What you need to know about Hormone replacement therapy (HRT)

Hormone replacement therapy ( HRT) may help balance the levels of estrogen and progesterone during or near menopause. There are also many other reasons why a doctor may be prescribing additional sex hormones.

Often called menopausal hormone therapy, HRT can help alleviate sweating, hot flashes and other menopause symptoms. Also, it can reduce osteoporosis risk.

Some HRT types contain both progesterone and estrogen, while others only contain estrogen. They sometimes contain testosterone.

Discover the uses, types, and risks of HRT below.

Uses

A person may use HRT to manage symptoms of menopause.
A person may use HRT to manage symptoms of menopause.

Hormone therapy can help address a range of problems.

The proper combination and dosage of the hormones would depend on why this type of treatment is prescribed.

Menopause

Menopause is not something of a disease. It is a natural transition from the years a female will reproduce to the next life stage.

Many women go through menopause without having to undergo any treatment. However, there are a variety of treatment approaches available when the transition causes troubling or distracting symptoms.

Around menopause, many people experience:

  • hot flashes and night sweats
  • vaginal dryness
  • bone thinning, or osteoporosis
  • urinary problems
  • thinning hair
  • sleep problems
  • mood changes
  • irregular periods
  • difficulties with concentration and memory

HRT can help manage some of the above symptoms.

In addition, some studies have suggested that HRT may help:

  • improve muscle function
  • reduce the risk of heart failure and heart attacks
  • reduce mortality among younger postmenopausal people
  • prevent skin aging, in some people, when used cautiously

However, confirming these benefits will require further research.

Learn more about what to expect during menopause.

Other uses

A doctor may also prescribe different types of sex hormones and their combinations for:

  • birth control
  • low blood testosterone levels
  • a transition from the sex assigned at birth
  • prostate cancer

Hormones and menopause

Progesterone and estrogen levels fluctuate in females, contributing to the menstrual cycle, throughout each month.

Such rates also change over the entire lifetime of a person.

Perimenopause

Estrogen and progesterone levels begin to fall when most females are in their 40’s, but menstruation will continue for some time to come.

Periods may become less regular, and during this time hot flashes and other symptoms of menopause may begin to show up.

As long as menstruation persists, it is possible to become pregnant, but with time the chances decrease.

Perimenopause, or the lead-up to menopause, usually lasts about 7 years but, according to the National Institute on Aging, this can occur for up to 14 years.

Menopause

Menopause commences 12 months after the last cycle of a person. On average this happens in the United States at the age of 52. It is no longer possible to become pregnant after a menopause without medical support.

Everyone experiences menopause differently but there are common hot flashes, changes in mood, and other symptoms.

A research published in 2015 indicates vasomotor effects, such as hot flashes, occur in more than half of females:

  • last for more than 7 years
  • start before the final monthly period
  • continue for an average of 4.5 years after menstruation ends

During this time, HRT can help manage the symptoms.

Early menopause

In certain people, menopause begins sooner and if this occurs, HRT may be beneficial.

Individuals experiencing the change early on may:

  • have had surgery to remove the uterus, ovaries, or both
  • have some types of cancer
  • have certain genetic or chromosomal factors
  • have certain autoimmune diseases
  • smoke

The transition sometimes begins early, for no clear reason.

Anyone scheduled to undergo surgery or other treatment that will affect their reproductive system should ask about the probability of early menopause.

A doctor can define the range of available treatments should a person need them.

Side effects

While HRT can help manage hot flashes and other menopause symptoms, it can also have adverse effects.

Depending on the type of treatment, these may include:

  • acne
  • bloating
  • indigestion
  • breast tenderness
  • swelling in the breasts or other parts of the body
  • abdominal or back pain
  • leg cramps
  • headaches
  • migraine
  • nausea
  • vaginal bleeding
  • mood changes
  • depression

These side effects usually disappear after a few weeks.

It is important to let the doctor know about any side effects that cause concern. They may be able to adjust the dosage or suggest an alternative.

Is it safe?

Using hormone therapy during menopause was common in the past, but HRT may not be safe or suitable for everyone — especially for people with specific risk factors.

Now, most doctors agree that it is safe to take hormone therapy:

  • for moderate-to-severe hot flashes and vaginal dryness
  • up to the age of 59 years
  • within 10 years of menopause
  • at the lowest possible dosage, for the shortest possible length of time

However, the overall health and preferences of the individual should influence the decision.

Risks: Who should not use HRT?

HRT may not be suitable for people with a history of:

Also, people should not use it if they are or may become pregnant.

Does HRT cause cancer?

Some older research connected HRT to endometrial cancer , breast cancer and ovarian cancer. However, not all aspects of HRT were looked into in this research.

The American Cancer Society underlines that the risk may depend on the type of treatment and cancer.

They report that while one type of HRT may slightly increase the risk of breast cancer, another may decrease the risk.

Anyone who thinks of using HRT will address the potential risks and benefits with their doctor.

Does it cause weight gain?

Some people worry that weight gain may lead in hormone treatment but there is no evidence to support this.

Eating a healthy diet and getting plenty of exercise can help manage the weight gain commonly affecting midlife females and males.

Types of HRT

There are different ways to deliver hormone therapy and the different types offer different combinations and hormone amounts.

Common types include:

Estrogen-only HRT: A doctor may recommend this if a person has had their uterus and ovaries removed, in which case progesterone is not necessary.

Cyclical, or sequential, HRT: This may be a good option if symptoms occur before menopause; the dosage can align with the menstrual cycle.

Continuous HRT: After menopause, a doctor may prescribe a continuous combination of estrogen and progesterone.

Local estrogen: Vaginal tablets, creams, or rings can help with urogenital symptoms, including vaginal dryness and irritation.

How to take it

The doctor will prescribe the lowest possible dosage that addresses the symptoms of the person, and it can take some trial and error to arrive at this dosage.

Ways of delivering HRT include:

  • tablets
  • creams or gels
  • vaginal rings
  • skin patches

If a person no longer needs the treatment, the doctor can explain how to phase it off.

Alternatives

Different lifestyle adjustments may help manage the menopause symptoms.

They include:

  • limiting the consumption of caffeine and alcohol
  • avoiding spicy foods
  • not smoking
  • exercising regularly
  • wearing loose clothing
  • maintaining regular sleeping habits, if possible
  • using a fan or cooling gel pad to help prevent night sweats
  • practicing stress reduction techniques, such as mindfulness, meditation, or yoga
  • talking to friends and family members about the experience

It is also a good idea to ask the doctor about treatment options for non-hormonal.

Some people take supplements such as ginseng, black cohosh, red clover, soy, or kava to help ease menopause symptoms.

However, more work is needed to confirm the effects of those supplements. Some may not be safe to use for all.

No recommendation or regulation of herbal treatments is made by the Food and Drug Administration (FDA). A person can not be certain of what a product contains or if it is safe or effective to use.

Talk to your doctor always before using any supplements.

Takeaway

Hormone therapy represents a standard approach to a range of health problems. Some hormones, or hormone combinations, may help manage menopause symptoms.

HRT isn’t ideal for everybody, however. Doctors and other healthcare providers can give detailed descriptions of the risks and potential benefits and help people make the decision.

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