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What is menopausal hormone therapy?

Donna Hill Howes, RN
Family Practitioner

Hormone therapy relieves symptoms by replacing some of a woman's declining estrogen during menopause. It is usually taken as a pill. Patches, gels and sprays are also available.

There are 2 types of hormone therapy, also called hormone replacement therapy (HRT). Most women need a combination of estrogen and progestin. Women who have had a hysterectomy only need estrogen.

Many hormone therapy products are available in the US. Estrogen-only products often contain the estrogen hormone estradiol. These include Alora, Climara, Divigel, Elestrin, EstroGel, Minivelle, Premarin, and Vivelle. Products that combine estrogen and progestin usually include the progestin hormones norethindrone, levonorgestrel or medroxyprogesterone. These include Activella, Climara Pro, CombiPatch, Femhrt, Fyavolv, Leribane and Prempro.

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Menopausal hormone therapy replaces the hormones that a woman's ovaries stop making at the time of menopause, easing symptoms like hot flashes and vaginal dryness. It involves using man-made estrogen alone or estrogen with a progestin, often in the form of a pill or skin patch, to supplement the hormones that your body still makes. The goal is not to bring hormone levels up to reproductive-age levels, but get them high enough to relieve symptoms. MHT used to be called hormone replacement therapy, or HRT.

Menopausal hormones have short-term benefits such as relief from hot flashes and vaginal dryness, but several health concerns are associated with their use. Women should discuss with their healthcare provider whether to take menopausal hormones and what alternatives may be appropriate for them. The U.S. Food and Drug Administration (FDA) currently advise women to use menopausal hormones for the shortest time and at the lowest dose possible to control symptoms.

This answer is based on source information from the National Cancer Institute.

Dr. Mehmet Oz, MD
Cardiologist (Heart Specialist)

Menopausal hormone therapy is a treatment that uses a hormone or combination of hormones to treat the symptoms of menopause. It replaces the hormones that decline during menopause, estrogen and progesterone. It may contain estrogen alone, progesterone alone, or a combination of both of these hormones. They can be delivered into the body by pills, cream, patch, spray, vaginal ring, vaginal tablet or intrauterine device. The goal of therapy is to reduce menopausal symptoms such as hot flashes, night sweats, vaginal dryness, vaginal tissue thinning and bone loss.

In the last few years, we have learned a lot about menopausal hormone therapies and that has led doctors to be very careful when it comes to prescribing them. While hormone replacement therapy (HRT) does a great job of reducing severe and disabling symptoms of menopause, not all women will be able to take it. We call that a contraindication or reasons to withhold treatment in certain people. There is a long list of contraindications so be sure to discuss it all with your doctor before taking it.

This content originally appeared on doctoroz.com.

 

Once prescribed as the first choice for the long-term prevention of osteoporosis and heart disease as well as for the short-term relief of menopausal symptoms such as hot flashes, menopausal hormone therapy is now only prescribed on a short-term basis (up to five years) for the management of menopausal symptoms in women without certain risk factors, such as a history of breast cancer, coronary artery disease and a previous blood clot or stroke.

Hormone therapy comes in several forms: synthetic or bioidentical estrogen, either alone or combined with progesterone or with a synthetic progestin. When combined with progestin, it is called hormone therapy. It is given only to women who still have their uterus because progesterone reduces the risk of uterine cancer that comes with supplemental estrogen.

When given as estrogen alone, hormone therapy is called estrogen therapy. It is typically given to women who no longer have a uterus.

Mrs. Marjorie Nolan Cohn
Nutrition & Dietetics Specialist

Hormone therapy is controversial, but may be an option for women who have severe hot flashes, night sweats, or mood swings. Hormone therapy is treatment with estrogen and, sometimes, progesterone.

Talk to your doctor about the benefits and risks of hormone therapy. Your doctor should be aware of your entire medical history before prescribing hormone therapy (HT). You should also learn about options that do not involve taking hormones.

Several major studies have questioned the health benefits and risks of hormone therapy, including the risk of developing breast cancer, heart attacks, strokes and blood clots.

Current guidelines support the use of HT for the treatment of hot flashes. Specific recommendations:

  • HT may be started in women who have recently entered menopause.
  • HT should not be used in women who started menopause years ago.
  • The HT medicine should not be used for longer than 5 years.
  • Women taking HT have a low risk for stroke, heart disease, blood clots or breast cancer.

To reduce the risks of estrogen therapy, your doctor may recommend:

  • A lower dose of estrogen or a different estrogen preparation (for instance, a vaginal cream or skin patch rather than a pill)
  • Frequent and regular pelvic exams and Pap smears to detect problems as early as possible
  • Frequent and regular physical exams, including breast exams and mammograms

Menopausal hormone therapy (MHT) may help reduce symptoms of menopause. For now, the safest option for meno­pausal hormone therapy is to stick with the lowest dose for the shortest time to treat menopausal symptoms or treat bone loss, but not to prevent heart disease. The following should not take menopausal hormone therapy for menopause:

Women who:

  • Think they are pregnant
  • Have problems with vaginal bleeding
  • Have had certain kinds of cancers (such as breast and uterine cancer)
  • Have had a stroke or heart attack
  • Have had blood clots
  • Have liver disease
  • Have heart disease

MHT can also cause these side effects:

  • Vaginal bleeding
  • Bloating
  • Breast tenderness or swelling
  • Headaches
  • Mood changes
  • Nausea

Be sure to see your doctor if you have any of these side effects while using MHT.

This answer is based on source information from the National Women's Health Information Center.

For decades, estrogen, taken in pill form, was prescribed to relieve menopausal symptoms. Estrogen was later found to help combat osteoporosis. Subsequent observational research suggested that estrogen therapy might also lower the risk of heart disease, the nation's leading cause of death in postmenopausal women.

But by the late 1990s, evidence from several studies  cast doubt on the heart-protecting benefits of hormones. Evidence from the Women's Health Initiative, the largest and longest clinical trial of postmenopausal hormone therapy, demonstrated that hormone therapy might actually increase the risk of heart attacks. Prempro (a combination of estrogen and progestogen) was found to slightly raise the risk of heart disease, stroke, serious blood clots and breast cancer. Two years later, evidence suggested that the risks of using Premarin (estrogen alone) also outweighed the benefits, with estrogen users more likely to have strokes.

Taking hormones for moderate to severe menopausal symptoms may still be prescribed, but women are advised to use the smallest effective dose for the shortest possible time. Understandably, interest in alternatives to hormone therapy has surged. Because nonhormonal treatments don't address all perimenopausal complaints, many women concentrate on first relieving their most troublesome symptoms with a combination of lifestyle changes, over-the-counter remedies and prescription drugs, before considering prescription hormone treatment.

Dr. Jan L. Shifren, MD
Fertility Specialist

The products listed below treat both vaginal dryness and other menopausal symptoms such as hot flashes and night sweats. Women without a uterus can take estrogen by itself; those who have a uterus must take a progestin or progesterone in addition to estrogen (either separately or in a combination product) to minimize the risk of uterine cancer that can occur with estrogen alone. If a woman has vaginal dryness without hot flashes, she should not take any of the products listed below, but rather use a low dose estrogen cream, tablet or ring directly in the vagina. These products treat dryness and discomfort with intercourse, but do not generally increase blood levels of estrogen. The higher dose estrogen products listed below are necessary to treat hot flashes. 

  • Oral estrogen (pills): Conjugated equine estrogens (Premarin); synthetic conjugated estrogens (Cenestin, Enjuvia); esterified estrogens (Menest); 17 beta-estradiol (Estrace, generics); estrone /estropipate (Ogen, Ortho-Est, generics)
  • Transdermal estrogen (patch, gel, cream, spray): 17 beta-estradiol patch (Alora, Climara, Esclim, Estraderm, Menostar, Vivelle-Dot, generics); 17 beta-estradiol gel (Divigel, Elestrin, Estrogel); 17 beta-estradiol cream (Estrasorb); 17 beta-estradiol spray (Evamist)
  • Vaginal estrogen (ring): Estradiol acetate (Femring)
  • Progestin pills: Medroxyprogesterone acetate (Provera, generics), norethindrone (Micronor, Nor-QD, generics); megestrol acetate (Megace)
  • Intrauterine progestin: Levonorgestrel IUS (Mirena)
  • Progesterone pill: Micronized progesterone USP (Prometrium)
  • Progesterone vaginal gel: Progesterone (Crinone 8%)
  • Combination estrogen-progestogen pills: Conjugated estrogens plus medroxyprogesterone acetate (Premphase, Prempro); ethinyl estradiol plus norethindrone acetate (Femhrt); 17 beta-estradiol plus norethindrone acetate (Activella); 17 beta-estradiol plus norgestimate (Prefest)
  • Combination estrogen-progestogen patch: 17 beta-estradiol plus norethindrone acetate (CombiPatch); 17 beta-estradiol plus levonorgestrel (Climara Pro)

For people with diabetes, hormone replacement therapy can help reduce symptoms of menopause. The benefits are decreased risk of osteoporosis, dry vagina and hot flashes.

Patricia Geraghty, NP
Women's Health

Menopausal hormone therapy is used to treat symptoms of menopause. Findings from the Women's Health Initiative Memory Study showed a doubling of the risks for signs of early dementia in women using menopause hormone therapy after the age of 65. This is not the typical age group where hormone use is recommended, and long-term data is not available to corroborate the finding of actual development of dementia. The risk of dementia from hormone use is younger women is not clear but appears to be absent or decreased.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.