• Hormone Replacement Therapy
• Vaginal Changes

Hormone Replacement Therapy (HRT): What are the Benefits and Risks?

Medically reviewed and edited by Kimberly Burrus, NP

Hormone replacement therapy (HRT) is a treatment option that is intended to help women manage uncomfortable symptoms associated with menopause.

It’s generally an effective way to significantly improve a woman’s quality of life during menopause.

However, there are some risks associated with HRT that are important to know about.

Understanding Hormone Replacement Therapy

HRT is a treatment approach that involves supplementing or replacing hormones like estrogen and progesterone.

This is a method for alleviating symptoms associated with menopause, including hot flashes, mood swings, and vaginal dryness.

Menopausal hormone therapy can provide relief from these symptoms by restoring hormone levels.

Many individuals may also use HRT to prevent osteoporosis — a condition characterized by weakened bones.

Estrogen plays a crucial role in maintaining bone density, and its decline during menopause can increase the risk of osteoporosis.

By using HRT to restore estrogen levels, patients can maintain their bone health and reduce their risk of developing this disease.

Helping individuals restore balance to fluctuating hormones also allows HRT to stabilize a person’s mood, which can improve their overall well-being.

Does HRT have any side effects?

While HRT can help manage and treat menopause symptoms, it can also cause some adverse side effects. These may include:

• Acne

• Bloating and indigestion

• Swollen and tender breasts

• Abdominal and back pain

• Leg cramps

• Headaches and migraines

• Nausea

• Vaginal bleeding

• Mood changes and depression

HRT side effects usually resolve on their own and will disappear after a few weeks. If any adverse reactions persist, speak to your doctor about adjusting your dosage.

Types of Hormones Used in HRT

There are several types of hormones used in HRT to address imbalances and symptoms associated with menopause.

Estrogen

Estrogen is the primary hormone used in HRT. It mimics the naturally occurring substance in your body.

This type of HRT — also known as estrogen therapy or estrogen replacement therapy — can be administered in various forms, including tablets, gels, and vaginal rings.

It’s recommended to use a type of estrogen that can be applied directly to the skin because this method is associated with fewer unpleasant side effects.

Topical estrogen — like a cream or patch — also has a lower risk of causing symptoms like migraines and blood clots because it’s derived from natural plant compounds.

Progestin or combined hormone therapy

Progestin is a synthetic form of progesterone and is often prescribed with estrogen — this is why it’s also known as combination HRT.

Women who still have a womb should use estrogen alongside progestin to lower the risk of endometrial cancer.

This type of HRT can be taken orally, in patch form, or through an intrauterine device (IUD).

Side effects of using progestin include:

• Bloating

• Breakouts

• Mood swings

Bioidentical hormones

Bioidentical hormones are derived from natural sources and mimic the chemical substances in your body. They are available in different forms, including creams, gels, and pellets.

These hormones are associated with a lower breast cancer risk and may be a safer option than synthetic alternatives. Bioidentical HRT also doesn’t affect blood clotting.

Benefits of Hormone Replacement Therapy

There are many benefits of using HRT, in addition to alleviating the symptoms of menopause and preserving bone health. These may include:

• Improved cognitive functioning: Hormonal changes during menopause can affect cognitive abilities like memory and concentration. HRT has shown potential in improving these functions and reducing the risk of cognitive decline. This may also lower the chances of developing degenerative diseases such as dementia.

• Enhanced mood and well-being: Hormonal fluctuations during menopause often lead to mood swings, irritability, and anxiety. HRT can help stabilize hormone levels, which may lead to an improved mood and an increase in overall well-being.

• Prevention of certain health conditions: HRT has been associated with a reduced risk of developing certain conditions, including colon cancer, heart disease, and diabetes. This is especially true for individuals who start HRT close to the onset of menopause.

While there are many benefits of HRT, the decision to start treatment should be made with your doctor.

Risks and Considerations of Hormone Replacement Therapy

Before starting HRT, it’s essential to be aware of the risks associated with this type of treatment.

For many women, the benefits tend to outweigh the risks if they are not very significant.

Breast cancer risk

HRT may increase your risk of developing breast cancer, depending on the type of hormones you receive during treatment.

Certain types of HRT — called systemic hormone therapy — are associated with a low risk of causing malignant growths in the body. These risks may become bigger the longer you take HRT.

If you are considering HRT, it’s important to attend all of your breast cancer screening appointments as recommended by your doctor.

Cardiovascular health

The relationship between certain types of hormone therapy and cardiovascular health isn’t fully understood yet.

However, most medical professionals agree that there is a risk of developing heart disease when using HRT as a menopause treatment.

Some studies suggest that the risk of cardiovascular events decreases significantly when HRT is used by women under the age of 60.

Other research also indicates that individuals over the age of 60 or who have had menopause for more than 10 years may be at an increased risk of blood clots and heart disease.

Endometrial cancer risk

Endometrial cancer develops in the lining of the uterus and typically occurs when a person is exposed to estrogen without the balancing effect of progesterone for a prolonged period.

Certain types of HRT only use estrogen to treat fluctuating hormone levels and may increase your risk of developing endometrial cancer — especially if you use HRT for a long time.

Other considerations

There are a few other factors to consider before starting HRT. These include:

• Increased risk of developing gallbladder disease: Estrogen used in HRT can increase a person’s risk of developing gallbladder issues. It’s recommended to report any symptoms of conditions like gallstones to your healthcare provider as soon as possible.

• Impact on breast density: HRT has been associated with increased breast density, which can make mammogram screenings more challenging and impact its ability to detect cancer. To avoid this, your doctor may recommend regular breast examinations to help them monitor any changes or abnormalities.

Ongoing monitoring of these HRT risks is important for addressing any health concerns early on.

When Should You Stop Taking HRT?

There is no limit to how long you can take HRT, so it’s recommended that you speak to a doctor to determine what would be appropriate for your circumstances.

It’s important to remember that the longer you take HRT, the higher your risk of developing secondary illnesses like breast cancer and heart disease.

In most cases, women stop taking HRT once their menopausal symptoms pass. When you do decide to stop, you can do it suddenly or gradually.

Decreasing your HRT dose gradually is usually recommended because it’s less likely to cause severe withdrawal symptoms.

Personalizing HRT and Seeking Medical Advice

When you’re deciding whether to start HRT or try an alternative, always consider what’s best for your needs.

It can be a difficult choice, which is why it’s always recommended to seek guidance from your healthcare provider.

They can help you determine the most appropriate HRT treatment regime based on your needs, medical history, and risk profile.

Your doctor can also monitor your symptoms and help detect any changes in your body that may be signs of underlying conditions.

Continuous monitoring is essential for preventing more severe diseases from developing or getting treated for them as soon as possible.

It’s also important to consistently evaluate the effectiveness of your HRT treatment with your doctor.

Prolonged exposure to certain hormones can be harmful, so your doctor can adjust your dosage and regime accordingly to help prevent adverse reactions.

Where Can I Learn More About HRT for Menopause?

If you’re concerned about your HRT regime or want to know more about this treatment, LifeMD can help.

A licensed medical professional can help you determine whether HRT is right for you and guide you through the most effective treatment plan for your needs — all from the comfort of your home.

They can also make adjustments to your medication if necessary.

Make an appointment with a doctor or nurse practitioner to start learning if HRT could be right for you.

Kimberly Burrus, NP

Kim’s approach to patient care focuses on compassion and evidence-based medicine brought together to provide high levels of care. She feels this combination allows patients to feel supported and heard throughout their healthcare journey.

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