Are you considering hormone therapy to treat your menopause symptoms? Before making a decision, here are some facts you should know. The experts at NAMS offer these answers to frequently asked questions about hormone therapy so that you have the information you need to make an informed choice.
Q. What is hormone therapy?
A. Hormone therapies are the prescription drugs used most often to treat hot flashes and genitourinary syndrome of menopause (GSM), which includes vaginal dryness, after menopause. For hot flashes, hormones are given in pills, patches, sprays, gels, or a vaginal ring that deliver hormones throughout the body—known as systemic therapy. For genitourinary symptoms, hormones are given in creams, pills, or rings that are inserted into the vagina. An approved pill is also available to treat genitourinary symptoms that is not considered a hormone but does affect estrogen receptors, mostly in and around the vagina.
Systemic hormones include estrogens—either the same or similar to the estrogens the body produces naturally—and progestogens, which include progesterone, the progestogen the body produces naturally—or a similar compound. Another approach to systemic hormone therapy is a pill that combines conjugated estrogens and a compound known as a SERM (selective estrogen receptor modulator) that protects the uterus but is not a progestogen. Women who have had a hysterectomy (had their uterus removed) can use estrogen alone to control their hot flashes. Women who still have a uterus need to take a progestogen in addition to estrogen or the estrogen-SERM combination to protect against uterine cancer. Systemic hormones are very effective for hot flashes and have other benefits, such as protecting your bones. They also can carry risks, such as blood clots and breast cancer.
Vaginal estrogen therapy for GSM after menopause is administered into the vagina and is effective for moisturizing and rebuilding tissue. Very little goes into blood circulation, so the risks are far lower.
You should discuss your individual risks and preferences with your healthcare team to determine whether hormone therapy or alternatives, including FDA-approved nonhormonal therapies, are right for you.
Q. Are there any side effects from hormone therapy?
A. Sometimes women have side effects from hormone therapy. If any of these symptoms occurs, discuss them with a healthcare provider:
• Uterine bleeding
• Nausea
• Breast tenderness or pain
• Abdominal bloating
• Fluid retention in arms or legs
• Blurry vision
• Headaches
• Dizziness
• Mood change
Many side effects are temporary, so unless they are severe or include bleeding, give hormone therapy 3 months to see whether the discomfort resolves. Lowering the dose or switching to another type of estrogen or progestogen may help reduce side effects.
Q. Who should not use hormone therapy?
Hormone therapy is not a good choice for every woman. For some, the risks outweigh the benefits, so careful consideration with a healthcare provider is advised. In general, women who have breast cancer, uterine cancer, unexplained uterine bleeding, liver disease, a history of blood clots, and cardiovascular disease should not use hormone therapy.
Q. I’ve heard about something called bioidentical hormones. What are they?
The term bioidentical hormone therapy began as a marketing term for custom-compounded hormones. But it is taken to mean hormones that have the same chemical and molecular structure as hormones that are produced in the body. Bioidentical hormones do not have to be custom-compounded (meaning custom mixed). There are many well-tested, FDA-approved hormone therapy products that meet this definition and are commercially available from retail pharmacies in a variety of doses that will allow you and your doctor to customize your therapy to meet your needs.
Custom-compounded hormones are not safer or more effective than approved bioidentical hormones. They are not tested for safety and effectiveness or to prove that the active ingredients are absorbed appropriately or provide predictable levels in blood and tissue. In fact, they may not even contain the prescribed amounts of hormones, and that can be dangerous. For example, when the progesterone level is too low, you are not protected against endometrial (uterine) cancer. When estrogen levels are too high, there can be overstimulation of the endometrium and breast tissue, putting you at risk of endometrial cancer and possibly breast cancer.
Q. How can I find a menopause specialist?
A. The North American Menopause Society maintains a search feature on this website for those women in the United States or Canada who are looking for an expert interested in helping them manage their health through menopause and beyond. Healthcare providers who have passed a competency examination leading to the prestigious credential of NAMS Certified Menopause Practitioner (NCMP) are noted in the displayed results.