What is Hormone therapy?

While menopause is a natural process, the symptoms associated with it can sometimes be bothersome. Fortunately, there are various options available for dealing with these symptoms, such as hormone replacement therapy (HRT).

Making an informed decision about HRT

The decision to undergo hormone therapy is personal and an informed choice should be made based on individual circumstances in consultation with the physician. Women are encouraged to play an active role in deciding whether HRT is right for them. However, the abundance of complex and uncertain information about HRT can make it challenging to decide.

When considering HRT, it is important to discuss concerns and expectations with the physician. Hormone therapy for treating menopause has raised concerns due to negative headlines in recent decades. Many women worry about its potential risks, especially for developing breast cancer. Nevertheless, it is important to note that dosing modes, products and treatment concepts have changed in the past and got adapted to current research outcomes. 

Which types of hormone therapies are available?

Hormone therapies come in different forms and combinations of active ingredients. The choice of therapy depends on individual circumstances, symptoms, and medical history.

There are two forms of hormone therapy: local and systemic. Local hormone therapy involves estrogen creams, suppositories, vaginal tablets, vaginal rings or vaginal gels to provide relief for vaginal dryness, painful intercourse and bladder problems. This approach focuses on the affected area without affecting the whole body.

Systemic hormone therapy can be in the form of pills, capsules, patches, creams, or gels. It relieves hot flashes, sweating, mood changes, sleep disturbances and other symptoms associated with menopause. Hormones administered through the skin rather than taken orally are associated with lower risks of developing thromboembolic events.

For systemic hormone therapies either mono-hormone therapy with estrogen or progestin (replacing progesterone) or a combined hormone therapy (estrogen and progestin) are available. Different approaches are recommended according to the individual case.

Why is HRT beneficial?

Treatment with HRT can relieve most menopausal symptoms, including i.e. hot flushes, mood swings, vaginal dryness, and joint pain. It replenishes female hormones that are at lower levels during menopause.

Hormone therapy is not only a valuable treatment option for typical menopausal symptoms, but it may also have positive effects on the risk to develop various diseases. It can reduce the risk of bone fractures, heart disease and dementia. Hormone therapy is associated with a lower risk of type II diabetes and osteoarthritis and helps to manage premature ovarian insufficiency (early menopause). Studies showed that HRT reduces mortality in women less than 60 years of age and if therapy is started within the first ten years of postmenopause.

Notably, hormones alone are no longer recommended as the remedy for skin aging, hair loss or increased facial hair growth. Lifestyle changes as well as phytomedicine (natural remedies) should be considered for overall well-being and potential aging delay.

Most common side effects of HRT

Like any other therapy, HRT may have side effects and risks. The main short-term side effects of taking hormones are stomach pain, breast tenderness, depression, swelling in the legs, fatigue, headaches, irritability, back pain and vaginal bleeding.

Although many women believe that HRT causes weight gain, scientific studies do not support this claim. In fact, it has been shown that gaining weight during menopause often happens, regardless of taking HRT, but can be improved with physical activity and a healthy diet.

Because some side effects usually improve over time, it is recommended to continue treatment for at least three months. If side effects are severe or persist, the physician may suggest adjusting the dose or changing the medication.

Especially when risk factors or pre-existing conditions are present, hormone therapy can increase the risk of more serious conditions, like blood clots, stroke, and certain types of cancer, marginally. However, the benefits of HRT outweigh the risks when given to healthy women with menopausal symptoms especially who are less than 60 years old or within ten years of menopause.

When is HRT not recommended?

HRT should be avoided in women with unexplained vaginal bleeding, breast cancer, endometrial cancer, blood clotting issues or during pregnancy. Women with a history of breast or uterine cancer, heart attacks or blood clotting problems in the family should also be cautious with HRT. Smoking, overweight, migraines, liver problems, gallstones or high blood pressure may also be risk factors that have to be discussed with the physician. The individual decision has to be taken by the physician together with the patient – for women, it is important to give their doctor all the information needed to weigh up benefits and risks of each therapy.

What are bioidentical hormones?

Bioidentical hormone therapy is currently a ‘hot topic’ in gynaecology. This therapy uses hormones that are identical in structure to the body's own hormones. They are considered safer and more effective than hormone derivatives used in conventional hormone therapy, even if there is not yet enough scientific evidence to confirm this. A hormone that is ‘bioidentical’ is not necessarily less risky to use. Bioidentical hormones can be obtained from plants, but are often produced synthetically or semi-synthetically.