Patient education: Hormone therapy for menopause (The Basics)

What is menopause? — This is the time in life when monthly periods naturally stop. At this time, the ovaries stop releasing eggs and stop making the hormones estrogen and progesterone.

Menopause can cause symptoms that are difficult for a lot of people. But there are treatments that can help.

What is hormone therapy? — This is a way to treat menopause symptoms. The main goal is to reduce hot flashes. But it might also help with other symptoms.

The hormones used for therapy are:

●Estrogen – The main estrogen used for this is called "estradiol."

●Progesterone – Most people who take estrogen also need to take progesterone or a progesterone-like hormone called a "progestin." This is to prevent changes in the uterus that can lead to cancer over time. People who have had a hysterectomy (surgery to remove the uterus) do not need to take progesterone or a progestin.

Who can get hormone therapy? — If you are struggling with hot flashes, talk to your doctor or nurse. They can tell you if hormone therapy is an option for you.

Experts think that hormone therapy is safe for most people younger than 60 years. But there are a few exceptions. You should not take hormones if you have had breast cancer, a heart attack, a stroke, or a blood clot.

Some doctors are not used to prescribing hormone therapy for menopause. If you feel that you are not getting the help you need, you might choose to talk to a different doctor who is an expert in menopause treatment. You can ask your doctor or nurse to refer you to someone.

What are the risks of hormone therapy? — Hormone therapy can increase the risk of certain problems, including:

●Heart disease

●Stroke

●Blood clots

●Breast cancer

However, these risks are very low in people younger than age 60. For most people in their 40s and 50s, the benefits of hormone therapy outweigh the risks. Your doctor can talk to you about your risks based on your age and health.

How do I take hormone therapy? — Estrogen comes in different forms for treating hot flashes. These include:

●Pills – Different types and doses of estrogen come in pills. You take 1 pill a day.

●Skin patch – Some patches are changed twice a week. Others are changed weekly.

●Gel, lotion, or spray – These are applied to the skin daily. Some go on the leg, and others go on the arm.

●Vaginal ring – This is a flexible ring you put in your vagina. It stays in for 3 months, then you remove it and put in a new one.

If you have a uterus, you will also need to take a progestin. This is usually taken as a pill. It can be taken for 12 to 14 days out of each month with a higher dose, or every day with a lower dose. You might also have the option of using a pill or a skin patch that contains both estrogen and a progestin.

In some countries, other forms of estrogen and progestin are available.

Your doctor can talk to you about your options. They will also work with you to find the form and dose that work best to treat your symptoms. The right choice depends on your age, health, and preferences.

Does hormone therapy cause side effects? — Some people have no side effects, but others do. Estrogen can cause breast soreness. Progestin pills can cause bloating, mood changes, or vaginal bleeding.

Sometimes, lowering the dose or changing the form you take can help with side effects. Tell your doctor if you have side effects that bother you.

How long can I take hormone therapy? — It depends. In the past, experts recommended only using hormone therapy for 3 to 5 years, and stopping at age 60. But for many people, hot flashes last longer than this.

Your doctor can talk to you about your situation and your options. If you both agree that the benefits are greater than the risks, you might be able to continue hormone therapy beyond 5 years or age 60. If so, you will probably use the lowest dose of estrogen possible.

When you do stop taking hormone therapy, your doctor might suggest gradually reducing your dose. Sometimes, stopping can cause hot flashes to return.

Can hormones help with other symptoms besides hot flashes? — Yes. Hormone therapy might also help with sleep problems and mood changes.

Estrogen can also help with vaginal dryness, which can be uncomfortable or make sex painful:

●If you have problems with vaginal dryness but not other symptoms, your doctor might prescribe vaginal estrogen only. This comes in lower doses than the estrogen used to treat hot flashes, and can be used without a progestin. It comes as a cream, tablet, or ring that goes into the vagina.

●If you already take hormone therapy for hot flashes, but still have problems with vaginal dryness, your doctor might suggest adding vaginal estrogen.

More on this topic

Patient education: Menopause (The Basics)
Patient education: Vaginal dryness (The Basics)

Patient education: Menopausal hormone therapy (Beyond the Basics)
Patient education: Non-estrogen treatments for menopausal symptoms (Beyond the Basics)
Patient education: Menopause (Beyond the Basics)
Patient education: Vaginal dryness (Beyond the Basics)