Is Hormone Replacement Therapy Right for You?

Hormone replacement therapy (HRT), also referred to as menopausal hormone therapy (MHT), is an estrogen- and/or progesterone-containing medication meant to replace hormones the body stops producing during perimenopause or the menopausal transition. HRT is available in pills, patches, and creams or through an intrauterine device (IUD).

Hormone therapy can help lessen symptoms of menopause including;

•    Hot flashes 
•    Night sweats
•    Vaginal dryness 
•    Sleep disturbances 

Symptoms that may or may not respond to hormone therapy include mood, joint pain, and the lack of focus and forgetfulness commonly known as ‘brain fog. “These symptoms sometimes respond to menopausal hormone therapy, but it's hard to know whether it's primarily the effect of the hormones or if it's the effect of better sleep,” said Dr. Howell.

If you are 60 or younger and are experiencing hot flashes, night sweats, vaginal dryness, or sleep disturbances, and your final menstrual period was less than 10 years ago, hormone therapy may be right for you.

It is not usually recommended that you start HRT if you are older than 60 and haven’t had a menstrual period in more than 10 years. It’s also not usually recommended for people with a history of blood clots in the legs or lungs, breast cancer, or heart attack, or if you have coronary artery disease, active liver disease, uncontrolled high blood pressure, or undiagnosed genital bleeding. In these instances, the risks associated with HRT typically outweigh the benefits.

If you are 60 or younger, taking HRT for five years or less has been shown to provide more benefits than risks. However, as you age, the risks of being on additional hormones increase and can outweigh the benefits. The duration of treatment will depend on your health and family medical history, as well as whether you continue to experience menopausal symptoms when you stop. “Long-term use is individualized because not everybody has the same risks,” said Dr. Howell.

Hormone therapy is a relatively low-risk medication when given to the right person and used for less than five years. In addition to reducing symptoms, people taking hormone therapy for less than five years usually experience an improved quality of life, better overall health, and better bone health. “We really don’t see a lot of risks,” Dr. Howell said.

Using hormone replacement therapy for more than five years can raise your chances of blood clots, stroke, and breast cancer, especially if the medication includes progesterone. These risks may become higher than what is typical for your age. Therefore, your doctor may recommend you stop HRT after five years if they believe the risks outweigh the benefits. Each person is different, and your provider will make recommendations tailored to you.

People older than 60 who begin hormone replacement therapy have an increased risk of cardiovascular disease and dementia, so HRT may not be recommended, as the risks may outweigh the benefits.

Hormone therapy will not help you lose weight. “Estrogen impacts where your body distributes fat, but it doesn't necessarily cause you to gain or lose weight,” said Dr. Howell. “The weight gain people get at midlife is not going to be improved by hormone therapy -- that's a common misconception.”

There is a 50% chance that hot flashes and night sweats will return after stopping HRT.

Your primary care provider or your ob-gyn can prescribe hormone therapy. Reach out to the doctor you feel most comfortable with -- they can always refer you to a specialist when necessary.