The road to menopause is paved with symptoms such as hot flashes, night sweats, and vaginal dryness. But, while normal, they shouldn’t have an outsize impact on your life.
That’s where hormone therapy comes in. Hormone therapy, which can be prescribed by your doctor, boosts the body’s levels of estrogen and progesterone, the same hormones that naturally drop during menopause. For most women,
hormone therapy is safe to take — and, since it comes in many forms, your doctor can help you find an option that works for you.
“If you're having symptoms,” says Juliana Kling, MD, MPH, a women’s health specialist at Mayo Clinic, “you deserve to have a conversation with your clinician about a safe and effective treatment.”
Main Types of Hormone Therapy
There are two main types of hormone therapy available, depending on whether you need to take just one hormone or two.
Estrogen Therapy
Estrogen is the main hormone used in hormone replacement therapy. If you’ve had a hysterectomy in the past and no longer have a uterus, you’ll take estrogen only.
Combination Therapy (Estrogen and Progesterone)
Combination therapy uses both estrogen and progesterone. If you still have a uterus, you can’t take estrogen alone because it causes the lining of the uterus to grow, increasing the risk of uterine cancer, says Ghazaleh Moayedi, DO, MPH, a board-certified ob-gyn at Pegasus Health Justice Center in Dallas. Taking progesterone, however, protects against this risk by thinning the lining of the uterus.
How to Take Hormone Therapy
There are two main ways to take hormone therapy: systemically (meaning, throughout the body) or locally (applied to a specific area).
Systemic Therapy
With systemic hormone therapy, the hormones are released into the bloodstream and travel throughout the body, helping to ease symptoms such as hot flashes and night sweats and to prevent osteoporosis. Systemic therapies include pills, patches, and topical treatments.
Localized Therapy
Localized hormone therapy is applied directly to the vaginal area, and is primarily used to treat something called genitourinary syndrome of menopause (GSM). GSM causes symptoms such as vaginal dryness, pain during sex, and urinary symptoms. Localized therapies include creams, rings, or tablets.
Because the estrogen is applied to a specific area, it isn’t absorbed throughout the rest of the body, which means it's associated with fewer risks than systemic therapy.
Benefits of Hormone Therapy
Hormone therapy can help ease the symptoms of menopause, including hot flashes, vaginal dryness, and sleep disturbances, among others. It can provide the following:
- Relief of vasomotor symptoms, including hot flashes and night sweats.
- Bone health protection, such as a reduced risk of osteoporosis and bone fractures.
- Treatment of GSM, which includes symptoms like vaginal dryness, painful sex, and urinary issues. This is usually done with localized hormone therapy.
- Better sleep, such as relief of sleep disturbances, which are common during menopause.
Risks of Hormone Therapy
In 2002, results from the Women’s Health Initiative study raised alarms when it found that hormone therapy increased women’s risk of cardiovascular disease and breast cancer.
However, more recent research has found major methodological flaws with the study,
and since then, newer research has challenged its findings.
Not everyone is a candidate, though. For example, research has found that starting hormone replacement therapy for menopause at the age of 60 or older (or 10 years after the onset of menopause) can increase your risk of developing complications. Your personal health history — including your risk of blood clots, heart disease, and breast cancer — may also affect your risk.
Overall, however, “we see that the hormone therapy benefit is much larger than the risk,” says Dr. Kling.
Who Should Avoid Hormone Replacement Therapy
If you have certain medical conditions, you may be at greater risk of serious side effects when taking hormone therapy. Before starting treatment, make sure your doctor is aware if you have a history of any of the following conditions so they can help you find the treatment that’s best for you:
- Breast cancer
- Deep venous thrombosis or pulmonary embolism
- Blood clotting disorder
- Stroke
- Unexplained vaginal bleeding
- Liver disease
- Heart attack
Side Effects of Hormone Therapy
As with any medication, there can be some side effects.
Common, Mild Side Effects of Hormone Therapy
Starting hormone therapy can cause mild side effects, which typically go away after a few weeks of treatment.
If these symptoms persist for more than six months after starting treatment, Kling says, mention it to your doctor.
Common side effects include:
- Breast tenderness
- Vaginal bleeding or spotting
- Mood swings
- Sleepiness
- Bloating
- Nausea
Other Side Effects
These side effects are less common but can still occur when taking hormone therapy:
- Headaches
- Skin irritation from patches or gels
- Hair loss
- Leg cramps
How Is Hormone Therapy Taken?
“There are dozens and dozens of products, and they all vary,” says Dr. Moayedi. A few of the most common delivery methods for hormone therapy include the following:
- Oral Pills Many women find this option convenient because it’s easy to take and has cheaper generic options available. However, oral hormone therapy also comes with greater risk of side effects like blood clotting compared with other delivery methods.
- Vaginal Rings, Creams, or Pills These localized delivery methods offer the best relief from GSM symptoms and have fewer risks than systemic treatments.
- Topical Treatments Topical treatments include sprays, creams, or gels that you apply to your skin.
- Patches Patches are applied once or twice a week to the thigh or stomach. Patches are generally estrogen-only, says Moayedi, meaning women taking combination therapy often need to take an oral progesterone tablet as well.
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