Hormone Therapy for Menopause: Treatment Options, Benefits, and Risks
Key takeaways:
Hormone therapy medications contain estrogen and/or progestins (progesterone). They come in many different forms, including pills, patches, and creams.
Hormone therapy can treat menopause symptoms like hot flashes, night sweats, and vaginal problems. It can also help protect your bones and heart.
If you’re under age 60 (or started menopause less than 10 years ago) hormone therapy may have more benefits than risks.
Table of contents
As you approach and go through menopause, your ovaries make less estrogen and progesterone. This is what causes your periods to slow down and stop. It can also cause classic menopause symptoms, like hot flashes, mood changes, and vaginal dryness.
For many, menopause symptoms are mild. But in some cases, symptoms can have a huge impact on your day-to-day life. Fortunately, hormone replacement therapy (HRT) — now known as menopausal hormone therapy (MHT) — can help.
What is hormone replacement therapy (HRT) for menopause?
HRT is medicine that contains hormones: estrogen and progesterone. These days, most people say “menopausal hormone therapy (MHT)” or just “hormone therapy.” These new terms do a better job of describing how hormones help with symptoms of menopause, instead of just “replacing” missing hormones.
Taking hormones can help your menopause symptoms get better. It can also offer other health benefits, like keeping your bones and heart strong. And for many people going through menopause, the benefits of hormone therapy outweigh the risks (more on this below).
What types of hormones are typically used in HRT?
Hormone therapy typically includes either:
Estrogen alone
Estrogen plus progesterone (or a “progestin,” a drug that acts like progesterone)
How long does menopause last? Check out our GoodRx guide to the stages and timeline of menopause.
What’s it like to take estradiol for menopause symptoms? Three women share their experience with estradiol (an estrogen medication).
Is it safe to take hormone therapy for menopause? Learn more about the risks and benefits of menopausal hormone therapy (MHT).
What are bioidentical hormones? Here’s what you need to know about bioidentical hormones, including a list of FDA-approved options.
Estrogen
Estrogen is the go-to hormone treatment for many menopause symptoms.
It can either be given as a whole-body medication or placed directly in the vagina.
Whole-body (systemic) estrogen: This type of estrogen can be taken by mouth, as a shot or implant, or absorbed through the skin. It contains estrogen that circulates throughout the body. It can help with many menopause symptoms and with bone thinning. It may have other health benefits too.
Vaginal estrogen: This type of estrogen is put in your vagina. It doesn’t circulate as widely throughout your body — which means it doesn’t have the same risks as whole-body estrogen. It also can’t help with whole-body menopause symptoms. But it can be helpful for vaginal and urinary menopause symptoms at any age.
Good to know: There’s one vaginal estrogen product — Femring (estradiol) — that provides whole-body estrogen. Femring contains a higher amount of estrogen than other vaginal estrogens. So it has similar benefits and risks as other whole-body estrogen products.
Progestins (progesterone)
Progestins are mostly used as an add-on treatment to whole-body estrogen.
Here’s why progestin is important. Taking estrogen alone can put you at risk for endometrial (uterine lining) cancer. So if you have a uterus, and you’re using whole-body estrogen, you’ll likely also need to protect your uterus with progestin. You might not need a progestin if you’ve had your uterus removed (a hysterectomy) or you’re using only vaginal estrogen.
Progestin is available as a pill or patch. A levonorgestrel intrauterine device (IUD) is another option for protecting the lining of your uterus. This is considered an off-label use of IUDs, but it’s supported by research.
Menopausal hormone therapy medication list
Hormone therapy comes in many different forms: pills, patches, creams, and more. Let’s take a closer look.
Hormone pills
Pills are taken by mouth, usually once per day. Options include:
Progestin-only pills: Prometrium, Provera, norethindrone acetate
Combination estrogen and progestin pills: Activella, Angeliq, Femhrt, Prefest, Prempro, Jinteli, Bijuva
Combination estrogen and bazedoxifene pill: Duavee
Skin patches
Hormone-releasing patches stick to your skin like a Band-Aid and release medicine into your blood. Options include:
Estrogen-only patch: Climara, Minivelle, Vivelle-Dot
Combined estrogen and progestin patch: Combipatch
Injections
This is an estrogen-only injection that’s given under your skin. Brands include:
Estrogen gel, cream, or spray
These are estrogen-only products that are rubbed or sprayed onto the skin. Options include:
Vaginal creams and inserts
These are estrogen-only creams and inserts that go directly into your vagina. Options include:
What are the benefits of HRT?
According to experts, hormone therapy is the most effective treatment for:
Genitourinary syndrome (which can cause vaginal dryness, pain during sex, and urinary problems)
Hormone therapy can have other benefits, too, including:
More stable mood
Better sleep
Reduced brain fog
Less joint pain
Protection against osteoporosis
Lowered risk of heart disease
Lowered risk of Type 2 diabetes
Protection against dementia
Benefits may depend on what type of hormones you take and when you take them.
What are the side effects of hormone therapy?
Common side effects of estrogen / progestin medications include:
Headache
Upset stomach or diarrhea
Breast tenderness
Vaginal bleeding or spotting
Mood changes
Muscle cramps
Mild rash or itching
Vaginal estrogen tends to have fewer side effects than whole-body hormones. Common side effects include:
Vaginal discomfort
Vaginal bleeding
Headache
Abdominal pain or discomfort
Will hormone therapy make me gain weight?
No — this is a myth. Hormone therapy doesn’t cause weight loss (or weight gain). In a large review of almost 30,000 women, there was no significant difference in weight between the people who used hormone therapy and people who didn’t use it.
The truth is: Weight gain during and after menopause has more to do with hormonal changes, aging, and diet and lifestyle than hormone therapy.
Is hormone replacement therapy safe?
Yes. For many women, the benefits of hormone therapy outweigh the risks.
This is especially true if you:
Start hormone therapy before age 60, or
Start hormone therapy within 10 years of the onset of menopause
Bodywide hormone therapy does have some risks. These include:
Blood clots (only with oral medication)
Heart problems
Stroke
Looking for more info? Here’s what we know about hormone therapy and safety, including who might be better off without it.
If I do take HRT, how can I reduce my risks?
If you decide to use hormone therapy, you may be able to lower your risks by:
Using lower doses of body-wide hormones
Using vaginal estrogen only
Tapering off hormone therapy after 3 to 5 years of use
Making other choices to protect your health as you get older, like eating nutritious foods, exercising, and managing stress
Is it ever too late to start hormone therapy?
Hormone therapy is considered safe for many people, especially if you begin before age 60 or within 10 years of starting menopause. But in older people, hormone therapy may be more likely to cause health problems.
Still, there are times when hormone therapy makes sense for older people. For example, about 1 in 5 women have hot flashes into their 60s and 70s. Other women have osteoporosis that doesn’t respond well to medications. These are examples where menopausal hormone therapy could be a reasonable choice.
If it has been a while since you went through menopause — or you’re older than 60 — talk to a healthcare professional about what options are right for you.
And, finally, it’s never too late to use vaginal estrogen. Vaginal estrogen creams, tablets, and rings can help with dryness, pain during sex, and urinary tract infection (UTI) prevention. But they don’t increase the risk for cancer or heart disease — even when used later in life.
Frequently asked questions
You’ve technically “completed” menopause after you’ve gone 12 months without having a period (and it’s not because of another health condition, like pregnancy).
Most people in the U.S. usually go through menopause between the ages of 40 and 58. But menopause-related hormone changes can begin as early as your 30s and 40s — a time that’s sometimes called “perimenopause” or the “menopause transition.”
No. In the U.S., hormone therapy is only available with a prescription.
It’s not clear. Menopause treatments are continuing to evolve. There’s ongoing research about HRT, including which hormones, medications, and herbal supplements are most helpful.
One example is whether testosterone (another hormone) could be helpful for menopause symptoms — especially low libido. Since testosterone is partially converted to estrogen in your body, it’s not clear yet whether this causes risks to your health.
The bottom line
If menopause symptoms are disrupting your daily life, hormone therapy can help. It’s the most effective treatment for common symptoms like hot flashes, night sweats, and vaginal problems. Hormone therapy may have other benefits, too, like better sleep and mood. And it can also protect your bones and heart.
There are many different types of hormone therapies available. Options include pills, patches, creams and gels, and even vaginal tablets and inserts. And the truth is: For many women, hormone replacement therapy has more benefits than risks.
If you’re interested in hormone therapy, talk to your primary care provider or OB-GYN. They can help you understand whether hormone therapy is the right fit — along with which option is the best match for your symptoms and personal needs.
Why trust our experts?
References
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