” via NHS
- “Bioidentical Hormones” via Cleveland Clinic
- “Estrogen & Hormones” via Cleveland Clinic
- “Estrogen and Thrombosis: A Bench to Bedside Review” via NIH
- “Estrogen-Dependent Cancers” via Cleveland Clinic
- “Hormone Therapy: Is it Right for You?” via Mayo Clinic
- “Hot Flashes” via Mayo Clinic
- “What is Menopause?” via NIH
