Section 4: Menopause Hormone Therapy
For many women, hormone therapy can successfully treat some of their most disruptive symptoms.
Menopause Hormone Therapy (MHT), also referred to as Hormone Replacement Therapy (HRT) or Hormone Therapy (HT), is medication that contains female hormones — estrogen and/or progesterone. Hormone therapy is prescribed by doctors and is used to treat common symptoms related to menopause transition, including hot flashes, mood imbalance, and discomfort due to vaginal dryness or thinning. Hormone therapy may also be prescribed to post-menopausal women at risk of Osteoporosis (i.e., bone loss and fracture-prone) or to those struggling with insomnia or other sleep disturbances.
Menopause Hormone Therapy (MHT) aims to replenish the estrogen your body stops producing during perimenopause and after menopause.
There are two main types of estrogen therapy:
1. Systemic Hormone Therapy: This type of estrogen, available as a pill, skin patch, ring, gel, cream, or spray, contains a higher estrogen dose absorbed throughout your body. It’s typically used to treat a range of common menopause symptoms, like hot flashes, night sweats, and mood swings.
2. Low-Dose Vaginal Products: These forms of estrogen—available as a cream, tablet, or ring—are designed to be absorbed in much smaller amounts by the body. Because of this, they’re usually used specifically to treat vaginal and urinary symptoms associated with menopause, like dryness or discomfort.
A Look Back at the HT Risk Controversy
For almost two decades, Menopausal Hormone Therapy (MHT) has infrequently been prescribed by doctors in the US to treat those going through menopause. However, recent research confirms that the health benefits of hormone therapy to those in perimenopause and within the first decade following menopause far outweigh the health risks.
In 2002, a major study called the Women’s Health Initiative (WHI) sparked widespread confusion about the safety of MHT. This large clinical trial aimed to evaluate the long-term effects of MHT in post-menopausal women. It looked at two types of therapy: 1) a combination of estrogen and progesterone for women with a uterus and 2) estrogen-only therapy for women who had undergone a hysterectomy. The initial results raised alarms, suggesting an increased risk of heart disease, stroke, and breast cancer, which led many doctors to stop prescribing MHT almost overnight.
The findings were widely publicized but lacked critical context, causing confusion and fear around MHT. As a result, the number of women using hormone therapy dropped dramatically, from about 50% to only around 5%. However, in the years since, reanalysis of the same data has led to a more nuanced understanding of the risks and benefits. Many of the original concerns have been disproven, and organizations like The Menopause Society (formerly the North American Menopause Society) have updated their guidelines to recommend more personalized approaches to MHT, helping women make informed decisions based on their unique health needs.
Current Guidelines on Menopause Hormone Therapy
Hormone therapy can be a safe and effective option. For many women experiencing moderate-to-severe symptoms throughout perimenopause and into post-menopause, the benefits far outweigh the risks. However, it may pose greater health risks for some. For example, women with estrogen-dependent cancers or a history of or risk for blood clot formation are not candidates for hormone therapy.
In addition to family and medical history, health risks should also be considered according to the dosage, duration, and type of hormone therapy you’re taking. Because of this, hormone therapy should be tailored to the individual and regularly re-evaluated by your doctor to ensure the benefits continue to outweigh the risks.
Alternatives to Menopausal Hormone Therapy
While MHT is safe and effective for most women, some cannot or choose not to take it. Non-hormonal medications are alternatives for women who can’t or choose not to take MHT. Part II of our module will provide a comprehensive list of the non-hormonal treatment options and lifestyle modifications that can help manage a range of menopause-related symptoms.