Types of hormone therapy
Hormone therapy (HT) uses one or more hormones to treat symptoms of menopause. HT uses estrogen, progestin (a type of progesterone), or both. Sometimes testosterone is also added.
HRT; Estrogen replacement therapy; ERT; Hormone replacement therapy
Menopause and hormones
Menopause symptoms include:
- Hot flashes
- Night sweats
- Sleep problems
- Vaginal dryness
- Less interest in sex
After menopause, your body stops making estrogen and progesterone. HT can treat menopause symptoms that bother you.
HT does have some risks. It may increase your risk for:
- Blood clots
- Breast cancer
- Heart disease
Despite these concerns, for many women, HT is a safe way to treat menopause symptoms, as long as you take it:
- No longer than 5 years
- At the lowest possible dose
Forms of hormone therapy
HT comes in different forms. You may need to try different types before finding one that works best for you.
Estrogen comes in:
- Nasal spray
- Pills or tablets, taken by mouth
- Skin gel
- Skin patches, applied to the thigh or belly
- Vaginal creams or vaginal tablets to help with dryness and pain with sexual intercourse
- Vaginal ring
Most women who take estrogen and who still have their uterus also need to take progestin. Taking both hormones together lowers the risk of endometrial (uterine) cancer. Women who have had their uterus removed can't get endometrial cancer. So estrogen alone is recommended for them.
Progesterone or progestin comes in:
- Skin patches
- Vaginal creams
- Vaginal suppositories
The type of HT your doctor prescribes may depend on what menopause symptoms you have. For example, pills or patches can treat night sweats. Vaginal rings, creams, or tablets help relieve vaginal dryness.
How you will take hormones
When taking estrogen and progesterone together, your doctor may suggest one of the following schedules:
Cyclic hormone therapy is often recommended when you start menopause.
- You take estrogen as a pill or use it in patch form for 25 days.
- Progestin is added between days 10 and 14.
- You use estrogen and progestin together for the remainder of the 25 days.
- You don't take any hormones for 3 to 5 days.
- You may have some monthly bleeding with cyclic therapy.
Combined therapy is when you take estrogen and progestin together every day.
- You may have some unusual bleeding when starting or switching to this HT schedule.
- Most women stop bleeding within 1 year.
Your doctor may prescribe other medicines if you have severe symptoms or have a high risk of osteoporosis. For example, you may also take testosterone, a male hormone, to improve your sex drive.
Side effects of hormone therapy
HT can have side effects, including:
- Breast soreness
- Mood swings
- Water retention
- Irregular bleeding
Tell your doctor if you notice side effects. Changing the dose or type of HT you take may help reduce these side effects. Don’t change your dose or stop taking HT before talking with your doctor.
When to call the doctor
If you have vaginal bleeding or other unusual symptoms during hormone therapy, call your doctor.
Be sure to continue seeing your doctor for regular checkups when taking hormone therapy.
American College of Obstetricians and Gynecologists. Hormone therapy and heart disease. Committee Opinion No. 565. Obstet Gynecol. 2013;121:1407-10. PMID: 23812486 www.ncbi.nlm.nih.gov/pubmed/23812486.
Davis SR, Davidson SL. Current perspectives on testosterone therapy for women. Menopausal Medicine. 2012;20(2).
Management of osteoporosis in postmenopausal women: 2010 position statement of The North American Menopause Society. Menopause: The Journal of The North American Menopause Society. 2010;17:25-54; quiz 55-56. PMID: 20061894 www.ncbi.nlm.nih.gov/pubmed/20061894.
National Osteoporosis Foundation. Clinician's Guide to Prevention and Treatment of Osteoporosis. 2013. http://nof.org/files/nof/public/content/file/2157/upload/872.pdf. Accessed October 29, 2013.
North American Menopause Society. Position Statement: The 2012 Hormone Therapy Position Statement of The North American Menopause Society. Menopause: The Journal of The North American Menopause Society. 2012; 19 (3): 257-271. PMID: 22367731 www.ncbi.nlm.nih.gov/pubmed/22367731.
Reviewed By: Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.