Hormone therapy 101
If you're nearing menopause, you may be thinking about hormone therapy. This primer explains some of the basics.
Hormone therapy replaces some of the female sex hormones that the ovaries stop making after menopause. Hormone therapy may include estrogen alone or estrogen and progestin (combination therapy).
Hormone therapy comes in different forms, such as pills, patches, injections, creams or a vaginal ring.
The pills can be taken on different schedules. Some women take cyclical estrogen and progestin, which means taking estrogen every day and adding progestin for several days each month or for several days every three or four months. Other women take estrogen and progestin every day. Others only take estrogen.
Hormone patches are worn on the skin, where they release a continuous stream of hormones. Creams and vaginal rings are used in the vagina to thicken, strengthen and moisten the vaginal walls.
Hormone therapy may be started before, during or after menopause. It may be taken for a short time or for a long time.
Like most medicines, hormone therapy may cause side effects in some women. Common side effects include vaginal bleeding (monthly or irregular); breast tenderness or enlargement; fluid retention or bloating; headaches; dizziness; skin discoloration; hair loss; stomach cramps; and nausea.
Hormone therapy can also increase risks for breast cancer, uterine cancer, heart attacks, stroke, blood clots, gallbladder disease and dementia.
According to the U.S. Food and Drug Administration (FDA), hormone therapy should only be prescribed to relieve moderate to severe effects of menopause such as hot flashes and vaginal dryness, itching, and burning. Even then, the FDA says, hormones should be taken for the shortest amount of time and at the lowest dose needed to provide relief.
Hormone therapy may also be used to protect against rapid bone loss in the first years of menopause, according to the American College of Obstetricians and Gynecologists.
Hormone therapy is not recommended for women who:
- Think they may be pregnant.
- Have unexplained vaginal bleeding.
- Have a history of breast or endometrial cancer.
- Have or have had blood clots.
- Have had a heart attack or stroke.
- Have liver problems or liver disease.
Some women choose not to take hormone therapy around menopause because they view menopause as a natural process.
Estrogen without progestin increases the risk of cancer of the uterus. But adding progestin to your hormone regimen will reduce that risk. Women with an intact uterus should take combined hormone therapy.
Hormone therapy can increase the risk for breast cancer, but it can decrease the risk for colon cancer.
Your doctor can help you figure out how hormone therapy is likely to affect your personal cancer risks.
All women who think they may want to take hormone therapy should have an open and honest conversation with a doctor. Ultimately, the decision depends on the woman's personal health, family history, preferences and the effects of menopause. The benefits and risks are not the same for any two women.
You may want to re-evaluate your decision every few years or as your health and health concerns change.