Contrary to outdated studies that demonized hormonal replacement therapy (HRT), contemporary HRT is effective and relatively safe for most women seeking relief from menopausal symptoms such as hot flushes, night sweats, mood swings, thinning hair, bone loss, and loss of skin elasticity. That said, as with any medication, there are risks associated with HRT. Here are some of the pros and cons that you should weigh when evaluating your symptom management options.

HRT is medication containing natural and/or synthetic hormones that you can take to replace your own naturally-produced estrogen and progesterone when they decline during the menopausal transition. There are two basic types of HRT:

• Systemic hormone therapy. Systemic HRT delivers a high dose of estrogen that is absorbed throughout the body. It can be administered by cream, gel, ring, skin patch, pill, or spray, and is used to treat a wide variety of menopause-related symptoms. 
• Low-dose vaginal hormone products. Low-dose vaginal preparations of estrogen minimize the amount of estrogen your body absorbs, and are primarily used to treat vaginal and urinary symptoms of menopause. This type of HRT comes in the form of a cream, tablet, or vaginal ring.

If you still have your uterus, you will likely also be prescribed progesterone, or its synthetic form called progestin, to lower your risk of endometrial cancer. Estrogen therapy alone can stimulate growth of the uterine lining. If you’ve had a hysterectomy (surgical removal of your uterus), then you may not require progesterone. 

HRT is medication containing natural and/or synthetic hormones that you can take to replace your own naturally-produced estrogen and progesterone when they decline during the menopausal transition.
(This image is from Shutterstock.)

HRT has helped millions of women who experience:

• Moderate to severe hot flashes and night sweats (systemic therapy remains the most effective hormonal treatment for these) 
• Vaginal dryness, itching, and burning, and discomfort during penetrative sex.
• Bone mineral loss, leading to thin, brittle bones that are more vulnerable to fractures and breaks, a condition known as osteoporosis (though systemic estrogen is better for prevention than for treatment)
• Early menopause, or estrogen deficiency from another cause such as surgical removal of your ovaries 

Estrogen therapy during peri- and post-menopause can also help reduce mood swings and thinning hair, and regulate your cholesterol. 

HRT is not without its own risks, however. One large clinical trial conducted in the early 2000s found that one particular estrogen-progestin pill called Prempro increased the risk of:

• Blood clots,
• Breast cancer,
• Heart disease, and 
• Stroke.

Results of studies conducted over the last 20 years, however, indicate that these risks tend to vary according to:

• The type, dosage, and duration of HRT used, 
• Your personal and family medical history, and
• Your age. 

Starting HRT before age 60 seems to be safer. Starting it at age 60 or older, or more than 10 years from the onset of perimenopause, places you at greater risk of developing serious health conditions. In addition to blood clots, cancer, heart disease, and stroke, a personal or family history of liver disease or osteoporosis are important factors to consider when deciding whether or not HRT may be an appropriate option for you. Speak openly with your doctor to weigh the benefits and risks. If you decide to try HRT, re-evaluate the benefit-to-risk ratio periodically.

If you feel that HRT may be a good option for you, and you’d like to minimize the risks, here are some topics to discuss with your healthcare provider:

• Consider each product and delivery method individually to find the best one for you. Different types of HRT can have different sources and combinations of ingredients. 
• Take the lowest dose possible for the shortest amount of time. If vaginal symptoms are your main complaint, a slow-releasing suppository or vaginal ring may be safer and more effective than an orally administered pill. 
• Follow up with your doctor on a regular basis to assess your HRT’s effectiveness and safety, and to schedule any recommended exams or health screenings such as mammograms. 
• Create and maintain lifestyle habits that support your overall health, including eating a healthy diet, not smoking, getting regular exercise, limiting alcohol intake, and managing stress and chronic conditions.

During both peri- and post-menopause, it’s a good idea to keep an open HRT dialogue going with your doctor, and to do your own research. As we learn more about HRT and non-hormonal treatments, and as new therapies become available, your thoughts about how best to manage your symptoms may change. Make informed decisions that help live your best life.