Is Hormone Replacement Therapy Right for You?

Hormone replacement therapy (HRT), also referred to as menopausal hormone therapy (MHT), is an estrogen- and/or progesterone-containing medication meant to replace hormones the body stops producing during perimenopause or the menopausal transition. HRT is available in pills, patches, and creams or through an intrauterine device (IUD).

Hormone therapy can help lessen symptoms of menopause including;

•    Hot flashes 
•    Night sweats
•    Vaginal dryness 
•    Sleep disturbances 

Symptoms that may or may not respond to hormone therapy include mood, joint pain, and the lack of focus and forgetfulness commonly known as ‘brain fog. “These symptoms sometimes respond to menopausal hormone therapy, but it's hard to know whether it's primarily the effect of the hormones or if it's the effect of better sleep,” said Dr. Howell.

If you are 60 or younger and are experiencing hot flashes, night sweats, vaginal dryness, or sleep disturbances, and your final menstrual period was less than 10 years ago, hormone therapy may be appropriate for you. 

HRT is not recommended if you are older than 60 and haven’t had a menstrual period in more than 10 years. It’s also not recommended for people with a history of blood clots in the legs or lungs, breast cancer, or heart attack, or if you have coronary artery disease, active liver disease, uncontrolled high blood pressure, or undiagnosed genital bleeding.

Hormone replacement therapy can typically be taken for up to five years. After five years, Dr. Howell explained that the risks increase and usually outweigh the benefits. However, some people may be able to take hormone therapy for longer, depending on their health and family medical history. “Long-term use is individualized because not everybody has the same risks,” she said.

Hormone therapy is a relatively low-risk medication when given to the right person. In addition to reducing symptoms, people taking hormone therapy usually experience an improved quality of life, better overall health, and better bone health when taking the medication for less than five years. “We really don’t see a lot of risks,” Dr. Howell explained.  

When hormone replacement therapy is used for longer than five years, the risks for blood clots, stroke, and breast cancer (specifically when using progesterone-containing medication) can increase as you age and the longer you’re on the medication. People older than 60 who begin hormone replacement therapy have an increased risk of cardiovascular disease and dementia, which is why HRT is not usually recommended for them, as the risks outweigh the benefits.

Hormone therapy will not help you lose weight. “Estrogen impacts where your body distributes fat, but it doesn't necessarily cause you to gain or lose weight,” said Dr. Howell. “The weight gain people get at midlife is not going to be improved by hormone therapy -- that's a common misconception.”

There is a 50% chance that hot flashes and night sweats will return after stopping HRT.

Duke Health’s certified menopause specialists are obstetrician-gynecologists who can prescribe MHT, but your primary care provider or your ob-gyn can also prescribe hormone therapy. Reach out to the doctor you feel most comfortable with -- they can always refer you to a specialist when necessary.