The Women’s Health Initiative (WHI) results 10 years ago scared many women away from using hormone therapy (HT) altogether. Some toughed out their hot flashes and night sweats with no relief until the symptoms settled down on their own.
We’ve learned a lot since then about the risks and benefits of HT. For most women, experts agree that HT is okay to control moderate to severe menopause symptoms, such as hot flashes and vaginal dryness, within 10 years of menopause and up to age 59. Also, women should use the lowest dose for the shortest amount of time needed to keep the symptoms under control.
But you and your healthcare provider need to balance the benefits and risks you have. For example, if you don’t have a uterus and can take estrogen therapy (ET) alone, your risks are different from those of women who still have a uterus and must use estrogen plus progestogen (EPT) to protect against uterine cancer. Here’s our list of risks and benefits to weigh:
Risks
- Stroke. Both ET and EPT increase the risk of stroke. That risk goes away, however, soon after you stop taking hormones.
- Blood clots. Risk increases if you take hormones by mouth. The risk may be lower if you use a transdermal estrogen, such as a patch, gel, or spray.
- Uterine cancer. If you didn’t have a hysterectomy and still have a uterus, you need to take EPT. If you have already had uterine cancer (also called endometrial cancer), it’s not a good idea to take HT, although a progestogen by itself might be okay. Check with your doctor.
- Breast cancer. The news is better for women who use ET. We’ve learned they can take ET for 7 years before the breast cancer risk increases. The risk goes up after 3 to 5 years for women who use EPT. Their risk might be lower if they take micronized progesterone intermittently and start HT early. We’ll know more soon as rigorous studies wrap up.
Benefits
- Lessen hot flashes, night sweats, and vaginal dryness and the poor sleep, irritability, and “brain fog” that go with them.
- Get relief from vaginal symptoms, such as thinning tissue and dryness, and the consequences, such as painful intercourse. (If you take low-dose oral or transdermal HT, you may need to add a vaginal estrogen to get relief.)
- Ease overactive bladder—that “gotta go” problem—and maybe even recurring urinary tract infections with vaginal estrogen.
- Protect your bones. Standard-dose HT helps prevent bone fractures later in life. If you are at high risk of broken bones or have early menopause, you may be able to take hormones earlier or longer. Check with your doctor.
- Lower your risk of heart disease if—it’s a big if—you start HT within 10 years of menopause.
- Help prevent diabetes. Good scientific evidence shows women who use HT have a lower risk of developing type 2 diabetes.
What we’ve learned so far about the benefits and risks comes from large groups of women, but you are unique. Only after you and your doctor have a thorough consultation about your individual risks, benefits, and preferences can you make a decision that’s right for you.