Should You Be Using Hormone Therapy During Menopause?
When a woman begins having menopause symptoms like hot flashes, irregular periods or mood changes, she will probably wonder at some point whether she should take some type of menopause hormone therapy (MHT). Sometimes called “hormone replacement therapy,” or HRT, it usually refers to a combination of the female hormones estrogen and/or progesterone.
Research is beginning to show what the risks and benefits of menopause hormone therapy are, but there is still a lot to learn about the effects of estrogen and progesterone on our bodies and our health. While it is a very effective treatment for many menopause symptoms, hormone therapy can increase the chances of other conditions, and the decision to use it is a balancing act of determining whether the pros outweigh the cons.
The Women’s Health Initiative (WHI) study is the largest study done on menopausal women and focused on heart disease, bone fractures, and breast and colorectal cancers. One of the preventive strategies studied was the effect of hormone therapy on these conditions. Originally it was assumed that hormone therapy would prevent heart disease and stroke in postmenopausal women. When it was shown that not only did estrogen not protect women from heart disease and stroke, but that women on hormone therapy actually had an increase in these conditions, the trials were stopped early. The women in the study will be followed up until 2010, and researchers are still sorting through the information to determine which women were at most risk, and which actually benefited from the hormone therapy.
The current recommendation for menopause hormone therapy is:
If hormone therapy is used to treat menopausal symptoms, it should be used in the smallest doses that are effective, for the shortest time necessary.
Benefits of Menopause Hormone Therapy
There are some proven benefits to at least a short course of estrogen and/or progesterone. Among the reasons you might consider using hormone therapy are:
- Hormone therapy is the most effective treatment for hot flashes and vaginal dryness
- MHT is often effective in treating mood-related symptoms including mood swings and depression
- MHT can improve sleep quality for women who suffer from insomnia during menopause
- MHT slows bone loss, preventing or delaying osteoporosis. Other medications, such as the bisphosphonates or raloxifene, are usually the first choice for preventing bone loss, but if you are using hormone therapy for other reasons an added benefit will be some protection from osteoporosis.
For women who have seriously disruptive symptoms during menopause, MHT can improve their quality of life, help them weather the changes and still maintain their health and emotional equilibrium.
Risks of Hormone Therapy
As the WHI and other research has shown, there are serious risks to consider with MHT. The risks are higher for some women, depending on their personal health history and their family health history. The most well known risks are these:
- Blood clots
- Cardiovascular events, including stroke and heart attack
- Certain types of breast cancer
- Gall bladder disease
Since your risk depends on your personal combination of risk factors, it’s important to discuss this decision carefully with your medical provider.