To help control the symptoms of menopause, some women can take hormones, called menopausal hormone therapy (MHT). MHT used to be called hormone replacement therapy or HRT. The use of MHT has been debated a great deal since the Women’s Health Initiative (WHI) Hormone Study findings were released in 2002. Before this study, it was thought that MHT could ward off heart disease, osteoporosis, and cancer, while improving women’s quality of life. Findings emerged from clinical trials that showed this was not so. In fact, long-term use of MHT poses some serious risks. New results from the WHI confirmed that using MHT does not protect against coronary heart disease (CHD, called heart disease here). There is good news, however: The results also suggest that short-term use of MHT does not increase heart disease risk in women who begin MHT within 10 years of onset of menopause. But, it appears that the longer a woman waits to begin MHT after the onset of menopause, the greater her risk of developing heart disease. More research is needed to fully understand this issue. Still, a woman has options when it comes to managing the symptoms of menopause.
During perimenopause, some doctors suggest birth control pills to help with very heavy, frequent, or unpredictable menstrual periods. These pills might also help with symptoms like hot flashes, as well as prevent pregnancy. As you get closer to menopause, you might be bothered more by symptoms like hot flashes, night sweats, or vaginal dryness. Your doctor might then suggest starting MHT. A woman whose uterus has been removed can use estrogen alone to control her symptoms. But a woman who still has a uterus must take progesterone or a progestin (a man-made progesterone) along with the estrogen. These hormones will probably help with menopause symptoms and prevent the bone loss that can happen at menopause. However, there is a chance your symptoms will come back when you stop MHT.
Once a woman reaches menopause, MHT currently is recommended only as a short-term treatment of moderate to severe symptoms such as hot flashes or night sweats. Women who have problems with vaginal dryness can try lower dose estrogen products, such as vaginal creams, rings, and tablets. Long-term use of MHT is no longer advised, and doctors very rarely prescribe MHT to prevent certain chronic diseases, like osteoporosis. Postmenopausal women should not take MHT as they grow older to prevent problems like heart disease. A woman should talk about the benefits and risks of using MHT with her doctor to decide if MHT is right for her.
Source: U.S. Department of Health and Human Services.
Some research has shown that women who start estrogen or certain types of hormone therapy around the time of menopause are less likely to get heart disease. But a very large study by the U.S. National Institutes of Health (NIH) had different results. The NIH research found that:
- Estrogen alone didn’t affect the risk of a heart attack. Estrogen did increase the risk of stroke. Estrogen also increased the risk of blood clots in the legs.
- Estrogen plus progestin may have slightly increased the risk of a heart attack. Progestin is a manmade form of the female hormone progesterone. Estrogen plus progestin raised the risk of stroke and blood clots in the legs and lungs.
Researchers continue to study this issue. The age at which MHT is started may be the key to whether this therapy reduces your chances of getting heart disease. Most of the women in the NIH study did not start MHT until after the age of 60. Yet menopause happens for most women after the age of 45. Some experts think that many of the women in the NIH study may have already developed narrowing and hardening of the arteries because of many years in which their estrogen levels were low. This would explain why estrogen did not protect against heart disease in the study.
More research on younger women may support the use of some kind of MHT to prevent heart disease. And more research will be needed to ensure that the benefits of such a therapy outweigh its risks. For now, the safest option for menopausal hormone therapy is to stick with the lowest dose for the shortest time to treat menopausal symptoms or treat bone loss, but not to prevent heart disease.
Studies on the effects of MHT on memory and other brain functions also have had mixed results. For now, MHT should not be used to prevent memory loss, dementia or Alzheimer’s disease.
Source: Office on Women’s Health in the U.S. Department of Health and Human Services.
Women who:
- Think they are pregnant
- Have problems with vaginal bleeding
- Have had certain kinds of cancers (such as breast and uterine cancer)
- Have had a stroke or heart attack
- Have had blood clots
- Have liver disease
- Have heart disease
MHT can also cause these side effects:
- Vaginal bleeding
- Bloating
- Breast tenderness or swelling
- Headaches
- Mood changes
- Nausea
Be sure to see your doctor if you have any of these side effects while using MHT.
Source: Office on Women’s Health in the U.S. Department of Health and Human Services.
If used properly, menopausal hormone therapy (MHT) (once called hormone replacement therapy or HRT) can be very good at relieving moderate to severe menopausal symptoms and prevents bone loss. But MHT also has some risks, especially if used for a long time.
MHT can help with menopause by:
- Reducing hot flashes and night sweats, and related problems such as poor sleep and irritability
- Treating vaginal symptoms, such as dryness and discomfort, and related effects, such as pain during sex
- Slowing bone loss
- Possibly easing mood swings and mild depressive symptoms (MHT is not an antidepressant and is not effective in treating depression.)
For some women, MHT may increase their chance of:
- Blood clots
- Heart attack
- Stroke
- Breast cancer
- Gall bladder disease
When deciding whether or not to use MHT, you and your doctor need to talk about the potential benefits and risks. Also ask about other treatment options. For example, lower dose estrogen products (vaginal creams, rings, and tablets) instead of MHT are a good choice for women who are only bothered by vaginal symptoms. And other drugs can help many women with bone loss. This information will help you decide if MHT is right for you. If you decide to try MHT, use the lowest dose that helps for the shortest time you need it.
Source: Office on Women’s Health in the U.S. Department of Health and Human Services.
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