For which of the following condition is hormone replacement therapy commonly used?

Summary

• Menopausal symptoms can be managed with education, lifestyle changes, support and hormone replacement therapy (HRT), also known as menopausal hormone therapy (MHT).
• In the early postmenopausal years, HRT is an effective therapy for menopausal symptoms. In most women with moderate to severe symptoms, the benefits outweigh the small increases in risk.
• The long-term use of HRT has some benefits, but also has some risks.
• The current role of HRT is for menopausal symptom relief, at the lowest effective dose and for the shortest duration required for the control of bothersome menopausal symptoms.
• The decision to use HRT, and for how long it should be used, must be based on individual assessment and needs.

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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.

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 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.

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 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.

Discuss the benefits and risks of HT with your provider.

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.

HT can have side effects, including:

• Bloating
• Breast soreness
• Headaches
• Mood swings
• Nausea
• 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. Do not change your dose or stop taking HT before talking with your doctor.

If you have vaginal bleeding or other unusual symptoms during HT, call your doctor.

Be sure to continue seeing your doctor for regular checkups when taking HT.

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

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Cosman F, de Beur SJ, LeBoff MS, et al. Clinician's guide to prevention and treatment of osteoporosis. Osteoporos Int. 2014;25(10):2359-2381. PMID: 25182228 pubmed.ncbi.nlm.nih.gov/25182228/.

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/.

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.

Magowan BA, Owen P, Thomson A. The menopause and hormone replacement therapy. In: Magowan BA, Owen P, Thomson A, eds. Clinical Obstetrics and Gynaecology. 4th ed. Elsevier; 2019: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/.

Updated by: John D. Jacobson, MD, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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