You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Don't use HT. Try other treatment to manage your menopause
symptoms.
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,
ovarian cancer,
stroke,
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
dryness.
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.
Menopause is
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,
such as
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.
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
can prevent
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.
Menopause symptoms
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
flashes.
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.
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.
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
treatments.
You have
menopause symptoms that are lowering your quality of
life.
Compare your options
Compare
What is usually involved?
What are the benefits?
What are the risks and side effects?
Take HT Take HT
You take daily pills or use a patch or
a vaginal ring to increase hormone levels.
You take
hormone therapy (HT) to relieve menopause
symptoms.
Taking HT:
Helps you deal with hot flashes and other menopause
symptoms.
Lowers your risk of osteoporosis.
Eases vaginal
dryness and soreness.
Slows loss of skin
collagen.
Reduces the risk of dental problems.
Side effects can
include:
Vaginal bleeding or
spotting.
Breast
tenderness.
Bloating.
Nausea.
Women who take HT may have slightly higher rates of:
Stroke.
Blood clots.
Heart attack.
Breast cancer.
Gallstones.
Ovarian cancer.
Dementia.
Urinary incontinence.
Some risks depend on your age, when HT is started, and how long it is used.
Don't take HT
Don't take HT
You manage menopause symptoms
such as
hot flashes with:
Breathing exercises.
Black cohosh and
dietary soy.
Antidepressant
medicines,
blood pressure medicine (clonidine), or gabapentin.
Vaginal lubricants (such as
Astroglide and K-Y Jelly) or low-dose
vaginal estrogen.
You avoid the health risks from
HT.
Your menopause
symptoms may still bother you.
Other prescription medicines can
have side effects, such as:
Headaches, upset stomach, and problems
sleeping (antidepressants).
Problems linked to low blood pressure (clonidine).
Personal Stories
Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.
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.
I've been
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
My doctor
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
bones.
Sondra, age
55
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.
Sam, age 49
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to use hormone therapy
Reasons not to use hormone therapy
Other treatment hasn't helped me deal with my menopause symptoms.
I want to try other treatment before I try HT for my symptoms.
More important
Equally important
More important
The benefits of HT outweigh the risks for me.
I feel the risks from HT are too high for me.
More important
Equally important
More important
I don't mind taking medicines to help me manage my symptoms.
I don't want to take medicines if I can avoid them.
More important
Equally important
More important
My other important reasons:
My other important reasons:
More important
Equally important
More important
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Using HT
NOT using HT
Leaning toward
Undecided
Leaning toward
What else do you need to make your decision?
Check the facts
1.
Does taking HT raise your risk of health problems and disease?
YesYou're right. Women who take HT have slightly higher rates of breast cancer, ovarian cancer, heart attack, stroke, blood clots, and dementia.
NoSorry, that's not right. Women who take HT have slightly higher rates of breast cancer, ovarian cancer, heart attack, stroke, blood clots, and dementia.
I'm not sureIt may help to go back and read "Get the Facts." Women who take HT have slightly higher rates of breast cancer, ovarian cancer, heart attack, stroke, blood clots, and dementia.
2.
Can HT help you deal with menopause?
YesYou're right. HT can help you deal with menopause symptoms such as hot flashes and sleep problems.
NoSorry, that's not right. HT can help you deal with menopause symptoms such as hot flashes and sleep problems.
I'm not sureIt may help to go back and read "Get the Facts." HT can help you deal with menopause symptoms such as hot flashes and sleep problems.
3.
Are there other treatments that can help with menopause symptoms?
YesYou're right. Instead of HT, you might try other prescription medicines, black cohosh, or a vaginal estrogen to help deal with symptoms.
NoSorry, that's not right. Instead of HT, you might try other prescription medicines, black cohosh, or a vaginal estrogen to help deal with symptoms.
I'm not sureIt may help to go back and read "Get the Facts." Instead of HT, you might try other prescription medicines, black cohosh, or a vaginal estrogen to help deal with symptoms.
Decide what's next
1.
Do you understand the options available to you?
2.
Are you clear about which benefits and side effects matter most to you?
3.
Do you have enough support and advice from others to make a choice?
Certainty
1.
How sure do you feel right now about your decision?
Not sure at all
Somewhat sure
Very sure
2.
Check what you need to do before you make this decision.
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.
Menopause: Should I Use Hormone Therapy (HT)?
You can use this information to talk with your
doctor or loved ones about your decision.
Get the facts
Compare your options
What matters most to you?
Where are you leaning now?
What else do you need to make your decision?
1. Get the Facts
Your options
Use hormone therapy (HT).
Don't use HT. Try other treatment to manage your menopause
symptoms.
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,
ovarian cancer,
stroke,
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
dryness.
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.
Menopause is
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,
such as
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.
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
can prevent
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.
Menopause symptoms
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
flashes.
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.
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.
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
treatments.
You have
menopause symptoms that are lowering your quality of
life.
2. Compare Options
Take HT
Don't take HT
What is usually involved?
You take daily pills or use a patch or
a vaginal ring to increase hormone levels.
You take
hormone therapy (HT) to relieve menopause
symptoms.
You manage menopause symptoms
such as
hot flashes with:
Breathing exercises.
Black cohosh and
dietary soy.
Antidepressant
medicines,
blood pressure medicine (clonidine), or gabapentin.
Vaginal lubricants (such as
Astroglide and K-Y Jelly) or low-dose
vaginal estrogen.
What are the benefits?
Taking HT:
Helps you deal with hot flashes and other menopause
symptoms.
Lowers your risk of osteoporosis.
Eases vaginal
dryness and soreness.
Slows loss of skin
collagen.
Reduces the risk of dental problems.
You avoid the health risks from
HT.
What are the risks and side effects?
Side effects can
include:
Vaginal bleeding or
spotting.
Breast
tenderness.
Bloating.
Nausea.
Women who take HT may have slightly higher rates of:
Stroke.
Blood clots.
Heart attack.
Breast cancer.
Gallstones.
Ovarian cancer.
Dementia.
Urinary incontinence.
Some risks depend on your age, when HT is started, and how long it is used.
Your menopause
symptoms may still bother you.
Other prescription medicines can
have side effects, such as:
Headaches, upset stomach, and problems
sleeping (antidepressants).
Problems linked to low blood pressure (clonidine).
Personal stories
Are you interested in what others decided to do? Many people have faced this decision. These
personal stories
may help you decide.
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.
" I've been
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
" My doctor
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
bones."
— Sondra, age
55
" 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. "
— Sam, age 49
3. Your Feelings
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to use hormone therapy
Reasons not to use hormone therapy
Other treatment hasn't helped me deal with my menopause symptoms.
I want to try other treatment before I try HT for my symptoms.
More important
Equally important
More important
The benefits of HT outweigh the risks for me.
I feel the risks from HT are too high for me.
More important
Equally important
More important
I don't mind taking medicines to help me manage my symptoms.
I don't want to take medicines if I can avoid them.
More important
Equally important
More important
My other important reasons:
My other important reasons:
More important
Equally important
More important
4. Your Decision
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Using HT
NOT using HT
Leaning toward
Undecided
Leaning toward
5. Quiz Yourself
Check the facts
1.
Does taking HT raise your risk of health problems and disease?
Yes
No
I'm not sure
You're right. Women who take HT have slightly higher rates of breast cancer, ovarian cancer, heart attack, stroke, blood clots, and dementia.
2.
Can HT help you deal with menopause?
Yes
No
I'm not sure
You're right. HT can help you deal with menopause symptoms such as hot flashes and sleep problems.
3.
Are there other treatments that can help with menopause symptoms?
Yes
No
I'm not sure
You're right. Instead of HT, you might try other prescription medicines, black cohosh, or a vaginal estrogen to help deal with symptoms.
Decide what's next
1.
Do you understand the options available to you?
2.
Are you clear about which benefits and side effects matter most to you?
3.
Do you have enough support and advice from others to make a choice?
Certainty
1.
How sure do you feel right now about your decision?
Not sure at all
Somewhat sure
Very sure
2.
Check what you need to do before you make this decision.
I'm ready to take action.
I want to discuss the options with others.
I want to learn more about my options.
3.
Use the following space to list questions, concerns, and next steps.
Credits and references
Credits
Author
Healthwise Staff
Primary Medical Reviewer
Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer
Carla J. Herman, MD, MPH - Geriatric Medicine
References
Citations
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.
Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.
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