Types of hormone therapy
HRT- types; Estrogen replacement therapy - types; ERT- types of hormone therapy; Hormone replacement therapy - types; Menopause - types of hormone therapy; HT - types; Menopausal hormone types
Hormone therapy (HT) uses one or more hormones to treat symptoms of menopause. HT uses estrogen, progestin (a type of progesterone), or both. Sometimes testosterone is also added.
You're a woman nearing middle age. It's that time in your life when your periods are starting to stop and your body is going through changes. You may be starting to have hot flashes that you've heard about before. Could menopause be around the corner? So, what is menopause? Menopause typically happens to women somewhere around the ages of 45 to 55. During menopause, your ovaries stop making eggs and produce less estrogen and progesterone, hormones that play a vital role in pregnancy and how your body uses calcium and maintains healthy cholesterol levels, among other things. Changes in these hormones cause menopause symptoms. You will often begin having fewer periods, and eventually they stop. Menopause is complete when you have not had a period for over a year. Women who are post-menopausal can no longer get pregnant without a donor egg. Symptoms can vary from woman to woman. And these symptoms may last 5 or more years. Also, some women have worse symptoms than others. The first thing you may notice is that your periods start to change. They might occur more often or less often. Some women get their period every 3 weeks during menopause. These changes may last several years before periods completely stop. Other common symptoms include your heart pounding or racing, hot flashes, night sweats, skin flushing, and problems sleeping. You may have a decreased interest in sex, develop forgetfulness, have headaches, and suffer from mood swings, and have vaginal dryness and painful sexual intercourse. Treatment for menopause depends on many things, including how bad your symptoms are, your overall health, and your preference. It may include lifestyle changes or hormone therapy. Hormone therapy may help if you have severe hot flashes, night sweats, mood problems, or vaginal dryness. Hormone therapy is treatment with estrogen and, sometimes, progesterone. Talk to your doctor about the benefits and risks of hormone therapy. Hormone therapy may increase your risk of developing breast cancer, heart attacks, strokes, and blood clots. Topical hormone therapy has some of the benefits and fewer of the risks. Your doctor can tell you about other options besides taking hormones, including antidepressants, a blood pressure medicine called clonidine, and Gabapentin, a seizure drug that can help reduce hot flashes. Lifestyle changes may help in reducing your menopause symptoms, though it's not been proven. You might consider trying to avoid caffeine, alcohol, and certain spicy foods. Or to try eating soy foods and other legumes, because they contain phytoestrogens. You'll want to remember to get plenty of calcium and vitamin D in your food or supplements, and plenty of exercise especially during this time. Consider Kegel exercises every day to strengthen the muscles of the vagina and pelvis. Practice slow, deep breathing if you feel a hot flash coming on. Yoga, tai chi, or meditation may also helpful. After menopause, you may be at risk for bone loss, higher cholesterol, and heart disease, so make sure you work with your doctor to manage or even prevent these problems.
Menopause and Hormones
Menopause symptoms include:
- Hot flashes
- Night sweats
- Sleep problems
- Vaginal dryness
- Less interest in sex
After menopause, your body stops making estrogen and progesterone. HT can treat menopause symptoms that bother you.
HT does have some risks. It may increase your risk for:
- Blood clots
- Breast cancer
- Heart disease
Despite these concerns, for many women, HT is a safe way to treat menopause symptoms.
Currently, experts are unclear on how long you should take HT. Some professional groups suggest that you can take HT for menopause symptoms for longer periods if there is no medical reason to discontinue the medicine. For many women, low doses of HT may be enough to control troublesome symptoms. Low doses of HT tend to have few side effects. These are all issues to discuss with your health care provider.
Forms of Hormone Therapy
HT comes in different forms. You may need to try different types before finding one that works best for you.
Estrogen comes in:
- Nasal spray
- Pills or tablets, taken by mouth
- Skin gel
- Skin patches, applied to the thigh or belly
- Vaginal creams or vaginal tablets to help with dryness and pain with sexual intercourse
- Vaginal ring
Most women who take estrogen and who still have their uterus also need to take progestin. Taking both hormones together lowers the risk of endometrial (uterine) cancer. Women who have had their uterus removed cannot get endometrial cancer. So, estrogen alone is recommended for them.
Progesterone or progestin comes in:
- Skin patches
- Vaginal creams
- Vaginal suppositories
- Intrauterine device or intrauterine system
The type of HT your doctor prescribes may depend on what menopause symptoms you have. For example, pills or patches can treat night sweats. Vaginal rings, creams, or tablets help relieve vaginal dryness.
Discuss the benefits and risks of HT with your provider.
How you Will Take Hormones
When taking estrogen and progesterone together, your doctor may suggest one of the following schedules:
Cyclic hormone therapy is often recommended when you start menopause.
- You take estrogen as a pill or use it in patch form for 25 days.
- Progestin is added between days 10 and 14.
- You use estrogen and progestin together for the remainder of the 25 days.
- You don't take any hormones for 3 to 5 days.
- You may have some monthly bleeding with cyclic therapy.
Combined therapy is when you take estrogen and progestin together every day.
- You may have some unusual bleeding when starting or switching to this HT schedule.
- Most women stop bleeding within 1 year.
Your doctor may prescribe other medicines if you have severe symptoms or have a high risk of osteoporosis. For example, you may also take testosterone, a male hormone, to improve your sex drive.
Side Effects of Hormone Therapy
HT can have side effects, including:
- Breast soreness
- Mood swings
- Water retention
- Irregular bleeding
Tell your doctor if you notice side effects. Changing the dose or type of HT you take may help reduce these side effects. Do not change your dose or stop taking HT before talking with your doctor.
When to Call the Doctor
If you have vaginal bleeding or other unusual symptoms during HT, call your doctor.
Be sure to continue seeing your doctor for regular checkups when taking HT.
ACOG committee opinion no. 565: Hormone therapy and heart disease. Obstet Gynecol. 2013;121(6):1407-1410. PMID: 23812486
Cosman F, de Beur SJ, LeBoff MS, et al. Clinician's guide to prevention and treatment of osteoporosis. Osteoporos Int. 2014;25(10):2359-2381. PMID: 25182228
de Villiers TJ, Hall JE, Pinkerton JV, et al. Revised global consensus statement on menopausal hormone therapy. Climacteric. 2016;19(4):313-315. PMID: 27322027
Lobo RA. Menopause and care of the mature woman: endocrinology, consequences of estrogen deficiency, effects of hormone therapy, and other treatment options. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 14.
Magowan BA, Owen P, Thomson A. The menopause and hormone replacement therapy. In: Magowan BA, Owen P, Thomson A, eds. Clinical Obstetrics and Gynaecology. 4th ed. Elsevier; 2019:chap 9.
Stuenkel CA, Davis SR, Gompel A, et al. Treatment of symptoms of the menopause: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015;100(11):3975-4011. PMID: 26444994
Last reviewed on: 1/10/2022
Reviewed by: John D. Jacobson, MD, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.