Hormone Replacement Therapy (HRT)

What is hormone therapy (HT)?

Hormone therapy (HT) is also known as hormone replacement therapy or HRT. It is a hormone treatment prescribed by a doctor. Some women take HT to offset the lower levels of estrogen and progesterone that happen naturally at the beginning of menopause.

HT is either:

  • estrogen taken alone, sometimes called estrogen therapy (ET) or estrogen replacement therapy (ERT);
  • progesterone (natural or synthetic);or
  • combination estrogen plus progesterone.

HT may be taken as:

  • a pill;
  • a patch;
  • a cream or gel;
  • an implant;
  • an injection; or
  • a vaginal ring.

What are the benefits of hormone therapy?

Hormone therapy may improve menopausal symptoms such as:

  • vaginal dryness; and
  • night hot flashes;
  • sweats.

There is no solid scientific evidence to show that HT can prevent:

  • urinary incontinence;
  • memory loss;
  • Alzheimer’s disease;
  • wrinkles;
  • aging; or
  • heart disease.

What are the risks associated with hormone therapy?

There are side-effects associated with hormone therapy, with some women reporting:

  • headaches and/or migraines;
  • breast tenderness;
  • bloating;
  • irritability; and
  • vaginal bleeding.

There is also a risk of blood clots that starts immediately when taking HT.

The known health risks associated with long-term use (more than 4 years) of HT are:

  • heart disease;
  • gallbladder disease;
  • breast cancer;
  • liver impairment; and
  • endometrial cancer (if only taking estrogen).

HT also affects mammography readings by making breasts appear more dense on the mammographs and more difficult to read. HT may also increase the risk of ovarian cancer, but more research needs to be done in this area.

Will hormone therapy prevent the signs of aging?

Hormone therapy will not likely prevent wrinkles.

There have been no significant controlled clinical trials conducted on the relation between wrinkles and HT so it is impossible to know if HT affects aging skin.

Will hormone therapy improve memory?

New clinical evidence shows that HT may actually increase women’s risk of memory loss. The Women’s Health Initiative Study indicates that women 65 and older taking estrogen plus progestin HT have an increased risk for dementia, including Alzheimer’s disease (AD), compared with women who did not take the medication.

The study also found that the combination therapy did not protect against the development of Mild Cognitive Impairment, or MCI, a form of cognitive decline less severe than dementia.

There is no clear clinical evidence to show that estrogen therapy alone improves brain function. Research done in this area has produced only inconclusive and conflicting results.

Will hormone therapy reduce the risk of osteoporosis (thinning of the bones)?

Research shows that estrogen therapy delays bone loss only while a woman is taking estrogen (and not after). Because of this, estrogen may be prescribed to help reduce the risk of osteoporosis. Many medical organizations have noted that the risks of HT may outweigh this benefit, and so suggest other, non-HT medications to reduce the risk of, and to treat osteoporosis.

Will hormone therapy improve my sex life?

Hormone levels are not linked directly to interest in sex, but lower levels of hormones after menopause may cause vaginal dryness.

Vaginal dryness may be relieved by:

  • regular sexual activity, including masturbation, which may help to maintain vaginal lubrication;
  • non-hormonal, water-based lubricants; and
  • supplemental estrogen available in a vaginal cream or vaginal ring (by prescription).

Who should take hormone therapy?

There is no right or wrong answer since each woman has her own medical history and individual needs.

However, those who may benefit most from HT include women:

  • with severe vasomotor symptoms, such as hot flashes and night sweats;
  • at high risk of bone fracture and osteoporosis who may not be able to take, or who may not respond to other, non-hormonal medications now available; or
  • who have experienced an early ‘induced’ menopause caused by:

  1. surgery to remove their ovaries;
  2. chemotherapy;
  3. radiation treatment; or
  4. ovarian malfunction.

Women who should not consider standard HT, unless they discuss their specific risks with their physician, include women with:

  • breast cancer or at high risk for breast cancer;
  • a history of liver disease;
  • a history of blood clots; and
  • a history of heart disease.

Do I have to take hormone therapy when I reach menopause?

Hormone therapy is only one of many options for women going through menopause. Many women do not have severe menopausal symptoms and choose to go through menopause naturally. Other women experience several menopausal symptoms and choose to manage their symptoms through:

  • diet;
  • exercise;
  • botanical and herbal supplements;
  • ‘natural’ hormone supplements (from plant sources);
  • massage therapy, acupuncture and chiropractic therapies; and
  • hormone therapy.

What a woman decides to do will depend on her needs and medical history. A woman considering HT or other therapies should weigh the health benefits and risks in consultation with her medical practitioner.