A Clear and Candid Guide to Hormone Therapy

What is hormone therapy? 

The term “menopause hormone therapy,” or MHT, describes a  range of hormonal treatments that can reduce symptoms of menopause. It’s one of the most effective ways to treat symptoms while imparting other long-term health benefits. Studies have shown that MHT is safe for most women in their 50s, or those within ten years of the onset of menopause. 

MHT is also called hormone therapy (HT). Formerly, it was referred to as HRT—short for “hormone replacement therapy.” Simply put, MHT works by supplementing the hormones  your body stops producing around menopause. There are many varieties of HT and ways it can be administered. 

What does MHT treat?

MHT is most commonly prescribed for hot flashes or night sweats (vasomotor symptoms) and vaginal dryness. It’s generally recommended for patients within 10 years of menopause or younger than 60. Those with a history of cancer, heart disease, stroke, or liver disease should not use MHT.‍

But first, a quick review. 

Before getting into more detail on HT, let’s go over a few basics:

• Estrogen and progesterone are sex hormones, which convey messages to target glands and organs. Sex hormones are essential to our physical development and reproduction, but they’re also important to our overall health.
• During menopause, ovarian follicles slowly stop making estrogen. The resulting hormonal change is central to most menopause symptoms.
  

What are the types of MHT, and how do I know which one is right for me? 

Hormone therapy typically includes some form of estrogen, sometimes paired with a progestin (the synthetic form of progesterone). There are various forms of and delivery methods for hormone therapy. Many factors go into identifying the right MHT for each unique person, such as existing conditions, personal and family medical histories, bothersome symptoms, and health goals. What follows is an overview of both hormone and medication types. If you’re curious to try HT, talk with your clinician to find the right solution for you. 

Categories of MHT:

Estrogen therapy (ET): 

• This is an estrogen-only treatment, also called “unopposed estrogen,” meaning it is not paired with a progestin. 
• ET is typically prescribed  as a low dose cream for vaginal-specific symptoms, or in other forms to those without a uterus.

Estrogen-progestin therapy (EPT): 

• EPT is a combined treatment of estrogen and progestin.
• EPT is usually prescribed to a patient with a uterus to protect the inner uterine lining. In certain cases, estrogen alone can increase the risk of cancer in the uterus. Progestin functions to partner with the estrogen, reducing that risk.

Estrogen agonist / antagonist therapy: 

• This is another type of treatment that essentially acts like estrogen in the tissues that will benefit from it, but against estrogen in the areas where it may cause problems. These medications are sometimes referred to as selective estrogen-receptor modulators (SERMs). 
• Estrogen agonist / antagonist therapy does not require an additional progestin. 

Types of HT Medication:

Systemic hormone therapy:

• “Systemic” HT is exactly that: system wide. It usually contains  higher doses of hormone medication absorbed throughout the body. 
• Systemic therapies are used to treat any of the common menopause symptoms. 
• These medications come in many forms—pill, skin patch, ring, gel, cream, or spray. A discussion with your clinician will help you decide which form may be the best fit for you. 

Low-dose vaginal products:

• These are more targeted, local medications that deliver estrogen vaginally. 
• They minimize the amount of estrogen absorbed throughout the body, so are typically used only for specific vaginal or urinary menopause symptoms. 
• Medications come in cream, tablet, or ring forms applied at the vulva and vagina. 

Are there other benefits to MHT besides relieving my symptoms?

Yes, MHT has the potential to improve brain and bone health, and possibly even reduce the risk of cancer. Hormone therapy prevents osteoporosis by reducing bone loss and fractures in postmenopausal women. ‍

‍A lack of estrogen early in life can also result in negative outcomes, like osteoporosis, heart disease, or stroke. This is why hormone therapy may be prescribed in the case of early menopause or estrogen deficiency. This might apply to you if: 

• You had your ovaries surgically removed before age 45.
• You stopped having periods before age 45 (considered premature or early menopause).
• Your ovaries stopped functioning naturally before age 40. 

Are there any risks associated with MHT?

Yes, in some instances, HT can increase the risk of certain medical conditions, such as heart disease, stroke, blood clots, and cancer.

The risks associated with HT vary according to a few crucial factors:

Age

• Patients who start MHT over age 60 or 10 years after the onset of menopause are at greater risk for the above conditions. 
• If patients begin MHT before age 60 or within 10 years of menopause, the benefits appear to outweigh the risks.

Type of MHT

• Various systemic or local uses of hormone therapy will carry different risks for individuals based on their family and personal medical history, as well as lifestyle factors. 

Health history

• Take your personal and family medical histories into account when considering HT. Pre-existing risk of cancer, heart disease, stroke, blood clots, liver disease, and osteoporosis will help inform whether MHT is right for you.  

A note on the risks found in the popular study, the Women’s Health Initiative (WHI).

Medical and popular opinion on MHT has waxed and waned over the past several decades, but no finding has been more influential than the Women’s Health Initiative (WHI). As written and presented to the media, the 2002 WHI indicated that hormone therapy could worsen existing or chronic conditions, including heart disease and stroke. 

In the years since its publication, doctors and researchers have come to question many parts of the study’s design and conclusions. A number of follow-up studies and reanalyses directly contradict WHI’s findings, showing that MHT safely reduces common postmenopausal health issues. Here’s what you should know about WHI as you consider MHT: 

• An important limitation of the study was in its selection of participants. Most were more than a decade past their last menstrual period, casting doubt on whether the results could reasonably be applied to younger patients. 
• WHI tested just one type of estrogen—either alone, or in combination with a single progestin—so did not address the safety or efficacy of other MHT formulations or delivery methods. 
• Many of WHI’s conclusions have been challenged by more recent studies and reanalysis of the data. 

Can I reduce the risks of HT? 

Yes. The following strategies can reduce the risks associated with hormone therapy: 

‍Find the right product and delivery method for you. 

• Review your symptoms, goals, and preferences to find the right medication. MHT comes in many forms, both systemic and local. The right medication, delivered in the optimal way, can reduce associated risks.

Talk with your doctor about any medication-specific actions you should take.

• For example, patients taking an oral form of estrogen should have their cholesterol carefully screened to avoid the risk of heart disease or stroke. 

Minimize the amount of medication you take.

• Treat your symptoms, but do so with the lowest effective dose for the shortest amount of time to reach your health goals.
• If you have lasting, troublesome symptoms, your doctor may recommend longer term treatment. And if you’re younger than 45, you’ll need enough estrogen to protect you against any long-term effects of estrogen deficiency.   

Get regular check-ups.

• Follow up with your doctor regularly to make sure the benefits of MHT continue to outweigh the risks. Don’t forget your regular screenings, like mammograms and pelvic exams. 

Cultivate a healthy lifestyle.

• No surprise here. Physical activity, exercise, and a healthy diet will lower risk across the board. Maintain a healthy weight, don’t smoke, limit alcohol, manage stress, and keep an eye on any chronic health conditions, like high cholesterol or blood pressure. 

If MHT isn’t right for me, are there other ways to relieve my symptoms?

Yes, there are other ways to manage these common menopause symptoms. 

For hot flashes and night sweats, try limiting your caffeine and alcohol intake. Paced relaxed breathing and meditation can also help. And there are several non-hormone prescription medications that relieve hot flashes.

‍For vaginal concerns, like dryness or painful sex, a moisturizer or lubricant might help. And, again, there are other prescription options besides MHT. 

The reality is, MHT isn’t all good or all bad. It depends on you, the patient.

Hormone therapy encompasses a wide variety of forms and medications, each with their own benefits and risks. Whether MHT is right for you will depend on your unique experience. Talk with your doctor to learn more about it, and check in regularly during your menopausal years.

Upliv clinicians are here to help.

Interested in learning more? Upliv menopause experts can help you determine if MHT is right for you. Sign up for our newsletter or send us an email to join the waiting list for care services at the following address: join@uplivhealth.com.

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Resources:

The Controversial History of Hormone Replacement Therapy - PMC

A critique of Women’s Health Initiative Studies (2002-2006) - PMC