Menopause (when menstrual periods stop) may be a natural part of reproductive aging. But the symptoms caused by the menopausal process can sometimes feel anything but natural.
During the menopause transition, the ovaries start making less estrogen and progesterone — female sex hormones. These hormonal changes can cause issues, such as:
- Hot flashes
- Irregular periods
- Joint discomfort
- Mood changes
- Sleep disturbances
Menopausal hormone therapy slightly increases hormone levels and can help relieve symptoms.
"Hormone therapy has been shown to be very effective for treatment of menopause-related symptoms," says Rajita Patil, MD, OBGYN and director of UCLA Health's Comprehensive Menopause Program. "It simply helps to close the gap between high and low estrogen levels to ease the transition and provide some relief."
However, not everyone who experiences menopause will need, or should use, menopausal hormone therapy. To shed some light on this often-misunderstood topic, Dr. Patil provides answers to five common questions about menopausal hormone therapy.
1. What is menopausal hormone therapy?
Menopausal hormone therapy increases the female hormones in your body at a time when they are fluctuating and eventually diminishing — before (perimenopause) and after (post-menopause) menstrual periods stop permanently.
"Many people refer to this treatment as hormone replacement therapy (HRT)," Dr. Patil says. "But HRT is a term that should be used to reflect an endocrine disorder requiring replacement doses of hormones, such as menopause before the age of 40. It is not specifically indicated for natural menopause that occurs after the age of 45. Menopausal hormone therapy (MHT) is the correct term to use and simply gives your hormones a boost during this time of transition."
Menopausal hormone therapy includes female hormones — primarily estrogen and progesterone — that are the same (bioidentical) or similar (synthetic) to your natural hormones. Both types work equally well. Dr. Patil recommends Food and Drug Administration-approved bioidentical and synthetic hormones because they are regulated for purity, potency and efficacy. Compounded treatments (custom formulations) are unregulated, and their safety and efficacy cannot be guaranteed.
2. How is menopausal hormone therapy administered?
Menopausal hormone therapy is typically systemic — it travels throughout your body after being absorbed into your bloodstream. Hormone therapy can be delivered using:
- Gels
- Oral medication
- Patches
- Sprays
- Vaginal ring
UCLA Health researchers found that how you take menopausal hormone therapy doesn't affect your benefits or risks. All methods of delivery involve the same, very-low dose of hormones.
Low-dose birth control is another way to use hormones to treat symptoms, especially in people who still get periods. Dr. Patil adds that birth control contains a higher level of hormones than traditional hormone therapy. The higher level helps regulate menstruation while at the same time manage menopause symptoms.
"When you take low-dose birth control in perimenopause, your eggs are still going through atresia (a process that causes cell death)," Dr. Patil says. "But since the birth control regulates your periods, we can't rely on your menstrual cycle to know whether you've gone through menopause. After a few years, we may transition you to standard menopausal hormone therapy or even take you off birth control to see where you are in the process and whether you still need hormone therapy."
3. Is hormone testing needed before starting menopausal hormone therapy?
If you are still having periods and have a uterus, your provider will use clinical symptoms to determine whether menopausal hormone therapy is appropriate.
"Checking hormone levels, especially during perimenopause, is of no help because they fluctuate wildly," Dr. Patil says. "If I line up 10 people at the same stage of the menopause transition with the exact same lab level and age, they would all be feeling differently and need different things. There is no magic level that tells us where you are in this process and there is no level that we are aiming for when recommending hormone dosing."
Treatment depends on how you are doing in your daily life, paying specific attention to areas commonly affected by hormonal changes, such as hot flashes and mood.
4. What are the benefits of hormone therapy during perimenopause and post-menopause?
Menopausal hormone therapy may reduce common symptoms including hot flashes, vaginal dryness, mood and sleep disturbances. This is very important not only to improve quality of life and well-being in the short term but also to optimize long-term risks. Severity and frequency of hot flashes may directly correlate to cardiac disease, dementia, and even osteoporosis.
According to The Menopause Society, hormone therapy can also have other health benefits. While more high-quality research is needed, current data suggests that menopausal hormone therapy may help reduce the risk of several diseases, including colorectal cancer (in post-menopausal people) and osteoporosis and bone loss.
"Hormone therapy is approved by the Food and Drug Administration for the prevention of osteoporosis," Dr. Patil says. "So it has great benefits for high-risk individuals, especially those with osteopenia (bone loss to a lesser degree than osteoporosis), within the first five years after menopause who also have menopause symptoms."
5. Are there risks associated with menopausal hormone therapy?
Like all prescription medications, menopausal hormone therapy has some health risks. For most healthy people, risks associated with hormone therapy are low, according to Dr. Patil.
However, depending on your personal and family health history, hormone therapy may increase the risk of:
- Blood clots
- Breast cancer (when hormone therapy contains both estrogen and progesterone)
- Heart attack (in people who start 10 or more years past their final menstrual period)
- Stroke
Your provider or a menopause specialist can help you assess the risks associated with menopausal hormone therapy and how they might affect your health.
"If hormone therapy is not a good option for you, there are many excellent non-hormonal options to help with symptoms of menopause," Dr. Patil says. "Ask your provider about FDA-approved non-hormonal medications that can help with hot flashes. Practicing mindfulness and meditation and living a heart healthy lifestyle can also help ease symptoms. They help decrease the stress and inflammation in the body that worsens menopause symptoms."
Tips for talking to your provider about menopausal hormone therapy
If you think menopausal hormone therapy might be an option for you, the first step is talking to a health care professional — one who specializes in menopause, if possible.
Dr. Patil recommends taking these steps to make the most of that conversation:
- Bring a log of your symptoms in relation to your menstrual periods, if applicable
- Discuss personal risks, based on health, family history and lifestyle
- Be open to all treatment options, not just hormone therapy
- Articulate your concerns and hopes for treatment
"There's no cookie-cutter approach to managing the symptoms of the menopausal transition," Dr. Patil says. "We have to personalize it and then reevaluate it regularly based on your health status and how you feel."
