Menopause: Should I Use Hormone Therapy (HT)?

Menopause is the point in a woman's life when she has not had a menstrual period for 1 year. Menopause marks the end of the childbearing years. It is sometimes called "the change of life."

For most women, menopause happens at around age 50, but every woman's body has its own time line. As you get closer to menopause, your estrogen levels go up and down unevenly. This causes changes in your period and other symptoms, such as hot flashes, headaches, and sleep problems. After your estrogen levels drop past a certain point, your menstrual cycles end.

Menopause is a natural part of growing older. You don't need treatment for it unless your symptoms bother you.

Hormone therapy uses a combination of two hormones, estrogen and progestin. HT comes in the form of a pill, patch, gel, spray, or vaginal ring. HT increases the estrogen and progestin levels in your body. It can prevent osteoporosis and ease menopause symptoms such as hot flashes and sleep problems.

Because of the risks from HT, many experts recommend that HT be used:

• For short-term treatment of menopause symptoms. If you decide to take HT, use the lowest dose you can, and take it for as short a time as possible.
• To prevent or treat osteoporosis. If you have a strong risk of osteoporosis, you might consider taking HT. The risk of osteoporosis may outweigh the risks linked to HT. But it's important to think about all possible osteoporosis treatments and to compare their risks and benefits.

Menopause symptoms can be upsetting and uncomfortable. But you don't have to suffer through them. There are other things besides taking HT that you can do to help.

The first step is to have a healthy lifestyle. This can reduce your symptoms and also lower your risk of heart disease and other long-term problems linked to aging. Eat a heart-healthy diet, get regular exercise, don't smoke, and limit caffeine, alcohol, and stress.

If you still need help dealing with symptoms, you might try:

• Breathing exercises to help with hot flashes and emotional symptoms.
• Black cohosh and dietary soy, which may reduce hot flashes.
• Vaginal lubricants (such as Astroglide and K-Y Jelly) to help with vaginal dryness, and vaginal estrogen to relieve soreness.
• Antidepressant medicines, a blood pressure medicine called clonidine, or gabapentin. These may lower the number of hot flashes you have. And they can make hot flashes less severe when you do have them.

To manage symptoms before you start menopause, you might think about taking low-dose birth control pills, if you don't smoke and aren't at risk for heart disease or breast cancer.

Hormone therapy:

• Reduces the number of hot flashes you have, and it makes them less severe when you do have them.^{footnote 3}
• Lowers your risk of osteoporosis. Estrogen slows bone thinning and helps increase bone thickness.^{footnote 3}
• Prevents vaginal dryness and soreness caused by low estrogen.
• Slows the loss of skin collagen. Collagen puts the stretch in skin and muscle.
• Reduces the risk of dental problems, such as tooth loss and gum disease.
• May reduce the risk of colon cancer.^{footnote 4}

Risk varies based on when you start HT in menopause and how long you take it. Short-term use of hormone therapy in early menopause has less risk than when it is started later in menopause.

Women who take HT have slightly higher rates of:^{footnote 1, footnote 2}

• Stroke.
• Blood clots.
• Heart attack.
• Breast cancer.
• Gallstones.
• Ovarian cancer.
• Dementia.
• Urinary incontinence.

Your risk will differ based on your personal or family history.

If you have had breast cancer, taking HT isn't safe for you.

Your doctor may recommend HT if:

• You have no risk factors for heart disease, blood clots, stroke, or breast or ovarian cancer; you are willing to accept the small increase in risks of cancer and heart disease; and
• You have thought about or tried other treatments.
• You have menopause symptoms that are lowering your quality of life.