Types of hormone therapy
Definition
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.
Alternative Names
HRT- types; Estrogen replacement therapy - types; ERT- types of hormone therapy; Hormone replacement therapy - types; Menopause - types of hormone therapy; HT - types; Menopausal hormone types
Menopause and Hormones
Menopause symptoms include:
- Hot flashes
- Night sweats
- Sleep problems
- Vaginal dryness
- Anxiety
- Moodiness
- 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
- Stroke
- Gallstones
Despite these concerns, for many women, HT is a safe and effective way to treat menopause symptoms.
Currently, experts are unclear on how long you should take HT. Some professional groups suggest that you can take HT for menopause symptoms for longer periods if there is no medical reason to discontinue the medicine. For many women, low doses of HT may be enough to control troublesome symptoms. Low doses of HT tend to have few side effects. These are all issues to discuss with your health care provider.
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 cannot get endometrial cancer. So, estrogen alone is recommended for them.
Progesterone or progestin comes in:
- Pills
- Skin patches
- Vaginal creams
- Vaginal suppositories
- Intrauterine device or intrauterine system
The type of HT your provider 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.
Discuss the benefits and risks of HT with your provider.
How you Will Take Hormones
When taking estrogen and progesterone together, your provider 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 provider 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:
- Bloating
- Breast soreness
- Headaches
- Mood swings
- Nausea
- Water retention
- Irregular bleeding
Tell your provider if you notice side effects. Changing the dose or type of HT you take may help reduce these side effects. Do not 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 HT, contact your provider.
Be sure to continue seeing your provider for regular checkups when taking HT.
References
ACOG committee opinion no. 565: Hormone therapy and heart disease. Obstet Gynecol. 2013;121(6):1407-1410. PMID: 23812486 pubmed.ncbi.nlm.nih.gov/23812486/.
de Villiers TJ, Hall JE, Pinkerton JV, et al. Revised global consensus statement on menopausal hormone therapy. Climacteric. 2016;19(4):313-315. PMID: 27322027 pubmed.ncbi.nlm.nih.gov/27322027/.
LeBoff MS, Greenspan SL, Insogna KL et al. The clinician's guide to prevention and treatment of osteoporosis. Osteoporos Int. 2022 Oct;33(10):2049-2102. PMID: 35478046 pubmed.ncbi.nlm.nih.gov/35478046/.
Lobo RA. Menopause and care of the mature woman: endocrinology, consequences of estrogen deficiency, effects of hormone therapy, and other treatment options. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 14.
Panay N. Menopause and hormone replacement therapy. In: Magowan B, ed. Clinical Obstetrics and Gynaecology. 5th ed. Elsevier; 2023:chap 9.
Stuenkel CA, Davis SR, Gompel A, et al. Treatment of symptoms of the menopause: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015;100(11):3975-4011. PMID: 26444994 pubmed.ncbi.nlm.nih.gov/26444994/.
Reviewed By: LaQuita Martinez, MD, Department of Obstetrics and Gynecology, Emory Johns Creek Hospital, Alpharetta, GA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
