Hormone replacement therapy may help relieve perimenopause and menopause symptoms like hot flashes and bone loss. Here’s everything you need to know about what HRT is, how to take it, and whether it’s safe.
As you get older, you go through perimenopause and transition into menopause.
These natural processes, usually beginning around your late 30s or mid to early 40s, mark the end of your reproductive years and the beginning of postmenopause, the next biological stage of your life.
But just because something is natural doesn’t mean it isn’t uncomfortable. In fact, the fluctuating hormones that accompany perimenopause and menopause can cause lots of symptoms, ranging anywhere from annoying to unbearable.
To help manage troublesome symptoms, some people choose to explore treatment options with their doctors. Hormone replacement therapy, or HRT, is one perimenopause treatment.
Here’s everything you need to know about hormone replacement therapy, including what the different types are, what it can treat, risks, and whether it could be right for you.
What is hormone replacement therapy (HRT)? Hormone replacement therapy helps treat symptoms of perimenopause and menopause caused by declining hormones.
During perimenopause , your body’s production of estrogen and progesterone fluctuates significantly, dropping dramatically as the transition to menopause progresses. As these hormones fluctuate, they’re also thrown out of balance with one another.
>>MORE: Perimenopause vs. Menopause: What’s the Difference?
The fluctuation, decline, and unstable balance of your hormone levels can lead to various physical and emotional perimenopause symptoms including hot flashes , vaginal dryness, sleep disturbances, and mood swings .
Hormone replacement therapy (HRT) aims to help supplement your body’s hormone production in order to steady hormone levels and relieve perimenopause and menopause symptoms .
Hormone replacement therapy is sometimes also called menopausal hormone therapy (MHT) or hormone therapy (HT).
What are the different kinds of hormone replacement therapy? There are two main types of HRT: estrogen-only therapy and combined hormone therapy.
Estrogen-only therapy Estrogen-only therapy, also called estrogen therapy, just administers estrogen, meaning it only supplements the estrogen levels in your body.
If you’ve had your uterus removed (a hysterectomy), you’ll likely start with estrogen-only HRT.
Combined hormone therapy Combined hormone therapy (also called combined estrogen and progesterone therapy, or combination estrogen and progesterone therapy) involves taking estrogen and progestogen.
Progestogen is a type of synthetic progesterone that produces the same effects in the body as progesterone – it’s also the compound used in birth control pills. Combined HRT supplements your body’s estrogen and progesterone levels.
If you still have your uterus, you’ll need to use combined HRT. Taking estrogen without progestogen puts you at risk of uterine cancer, but combined HRT protects against that risk.
How do you take hormone replacement therapy? Hormone replacement therapy comes in multiple forms.
Your options for estrogen therapy include:
Pills : taken orally, available as both estrogen-only HRT and combined HRTPatches : placed on the skin on your lower body, available as both estrogen-only HRT and combined HRTGel : applied to the skin on your lower body or arms, available as estrogen-only HRT and supplemented with progestogen for combined HRTSpray : applied to the skin of your inner arm or thigh, available as estrogen-only HRT and supplemented with progestogen for combined HRTInjection : injected every three to four weeks, available as estrogen-only HRT and supplemented with progestogen for combined HRTIf you’re taking combined HRT and using the gel, spray, or injection for your estrogen treatment, options for supplementing with progestogen include:
Progestogen pill : taken orallyProgestogen-releasing intrauterine devices (IUDs) : placed in your uterus, like IUDs used for birth controlThe above forms of estrogen-only HRT and combined HRT enter your bloodstream and circulate throughout your body, meaning they’re “systemic.”
Other forms of estrogen-only HRT are localized, or “nonsystemic,” meaning the hormones stay in specific parts of your body. Local estrogen-only HRT is administered directly into the vagina and treats vaginal symptoms only. Because vaginal estrogen is localized, you don’t need to take progestogen , even if you still have a uterus.
Options for vaginal estrogen HRT are inserted into the vagina. They include:
What are the signs you need to start hormone replacement therapy? Hormone replacement therapy can be a helpful treatment if you’re experiencing difficult perimenopause or menopause symptoms that interfere with your everyday life. However, it’s important to consult with a healthcare professional to discuss your unique health situation and potential risks.
Estrogen-only HRT and combined HRT can help relieve perimenopause symptoms such as:
Hot flashes Night sweats (hot flashes that happen at night) Sleep problems Bone loss and osteoporosis Vaginal discomfort Vaginal estrogen HRT can ease vaginal symptoms of perimenopause, like:
Dryness Itching Irritation Discomfort during sex If you only want to address vaginal symptoms, vaginal estrogen HRT on its own is the recommended treatment method.
Is hormone replacement therapy safe? Hormone replacement therapy is safe for people who check yes to these three items:
You’re 59 or younger You reached menopause less than ten years ago You aren’t at high risk of breast cancer, blood clots, or stroke In the early 2000s, doubts were raised about the safety of HRT. However, more recent research has shown that for people who fit the above description, the potential benefits of HRT likely outweigh the potential risks.
For these people, the North American Menopause Society says that the benefit-risk ratio is favorable to treat vasomotor symptoms of perimenopause and menopause and to prevent bone loss and fracture.
Medical organizations advise beginning HRT treatment with the lowest possible hormone doses, and administering treatment for the shortest possible amount of time. Treatment with combined HRT should last a maximum of five years. There may be more flexibility in the duration of estrogen-only HRT, as this form may be safer overall.
What are the risks of hormone replacement therapy? Like any medical treatment, HRT has potential risks.
According to the North American Menopause Society, the main concerns with hormone use are related to long-term treatment with systemic HRT (the forms that circulate throughout the body), and age. Risks are relatively low in people younger than 59 who take HRT for a short amount of time.
Risks vary depending on whether you’re using estrogen-only HRT or combined HRT, the specific form being used, your personal and family medical history, your age, and the duration of treatment.
Estrogen-only HRT and combined HRT have a risk of:
Stroke Blood clots Breast cancer Combined HRT has an increased risk of:
The risk of breast cancer decreases after hormone replacement therapy is stopped.
Compared to standard-dose pills of estrogen-only HRT, the risk of blood clots and stroke appears to be lower for estrogen-only:
Low-dose pills Patches Gels Sprays Vaginal estrogen HRT does not increase the risk of stroke, blood clots, breast cancer, or other conditions.
Is hormone replacement therapy right for me? If you're considering hormone replacement therapy, talking with your doctor is a great place to start.
They can help you weigh the benefits and risks of HRT to decide if treatment is appropriate for you.
HRT may not be the right fit if:
You’re at high risk of breast cancer, blood clots, or stroke You’re over 60 You reached menopause more than ten years ago These factors all increase the risks associated with HRT, and may outweigh any potential benefits.
Other perimenopause and menopause treatment options HRT is not the only form of perimenopause and menopause treatment available to you.
You may be able to help ease perimenopause symptoms using other lifestyle strategies and medical treatments, including:
Changes to diet Regular physical exercise Mindfulness practices, like meditation and yoga Improved sleep hygiene Certain perimenopause vitamins and supplements Certain over-the-counter painkillers Certain prescription medications, including some antidepressants Should I use hormone replacement therapy (HRT)? The bottom line For many people, perimenopause and menopause come with symptoms that can be uncomfortable or even unbearable.
The good news is, you don’t have to suffer in silence.
Hormone replacement therapy (HRT) is one option among many for perimenopause and menopause symptom relief.
For people who are under 59, reached menopause ten or fewer years ago, and aren’t at risk for breast cancer, blood clots, or stroke, HRT may well be a good method to help you manage troubling perimenopause symptoms like hot flashes, bone loss, and vaginal discomfort.
If you’re interested in exploring HRT, talk to your doctor to understand the potential benefits and risks. Your doctor can help you decide if HRT is right for you.
