Hormone Therapy & Menopause FAQs

FAQs: Hormone Therapy and Menopause

• What is hormone therapy?

  Hormone therapies are the prescription drugs used most often to treat hot flashes and genitourinary syndrome of menopause (GSM), which includes vaginal dryness, after menopause. For hot flashes, hormones are given in pills, patches, sprays, gels, or a vaginal ring that deliver hormones throughout the body—known as “systemic” therapy. For genitourinary symptoms, hormones are given in creams, pills, or rings that are inserted into the vagina. (An approved pill is also available to treat genitourinary symptoms that is not considered a hormone but does affect estrogen receptors, mostly in and around the vagina.)

  
  Systemic hormones include estrogens—either the same or similar to the estrogens the body produces naturally—and progestogens, which include progesterone—the progestogen the body produces naturally—or a similar compound. Another approach to systemic hormone therapy is a pill that combines conjugated estrogens (those in the brand Premarin) and a compound known as a “SERM” (selective estrogen receptor modulator) that protects the uterus but is not a progestogen. Women who have had a hysterectomy (had their uterus or womb removed) can use estrogen alone to control their hot flashes. Women who still have a uterus or womb need to take a progestogen in addition to estrogen or the estrogen-SERM combination to protect against uterine cancer. Systemic hormones are very effective for hot flashes and have other benefits, such as protecting your bones. They also carry risks, such as blood clots and breast cancer. The breast cancer risk usually doesn’t rise until after about 5 years with estrogen-progestogen therapy or after 7 years with estrogen alone.
  
  Vaginal estrogen therapy for GSM after menopause is administered in the vagina and is effective for both moisturizing and rebuilding tissue. Very little goes into blood circulation, so the risks are far lower. 
  
  You should discuss your individual risks and preferences with your healthcare team to determine whether hormone therapy or alternatives, including FDA-approved nonhormonal therapies, are right for you.
• What are bioidentical hormones?
  The term “bioidentical hormone therapy” began as a marketing term for custom-compounded hormones. But it is taken to mean hormones that have the same chemical and molecular structure as hormones that are produced in the body. Bioidentical hormones do not have to be custom-compounded (meaning custom mixed). There are many well-tested, FDA-approved hormone therapy products that meet this definition and are commercially available from retail pharmacies in a variety of doses that will allow you and your doctor to customize your therapy to meet your needs. Custom-compounded hormones are not safer or more effective than approved bioidentical hormones. They are not tested for safety and effectiveness or to prove that the active ingredients are absorbed appropriately or provide predictable levels in blood and tissue. In fact, they may not even contain the prescribed amounts of hormones, and that can be dangerous. For example, when the progesterone level is too low, you are not protected against endometrial (uterine) cancer. When estrogen levels are too high, there can be overstimulation of the endometrium and breast tissue, putting you at risk of endometrial cancer and possibly breast cancer.
• How can I find a menopause specialist?

  The North American Menopause Society maintains a search feature on this website for those women in the United States or Canada who are searching for physicians and other healthcare providers interested in helping them manage their health through menopause and beyond. Those who have passed a competency examination leading to the prestigious credential of NAMS Certified Menopause Practitioner are noted in the displayed results.

  ►Find a Menopause Practitioner now