Is It Safe to Take Hormone Therapy for Menopause?

If you’re one of the millions of people experiencing hot flashes, night sweats, vaginal dryness, or other symptoms of menopause, you may be thinking about hormone replacement therapy (HRT). Or, maybe you heard at some point that HRT can cause some serious health problems. Research, however, has proven that HRT is a safe treatment option for many people. 

If you’re considering using HRT, learn more about how it works and if this treatment is right for you.

Is hormone replacement therapy safe now?

Some people have been avoiding HRT, now referred to as hormone therapy, for decades because of worry about its safety. 

In 2002, a large, highly publicized study in the journal JAMA caused widespread panic among those taking HRT. It concluded that hormone therapy increased the risk for a number of diseases including heart disease, stroke, and breast cancer. 

In the years following that study, prescriptions for HRT plummeted by 72%, from about 112 million prescriptions in 2001 to about 32 million in 2008.

But many experts found the study results misleading. For example, most of the people in the study were in their 60s — more than a decade past the typical start of menopause. 

Newer studies, however, have found that the health risks associated with taking HRT are relatively low for most people in their 40s and 50s (the age when menopause symptoms typically start). 

Today, many healthcare professionals and women’s health advocates want people to know that HRT can be safely used to treat the symptoms of menopause in many people. But it’s always important to talk to a healthcare professional about the pros and cons of hormone therapy based on your age, health, and personal risk factors.

What are the pros and cons of HRT?

The Menopause Society’s most recent recommendations are in favor of using hormone therapy for most people age 60 or younger. It’s relatively low risk if you’re within 10 years of starting menopause and have no other risk factors for taking it. If you fall into this group, the benefits of hormone therapy for relieving your symptoms may outweigh the risks. 

These recommendations are based on research that shows for people age 50 to 59 who used estrogen or estrogen plus progestin, taking HRT did not increase their risk of dying from cancer or cardiovascular diseases. In fact, the risk of dying from all causes was reduced compared to people who didn’t take hormone therapy. 

“The risks for healthy women are low, and women should be considering this as an option,” said Dr. Chrisandra Shufelt, MD, the past president of The Menopause Society and associate director of the Women's Health Research Center at Mayo Clinic in Jacksonville, Florida. 

“Menopause hormone therapy is the most effective treatment for vasomotor symptoms, like hot flashes and night sweats,” she said.

The Menopause Society recommends that healthcare professionals tailor hormone therapy to maximize your benefits and minimize risks. The type of hormone therapy you use (such as oral versus a patch), the dose, and how long you take it will depend on your symptoms, the age you start taking it, and risk factors you may have. 

Who should not have hormone replacement therapy?

HRT may not be a match for everyone. Your primary care doctor or gynecologist may recommend that you avoid hormone therapy in these scenarios:

• Age and onset of menopause: If you’re older than 60 or went through menopause more than 10 years ago, you may have an increased risk for heart disease, stroke, and dementia if you use HRT.

• Breast cancer: Breast cancers are known to be sensitive to estrogen. The research is not definitive. But studies have found that hormone therapy could increase the risk of breast cancer recurring. Guidelines recommend not taking HRT if you’ve had breast cancer. But if you have severe menopause symptoms that don’t respond to non-hormonal treatments, you’ll want to talk to your healthcare professional to weigh the risks and benefits of taking hormone therapy. 

• Uterine and ovarian cancers: Uterine cancers are also sensitive to estrogen. For people with certain types of endometrial cancer or ovarian cancer, The Menopause Society doesn't recommend taking hormone therapy. 

• Cardiovascular conditions: If you have a history of heart attack, stroke, or blood clots, HRT may increase the risk of these conditions occurring again. So, experts recommend against taking HRT in these cases.

How does hormone therapy for women work?

Hormone therapy works by supplementing hormones that are found in lower levels after menopause. Conventional HRT includes estrogen and progestin (progesterone) to help replace hormones that were once produced by the ovaries. 

Estrogen plays a role in many bodily functions, and the loss of it is largely responsible for menopause symptoms. When taken alone, estrogen can cause changes in the lining of the uterus (the endometrium) that can lead to cancer. 

Progesterone is taken to help protect the endometrium, which lowers the risk of endometrial cancer.

Hormone therapy may help relieve these common symptoms of menopause:

• Hot flashes

• Vaginal dryness

• Night sweats

• Bone loss

• Poor sleep

• Urinary incontinence

What types of hormone therapy are available?

The most common hormone therapy is a combination of two hormones: estrogen and progestin. If you’ve had your uterus removed during a hysterectomy, you can take estrogen alone. As mentioned above, progestin is only added to protect against endometrial cancer in people with a uterus.

Sometimes vaginal estrogen is used alone to treat vaginal symptoms, like dryness and pain. This tends to contain lower doses and, because it’s taken locally, lower amounts get into the bloodstream.

Progesterone-only therapy may also help with symptoms, like hot flashes, for people who can’t take estrogen, like those with hormone-sensitive cancers. 

 You can take HRT in a variety of forms. Estrogen-only medicines come as patches, pills, injections, gels, and creams. Combination medicines come in pills and patches. There are also vaginal rings, creams, and inserts.

 Talk to a healthcare professional about which type of treatment makes the most sense for you.

What are the side effects of HRT?

There are different side effects of using HRT, depending on which type of treatment you use. If your therapy combines estrogen and progesterone, you may experience these side effects: 

• Headaches

• Breast pain and/or tenderness

• Unexpected vaginal bleeding or spotting

• Nausea

• Mood changes, including depression

• Leg cramps

• Itching or a mild rash

• Hair loss

If you have any of these side effects after starting HRT, it’s important to discuss the symptoms with a healthcare professional.

Is it better to go through menopause naturally?

Taking HRT is a personal choice. If your symptoms consistently impact your quality of life — and you’re not at high-risk for taking HRT — it may make sense for you to discuss your options with your primary care doctor or gynecologist. 

But if your menopause symptoms aren’t causing significant quality-of-life issues, it’s reasonable to decide that you’ll skip HRT and let nature take its course.

Why trust our experts?

Written by:

Cathy Garrard

Cathy Garrard is a journalist with over 20 years of experience writing and editing health stories. Her work has appeared in print and online for Everyday Health, Reader’s Digest, Prevention, USA Today, Self, Men’s Fitness, and more.

Edited by:

Laurie Tarkan

Laurie Tarkan is a senior health editor for general health and well-being at GoodRx. She has an extensive background in health journalism, and wrote regularly for The New York Times for a decade.

Reviewed by:

Adriena Beatty D.O., MBA, CPE

Adriena Beatty, DO, MBA, CPE, is an Army veteran and board-certified obstetrician and gynecologist with over 20 years of experience. She is a graduate from Tuskegee University with a degree in chemical engineering and chemistry.

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