What Is Hormone Therapy for Menopause?

The road to menopause is paved with symptoms such as hot flashes, night sweats, and vaginal dryness. But, while normal, they shouldn’t have an outsize impact on your life.

“If you're having symptoms,” says Juliana Kling, MD, MPH, a women’s health specialist at Mayo Clinic, “you deserve to have a conversation with your clinician about a safe and effective treatment.”

Main Types of Hormone Therapy

There are two main types of hormone therapy available, depending on whether you need to take just one hormone or two.

Estrogen Therapy

Estrogen is the main hormone used in hormone replacement therapy. If you’ve had a hysterectomy in the past and no longer have a uterus, you’ll take estrogen only.

Combination Therapy (Estrogen and Progesterone)

Combination therapy uses both estrogen and progesterone. If you still have a uterus, you can’t take estrogen alone because it causes the lining of the uterus to grow, increasing the risk of uterine cancer, says Ghazaleh Moayedi, DO, MPH, a board-certified ob-gyn at Pegasus Health Justice Center in Dallas. Taking progesterone, however, protects against this risk by thinning the lining of the uterus.

How to Take Hormone Therapy

There are two main ways to take hormone therapy: systemically (meaning, throughout the body) or locally (applied to a specific area).

Systemic Therapy

With systemic hormone therapy, the hormones are released into the bloodstream and travel throughout the body, helping to ease symptoms such as hot flashes and night sweats and to prevent osteoporosis. Systemic therapies include pills, patches, and topical treatments.

Localized Therapy

Because the estrogen is applied to a specific area, it isn’t absorbed throughout the rest of the body, which means it's associated with fewer risks than systemic therapy.

Benefits of Hormone Therapy

Hormone therapy can help ease the symptoms of menopause, including hot flashes, vaginal dryness, and sleep disturbances, among others. It can provide the following:

• Relief of vasomotor symptoms, including hot flashes and night sweats.

  [2]

• Bone health protection, such as a reduced risk of osteoporosis and bone fractures.

  [3]

• Treatment of GSM, which includes symptoms like vaginal dryness, painful sex, and urinary issues. This is usually done with localized hormone therapy.

  [4]

• Better sleep, such as relief of sleep disturbances, which are common during menopause.

  [5]

Risks of Hormone Therapy

Overall, however, “we see that the hormone therapy benefit is much larger than the risk,” says Dr. Kling.

Who Should Avoid Hormone Replacement Therapy

• Breast cancer
• Deep venous thrombosis or pulmonary embolism
• Blood clotting disorder
• Stroke
• Unexplained vaginal bleeding
• Liver disease
• Heart attack

Side Effects of Hormone Therapy

As with any medication, there can be some side effects.

Common, Mild Side Effects of Hormone Therapy

• Breast tenderness
• Vaginal bleeding or spotting
• Mood swings
• Sleepiness
• Bloating
• Nausea

Other Side Effects

• Headaches
• Skin irritation from patches or gels
• Hair loss
• Leg cramps

How Is Hormone Therapy Taken?

• Oral Pills Many women find this option convenient because it’s easy to take and has cheaper generic options available. However, oral hormone therapy also comes with greater risk of side effects like blood clotting compared with other delivery methods.
• Vaginal Rings, Creams, or Pills These localized delivery methods offer the best relief from GSM symptoms and have fewer risks than systemic treatments.
• Topical Treatments Topical treatments include sprays, creams, or gels that you apply to your skin.
• Patches Patches are applied once or twice a week to the thigh or stomach.

  [14]

   Patches are generally estrogen-only, says Moayedi, meaning women taking combination therapy often need to take an oral progesterone tablet as well.