Hormone replacement therapy (HRT), also called menopausal hormone therapy (MHT) when used to treat menopausal symptoms, is medication that contains the female sex hormones estrogen and/or progesterone. This medication, which comes in several forms, can help relieve the discomfort that may accompany your menopausal transition due to the naturally fluctuating and reduced levels of these hormones during this time of life. Here are some HRT basics, so you can make more informed decisions about whether or not it’s right for you. 

What Are Some Benefits of HRT?

Hormone therapy is most commonly used to treat hot flashes, and challenges with vaginal dryness, itchiness, and burning sensations. It can also potentially keep skin looking younger and help with thinning hair, and it’s been proven to prevent bone mineral loss, reduce the risk of fracture and breakage from osteoporosis in postmenopausal women by stimulating the production of bone tissue.

HRT does come with risks, however, and your doctor should discuss them with you prior to prescribing the medication, to make certain that the potential benefits outweigh the risks.

What Are Some Risks of HRT?

According to results of the largest clinical trial to-date, in which an estrogen-progestin pill called Prempro was used, HRT increased the risk of several serious conditions, such as:

• Blood clots
• Breast cancer
• Heart disease
• Stroke

Subsequent studies have found that these risks are dependent upon:

• Your age (risks are greater after 60)
• The dosage 
• How long you take the medication for
• Your individual health risks and underlying medical conditions
• The type of hormone therapy used

What are the basic types of HRT?

The main goal of HRT is to replace the estrogen that your body is no longer producing. There are two main types of estrogen therapy:

• Systemic hormone therapy–administered via pill, skin patch, ring, gel, cream, or spray—usually contains a higher dose of estrogen that is absorbed into the body. It can treat any common menopausal symptoms.
• Low-dose vaginal estrogen products–administered in cream, tablet or ring form–are typically only used to treat vaginal and urinary symptoms of menopause.

If you still have your uterus, your doctor will likely prescribe both estrogen and progesterone or progestin (a synthetic form of progesterone). Estrogen alone can stimulate uterine lining growth and increase your risk for endometrial cancer. 

How Can I Reduce the Risks of HRT?

The best way to benefit from HRT while reducing the risks is to work closely with your healthcare provider to devise an individual hormone therapy method, dosage, and duration to suit your unique situation and needs. 

If vaginal symptoms are your main concern, then a low-dose, localized delivery method such as a vaginal gel, cream, or ring might be a better option than a broad, systemic form such as a pill.

You can also:

• Use the lowest effective dose for the shortest amount of time necessary to relieve your symptoms. If you’re under 45, you need enough estrogen to protect you against long-term adverse health effects of estrogen deficiency. 
• Visit your doctor regularly, to ensure that your HRT benefits continue to outweigh risks.
• Make healthy lifestyle choices regarding diet, exercise, stress management, not smoking, limiting alcohol intake, and managing chronic conditions. 

Your doctor can help you find the delivery method that maximizes benefits and convenience and minimizes risks and cost.

What if I Can’t Use HRT?

If you can’t use HRT for medical reasons, or if it’s just not working for you, you may still be able to manage some symptoms with the lifestyle changes mentioned above. You can also try:

• Reducing your caffeine intake
• Wearing clothes made of light, breathable fabrics
• Drinking cool, hydrating beverages 
• Using portable fans
• Apply a vaginal lubricant before sexual intercourse, or ask your doctor about the prescription medication ospemifene

You can also ask your doctor about nonhormone prescription medications to help relieve hot flashes.

Have an honest dialogue with your doctor to determine if, and which, hormone therapy is an appropriate option for you, and be sure to keep the lines of communication open throughout your menopausal journey. 

*Mayo Clinic Staff. (2022). Hormone Therapy: Is It Right for You? Mayo Clinic.   https://www.mayoclinic.org/diseases-conditions/menopause/in-depth/hormone-therapy/art-20046372