Don't use HT. Try other treatment to manage your menopause
Key points to remember
Hormone therapy lowers the risk of
osteoporosis and possibly
colon cancer. But for some women, HT may increase the risk of breast cancer,
blood clots, and
possibly dementia and heart attack.1
The health risks linked
to HT are not high for most women. But on average, these small risks outweigh
the small benefits of HT.
HT can help you deal with menopause
symptoms such as
hot flashes and sleep problems. If you decide to use
it, take the lowest dose you can for the shortest possible time. See your
doctor regularly to check your benefits and health risks.
Instead of HT, you might
try other prescription medicines,
black cohosh, or
dietary soy to manage hot flashes. A lubricant gel or
an estrogen cream, ring, or tablet may help with vaginal soreness and
HT helps prevent bone loss and
osteoporosis. But if you are at high risk for
osteoporosis, HT is only one of several treatments you could try.
What is menopause?
the point in a woman's life when she has not had a
menstrual period for 1 year. Menopause marks the end
of the childbearing years. It is sometimes called "the change of life."
For most women, menopause happens at around age 50, but every woman's
body has its own time line. As you get closer to menopause, your estrogen levels
go up and down unevenly. This causes changes in your period and other symptoms,
hot flashes, headaches, and sleep problems. After your
estrogen levels drop past a certain point, your menstrual cycles end.
Menopause is a natural part of growing older. You don't need treatment
for it unless your symptoms bother you.
What is hormone therapy?
Hormone therapy uses a combination of two hormones, estrogen
and progestin. You can take the hormones as pills, use a patch, or use a
vaginal ring. HT increases the estrogen and progestin levels in your body. It
osteoporosis and ease menopause symptoms such as
hot flashes and sleep problems.
Because of the risks from HT, many experts recommend that HT be used:
For short-term treatment of menopause symptoms. If you
decide to take HT, use the lowest dose you can, and take it for as short a
time as possible.
To prevent or treat osteoporosis. If you have a strong
risk of osteoporosis, you might consider taking HT. The risk of osteoporosis
may outweigh the risks linked to HT. But it's
important to think about all possible osteoporosis treatments and to compare
their risks and benefits.
What if you don't take HT?
can be upsetting and uncomfortable. But you don't have to suffer through them.
There are other things besides taking HT that you can do to help.
The first step is to have a healthy lifestyle. This can reduce your
symptoms and also lower your risk of heart disease and other long-term problems
linked to aging.
Eat a heart-healthy diet, get regular exercise, don't smoke, and limit
caffeine, alcohol, and stress.
If you still need help dealing with
symptoms, you might try:
Breathing exercises to help with
hot flashes and emotional symptoms.
Black cohosh and
dietary soy, which may reduce hot
Vaginal lubricants (such as Astroglide and K-Y Jelly) to
help with vaginal dryness, and
vaginal estrogen to relieve soreness.
Antidepressant medicines, a blood pressure medicine called clonidine, or gabapentin. These may lower the number of hot flashes you have.
And they can make hot flashes less severe when you do have them.
To manage symptoms before you start menopause, you might
think about taking
low-dose birth control pills, if you don't smoke and
aren't at risk for heart disease or breast cancer.
What are the benefits of taking HT?
Reduces the number of
hot flashes you have, and it makes them less
severe when you do have them.2
risk of osteoporosis. Estrogen slows bone thinning and
helps increase bone thickness.2
vaginal dryness and soreness caused by low estrogen.
Slows the loss of skin
collagen. Collagen puts the stretch in skin and
Reduces the risk of dental problems, such as tooth loss and
May reduce the risk of colon cancer.3
What are the risks from HT?
Risk varies based on when you start HT in menopause and how long you take it. Short-term use of hormone therapy in early menopause has less risk than when it is started later in menopause.
Women who take HT have slightly higher rates of:1
Your risk will differ based on your personal or family history.
If you have had
breast cancer, taking HT isn't safe for you.
Why might your doctor recommend hormone therapy?
Your doctor may recommend HT if:
You have no risk factors for heart disease,
blood clots, stroke, or breast or ovarian cancer; you are willing to accept the
small increase in risks of cancer and heart disease; and
You have thought about or tried other
menopause symptoms that are lowering your quality of
Personal stories about deciding whether to take hormone therapy (HT)
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
very fortunate. Like my mother, I made it through menopause without hot flashes
or other major discomforts. My doctor tells me that all I have to do now is be
sure I get my regular checkups and exams, take calcium and vitamin D for bone
health, and take good care of myself.
Karen, age 55
By the time
my periods stopped, I didn't have bad hot flashes or other problems. I was
pretty proud of myself for getting exercise and eating right, and thought that
I was one of the lucky ones. Did I get hit, though! The night sweats started a
few months after my last period, and I couldn't sleep or get through the day
after that. So, I tried low-dose HT for 6 months, to get some relief. Then, I
tapered off of it over a few months, and they weren't as bad. I figure I can
tough it out now till my body adjusts to its new state.
Jane, age 52
told me that HT would help me in so many ways, so I started taking it after my
periods stopped. The problem is, I had bleeding on and off that was like my
period, and I just couldn't take it after 6 months. I haven't taken it since,
and I've grown used to my body's changes. I still get hot flashes sometimes but
not like I used to. When I feel one coming on, it really helps me to do
relaxation breathing. I think that calming my body and mind has a big effect on
making a hot flash go away.
Mary Anne, age 60
I have already had a terrible time with
perimenopausal moodiness and some occasional hot flashes, and low-dose birth
control pills have helped even out the hormone ups and downs. So I know what my
plan is. When my doctor gives me the go-ahead around menopause age, I'm going
to switch to low-dose HT. Then I'll taper off of it after a year or so. I need
to be able to function!
Jenessa, age 45
There is no way I'd ever take estrogen or
progestin, because of the cancer risks. There's just too much we don't know,
and what we do know from recent studies scares me. I used an antidepressant
when my hot flashes were bad, and that helped me a lot. Now, I just take
calcium and vitamin D supplements and get regular exercise to help protect my
A girlfriend told me that she was having
great results from taking black cohosh, so I tried it for the occasional hot
flashes and mood swings I was having. I think it's working quite well. But
it wasn't until I went for my annual gyn exam that I learned it's best to have
a checkup every 6 months, like women in Germany who take it by prescription.
Now I know to think of black cohosh as a prescription drug, kind of like
estrogen, that's still being studied.
North American Menopause Society (2012). The 2012 hormone therapy position statement of
the North American Menopause Society. Menopause, 19(3): 257–271. Also
available online: http://www.menopause.org/PSht12.pdf.
Shifren JL, et al. (2010). Role of hormone therapy in the management of menopause. Obstetrics and Gynecology, 115(4): 839–855.
Fritz MA, Speroff L (2011). Postmenopausal hormone therapy. In Clinical Gynecologic Endocrinology and Infertility, 8th ed., pp. 749–857. Philadelphia: Lippincott Williams and Wilkins.
Last Revised: January 17, 2013
Anne C. Poinier, MD - Internal Medicine Carla J. Herman, MD, MPH - Geriatric Medicine