Menopausal symptoms and hormone therapy
Types of Hormone Therapy
Hormone therapy can help relieve the symptoms of perimenopause and menopause. Hormone therapy means taking estrogen and, if you have never had a hysterectomy and still have a uterus, progestin. Progestin is a form of progesterone. Taking progestin helps reduce the risk of cancer of the uterus that occurs when estrogen is used alone. If you do not have a uterus, estrogen is given without progestin. Estrogen plus progestin sometimes is called “combined hormone therapy” or simply “hormone therapy.” Estrogen-only therapy sometimes is called “estrogen therapy.”
Risks and Benefits
Systemic estrogen therapy (with or without progestin) has been shown to be the best treatment for the relief of hot flashes and night sweats.
Systemic and local types of estrogen therapy relieve vaginal dryness.
Systemic estrogen protects against the bone loss that occurs early in menopause and helps prevent hip and spine fractures.
Combined estrogen and progestin therapy may reduce the risk of colon cancer.
As with any treatment, hormone therapy is not without risks. Hormone therapy may increase the risk of certain types of cancer and other conditions:
Estrogen therapy causes the lining of the uterus to grow and can increase the risk of uterine cancer. Adding progestin decreases the risk of uterine cancer.
Combined hormone therapy is linked to a small increased risk of heart attack. This risk may be related to age, existing medical conditions, and when a woman starts taking hormone therapy. Some research suggests that for women who start combined therapy within 10 years of menopause and who are younger than 60 years, combined therapy may protect against heart attacks. However, combined hormone therapy should not be used solely to protect against heart disease.
Combined hormone therapy and estrogen-only therapy are associated with a small increased risk of stroke and deep vein thrombosis (DVT). Forms of therapy not taken by mouth (patches, sprays, rings, and others) have less risk of causing DVT than those taken by mouth.
Combined hormone therapy is associated with a small increased risk of breast cancer. Currently, it is recommended that women with a history of hormone-sensitive breast cancer try nonhormonal therapies first for the treatment of menopausal symptoms.
There is a small increased risk of gallbladder disease associated with estrogen therapy with or without progestin. The risk is greatest with forms of therapy taken by mouth.
Combined hormone therapy may cause vaginal spotting. Some women may have heavier bleeding like that of a menstrual period. If you are postmenopausal, it is important to tell your health care provider if you have bleeding. Although it is often an expected side effect of hormone therapy, it also can be a sign of endometrial cancer. All bleeding after menopause should be evaluated.
Other side effects reported by women who take hormone therapy include fluid retention and breast soreness. This soreness usually lasts for a short time.
An antidepressant is available for the treatment of hot flashes. Gabapentin, an antiseizure medication, and clonidine, a blood pressure medication, are prescription drugs that can be prescribed to reduce hot flashes and ease sleep problems associated with menopause. Selective estrogen receptor modulators (SERMs) are drugs that act on tissues that respond to estrogen. Two drugs that contain SERMs are available for the relief of hot flashes and pain during intercourse caused by vaginal dryness.
Plants and herbs that have been used for menopause symptoms include soy, black cohosh, and Chinese herbal remedies. Only a few of these substances have been studied for safety and effectiveness. Also, the way that these products are made is not regulated by the U.S. Food and Drug Administration (FDA). There is no guarantee that the product contains safe ingredients or effective doses of the substance. If you do take one of these products, be sure to let your health care provider know.
Bioidentical hormones come from plant sources. They include commercially available products and compounded preparations. Compounded bioidentical hormones are made by a compounding pharmacist from a health care provider’s prescription. Compounded drugs are not regulated by the FDA. They have the same risks as FDA-approved hormone therapies, and they also may have additional risks because of the way they are made. There is no scientific evidence that compounded hormones are safer or more effective than standard hormone therapy.
If you choose to take hormone therapy, regular follow-up is important. Your need to take hormone therapy may change. Benefits and risks also may change over time. Your health care provider should assess your continued use of hormone therapy on a yearly basis. At your yearly visits, tell your health care provider if you have any new symptoms. Let your health care provider know how well the hormone therapy is working. Report any side effects, especially vaginal bleeding, to your health care provider right away.