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Hormone Therapy: Benefits & Risks

Hormone therapy (HT) is one of the government-approved treatments for relief of menopausal symptoms. These symptoms, caused by lower levels of estrogen at menopause, include hot flashes, sleep disturbances, and vaginal dryness. HT is also approved for the prevention of osteoporosis. Today, clinicians prescribe much lower doses for much shorter terms (3-5 years) than before 2002.

To begin this discussion about the benefits and risks of menopausal HT, here is some background information.

There are three benchmark stages of natural menopause:

  • Perimenopause (or the menopause transition) is the span of time between the start of symptoms (such as erratic periods) and 1 year after the final menstrual period.
  • Menopause is confirmed 1 year (12 months) after the final menstrual period.
  • Postmenopause is all the years beyond menopause.

There are two basic types of HT:

  • ET means estrogen-only therapy. Estrogen is the hormone that provides the most menopausal symptom relief. ET is prescribed for women without a uterus due to a hysterectomy.
  • EPT means combined estrogen plus progestogen therapy. Progestogen is added to ET to protect women with a uterus against uterine (endometrial) cancer from estrogen alone.

There are two general ways to take HT:

  • Systemic products circulate throughout the bloodstream and to all parts of the body. They are available as an oral tablet, patch, gel, emulsion, spray, or injection and can be used for hot flashes and night sweats, vaginal symptoms, and osteoporosis.
  • Local (nonsystemic) products affect only a specific or localized area of the body. They are available as a cream, ring, or tablet and can be used for vaginal symptoms.

Current prescribing practice:

Begin HT with the lowest effective dose for the shortest amount of time consistent with their individual goals. The benefit-risk ratio is favorable for women who initiate HT close to menopause (ages 50-59, typically) but becomes riskier with time since menopause and advancing age.

Women with early menopause before age 40 without a history of breast cancer risk can take HT until the typical age of menopause at 51 if there is no reason not to take it.

Clinicians will recommend an individualized plan for each woman. There is no “one size fits all” therapy.


Literally hundreds of clinical studies have provided evidence that systemic HT (estrogen with or without progestogen) effectively helps such conditions as hot flashes, vaginal dryness, night sweats, and bone loss. These benefits can lead to improved sleep, and sexual relations, and quality of life.

The primary indications for HT are hot flashes, night sweats, vaginal dryness, and prevention of osteoporosis.


In order to minimize serious health risks, HT is recommended at the lowest effective dose for the shortest time period. The real concern about hormone safety is with long-term use of systemic ET or EPT.

As a result of the Women’s Health Initiative (WHI) trial in 2002, the US Food & Drug Administration and Health Canada require all estrogen-containing prescription therapies to carry a “black box” warning in their prescribing information about the adverse risks of HT. Although only two products were studied in the WHI, Premarin and Prempro, the risks of all HT products, including “natural” bioidentical and compounded hormones, should be assumed to be similar until evidence shows otherwise.

Most of the risk of breast cancer is associated with EPT. Both ET and EPT have been associated with stroke and an increase in blood clots in the veins. These risks are higher in women over age 60.

For women with a uterus, progestogen must be prescribed along with estrogen to protect her against uterine cancer.

Weighing Benefits & Risks

There is no single way to ensure the best possible quality of life around menopause and beyond. Each woman is unique and must weigh her discomfort against her fear of treatment. Risk is defined as the possibility or chance of harm; it does not indicate that harm will occur. Generally, HT risks are lower in younger women than originally reported in all women ages 50 to 70 combined. It is now believed that women taking estrogen alone—women who have had their uterus removed by a hysterectomy—have a more favorable benefit-risk profile than those taking EPT. This is especially true for younger menopausal women (in their 50s or within 10 years of menopause) than for older women.

Medical professionals have modified their views about the role of hormones as more research has been conducted. Experts agree that there is much they still have to learn. Although recent studies such as the WHI have provided some clarity for large populations, they don’t necessarily address all of the issues an individual woman faces. Only she, with the counsel of her healthcare providers, can do that.

Many factors will be part of a woman’s decision to use a particular hormone product—her age, her risks, her preferences, available treatment options, and the cost of the product. Do her potential benefits outweigh her potential risks? Only after examining and understanding her own situation and after a thorough consultation with her clinician can a woman make the best treatment choice. As new therapies and guidelines are available, and as a woman’s body changes over time, reevaluation and adjustments should be made.

For more information, continue to visit this website where the latest reports about menopause and HT are regularly discussed.

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