Hormone Replacement Therapy (HRT) for Menopause

What is hormone replacement therapy?

Hormone replacement therapy is the use of artificial (synthetic) hormones to replace hormones that your body stops producing during menopause.

Menopause is the normal time of life when menstrual periods stop completely and the ovaries stop producing the female hormones estrogen and progesterone. This lack of hormones can affect your health and cause undesirable symptoms. HRT can relieve some of those symptoms.

What are my options for HRT?

HRT may consist of the synthetic hormones estrogen and progestin, or it may consist of only estrogen (estrogen-only therapy). You and your health care provider will decide which form of HRT is best for you.

If you choose to be on HRT and you have a uterus, estrogen and progestin are usually prescribed. Estrogen-only therapy is used for women who do not have a uterus.

Possible options for taking HRT include:

• Pills.
• Patches.
• Gels.
• Sprays.
• Vaginal cream.
• Vaginal rings.
• Vaginal inserts.

The amount of hormone(s) that you take and how long you take the hormone(s) varies depending on your individual health. It is important to:

• Begin HRT with the lowest possible dosage.
• Stop HRT as soon as your health care provider tells you to stop.
• Work with your health care provider so that you feel informed and comfortable with your decisions.

What are the benefits of HRT?

HRT can reduce the frequency and severity of menopausal symptoms. Benefits of HRT vary depending on the menopausal symptoms that you have, the severity of your symptoms, and your overall health.

HRT may help to improve the following menopausal symptoms:

• Hot flashes and night sweats. These are sudden feelings of heat that spread over the face and body. The skin may turn red, like a blush. Night sweats are hot flashes that happen while you are sleeping or trying to sleep.
• Bone loss (osteoporosis). The body loses calcium more quickly after menopause, causing the bones to become weaker. This can increase the risk for bone breaks (fractures).
• Vaginal dryness. The lining of the vagina can become thin and dry, which can cause pain during sexual intercourse or cause infection, burning, or itching.
• Urinary tract infections.
• Urinary incontinence. This is a decreased ability to control when you urinate.
• Irritability.
• Short-term memory problems.

What are the risks of HRT?

Risks of HRT vary depending on your individual health and medical history. Risks of HRT also depend on whether you receive both estrogen and progestin or you receive estrogen only. HRT may increase the risk of:

• Spotting. This is when a small amount of blood leaks from the vagina unexpectedly.
• Endometrial cancer. This cancer is in the lining of the uterus (endometrium).
• Breast cancer.
• Increased density of breast tissue. This can make it harder to find breast cancer on a breast X-ray (mammogram).
• Stroke.
• Heart attack.
• Blood clots.
• Gallbladder disease.

Risks of HRT can increase if you have any of the following conditions:

• Endometrial cancer.
• Liver disease.
• Heart disease.
• Breast cancer.
• History of blood clots.
• History of stroke.

How should I care for myself while I am on HRT?

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Get mammograms, pelvic exams, and medical checkups as often as told by your health care provider.
• Have Pap tests done as often as told by your health care provider. A Pap test is sometimes called a Pap smear. It is a screening test that is used to check for signs of cancer of the cervix and vagina. A Pap test can also identify the presence of infection or precancerous changes. Pap tests may be done:
  • Every 3 years, starting at age 21.
  • Every 5 years, starting after age 30, in combination with testing for human papillomavirus (HPV).
  • More often or less often depending on other medical conditions you have, your age, and other risk factors.
• It is your responsibility to get your Pap test results. Ask your health care provider or the department performing the test when your results will be ready.
• Keep all follow-up visits as told by your health care provider. This is important.

When should I seek medical care?

Talk with your health care provider if:

• You have any of these:
  • Pain or swelling in your legs.
  • Shortness of breath.
  • Chest pain.
  • Lumps or changes in your breasts or armpits.
  • Slurred speech.
  • Pain, burning, or bleeding when you urine.
• You develop any of these:
  • Unusual vaginal bleeding.
  • Dizziness or headaches.
  • Weakness or numbness in any part of your arms or legs.
  • Pain in your abdomen.