Hot Flashes, Night Sweats, and More

Hot Flashes, Night Sweats, and More

If used correctly, hormone therapy can provide relief from menopause symptoms -- but is it right for you?

Feel like the only thing that fluctuates more than your hormones is the consensus on hormone therapy? The truth is, hormone therapy—used to manage menopausal symptoms—is safe for many, but not all, women. Here are the top benefits and risks to discuss with your physician.

Hormone Therapy Keeps You Cool
If you're bothered by hot flashes or night sweats, systemic hormone therapy—meaning it circulates through your body by way of a pill, skin patch, cream, gel, or spray—is still the most effective medical treatment available. According to JoAnn Manson, MD, one of the principal investigators of the Women's Health Initiative (WHI) hormone therapy trials, only 20% of women have hot flashes that are serious enough to warrant hormone therapy. If you need relief and haven't undergone a hysterectomy, your doctor may prescribe combination hormone therapy: estrogen, plus progesterone (or progestin, a med that mimics progesterone). The purpose of adding progesterone to the mix is that estrogen, when taken alone, can raise the risk of endometrial cancer (a type of uterine cancer). Women who've had their uterus removed can be prescribed estrogen-only therapy.

Hormone Therapy Gets Your Groove Back
Hormone therapy is one of the best options for vaginal discomfort and dryness. Women with vaginal symptoms only should opt for local (nonsystemic) hormone therapy (low-dose therapy, applied topically in the vagina, as a cream, ring, or tablet). "This will effectively treat her symptoms, while her exposure to hormone therapy will be lower," Manson says.

Hormone Therapy May Protect Your Ticker
For healthy women under age 60 who are within 10 years of the onset of menopause, hormone therapy may in fact reduce the risk of heart disease and death. However, it should only be taken to treat menopause symptoms—not to prevent chronic disease.

Hormone Therapy Keeps Bones Strong
In people over age 65, falling and fracturing a hip can be a serious hazard. In fact, one in five seniors will die within a year of breaking their hip. Hormone therapy helps to restore estrogen and prevent bone loss. For women who can't take bone-building drugs, such as bisphosphonates, hormone therapy may be an option.

Hormone Therapy Increases Risk of Stroke and Blood Clots
Hormone therapy has been linked to a greater risk of blood clots and strokes. The older the woman and the higher the hormone dosage, the greater the risk of stroke. According to Manson, hormone therapy patches may pose less risk than other methods. Women with a personal or family history of blood clots or strokes should avoid hormone therapy altogether.

Hormone Therapy Boosts Breast Cancer Risk
Combination hormone therapy poses a small, though real, increase in breast cancer risk, especially after four or five years of use. According to WHI researcher Matthew Allison, MD, MPH, obesity, not exercising, and too much alcohol pose greater breast cancer risks. "Still, women at least deserve to be informed that the rate of breast cancer in women on hormone therapy becomes noticeable at a five-year point," says Margery Gass, MD, executive director of the North American Menopause Society.

The Bottom Line
If you're under age 60, within 10 years of entering menopause, and significantly bothered by hot flashes, vaginal dryness, or other symptoms, the benefits of hormone therapy may outweigh the risks. Every woman's circumstances are different and treatments can be highly individualized, so talk to your doctor about whether hormone therapy is right for you.

Medically reviewed in November 2018.

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