Your Intro to Menopause Hormone Therapy
The foundational information you need for when you're feeling hot & bothered.
Hello all! We are home from one family reunion and about to embark on a roadtrip west where I’ll spend the next 5-ish weeks exploring the mountains, desert and beach with loved ones from my side of the family.
We used to head west (where I grew up) for the majority of the summer when my boys were little, but a prolonged trip has been harder and harder to manage as my boys got older and our schedules got more complicated. But this summer it miraculously made sense, which means I get to spend an extended amount of time with some of my favorite people in some of my favorite places. I am so excited.
While I load of the car and prepare to drive 1700 miles (gulp), I thought I’d publish the first of a series of posts designed to give midlife women some much-needed foundational information about menopause hormone therapy.
The series is thoughtfully written to give you a fact-based overview from a wide variety of angles so that you can go into an appointment with a qualified menopause provider with a solid understanding of what MHT is, what is treats, what the risks are, etc.
Without further ado …
As you can imagine, I talk to a lot of women about menopause. And one thing everyone asks about is menopause hormone therapy.
Menopause hormone therapy (MHT) is a complicated topic rife with confusion and misinformation. What is MHT exactly? Does it cause breast cancer? What symptoms does it treat? What about hormone pellets and bioidentical hormones? Are there any non-hormonal options for treating menopause symptoms?
Over several posts, I’ll be answering these questions and more.
My primary source for this series is The Menopause Society’s 2022 position statement for menopause hormone therapy and 2024 Statement on Misinformation Surrounding Hormone Therapy. These guidelines are endorsed by every major national and international medical society, which means they’re the go-to source for up-to-date, legitimate, science-based information.
Are you ready? Let’s dive in!
What exactly is menopause hormone therapy?
Menopause hormone therapy refers to FDA approved prescription drugs containing either estrogen or progesterone to treat vasomotor symptoms (hot flashes and night sweats), genitourinary symptoms of menopause (vaginal dryness, urinary tract issues, etc.) and prevention of osteoporosis.
MHT also treats other symptoms of menopause but is only FDA approved for the symptoms listed above.
For vasomotor symptoms like hot flashes and night sweats, systemic hormone therapy is prescribed, “systemic” meaning that the hormones circulate through the body. Systemic hormones can come in all kinds of forms: patches, pills, sprays, and gels.
If you have a uterus and want to start systemic hormone therapy, it’s important that your doctor prescribe both estrogen and progesterone to protect against uterine cancer. Had a hysterectomy? Totally fine to just take estrogen.
For genitourinary symptoms, “vaginal estrogen therapy” is prescribed and comes in creams, pills or rings that are all inserted directly into the vagina to help moisturize and rebuild vaginal tissue.
What about testosterone?
Testosterone declines with age rather than menopause and therefore isn’t grouped in with estrogen and progesterone when it comes to menopause hormone therapy. That said, some women may experience low libido in mid-life, which can coincide with the menopause transition.
There is currently no FDA approved testosterone therapy for women, but The Menopause Society supports the use of testosterone in “carefully selected” postmenopausal women with “no other etiology for their sexual problem”.
Who is a good candidate for MHT?
The Menopause Society’s guidelines state that women under the age of 60 or who are within 10 years of menopause and have no contraindications (i.e. a condition or circumstance that disqualifies you from taking certain medications or receiving certain treatments), MHT is appropriate to treat hot flashes, night sweats, genitourinary syndrome of menopause, and for preventing osteoporosis.
MHT is also recommended for women who reach menopause prior to age 45 (who, again, have no contraindications) to protect against heart disease.
And last, MHT should always be part of the conversation any time a woman will undergo surgical menopause by having her ovaries removed. Surgical menopause is associated with abrupt, disruptive menopause symptoms as well as increased risk of heart disease, osteoporosis and dementia (especially if surgical menopause happens prior to age 45). These risks may be reduced by taking hormone therapy, if the woman undergoing surgical menopause is willing and able to take it.
Who shouldn’t take menopause hormone therapy?
MHT may not be appropriate for women who have had breast cancer or are at high risk for breast or uterine cancer. MHT may also not be a safe option for women with a history of blood clots or stroke. Definitely have a conversation with a qualified menopause expert (you can find one here) about the risks and benefits for your particular situation.
Menopause hormone therapy for genitourinary symptoms is generally considered a safe option for all women since very little of the hormone is absorbed into the body when used directly in the vagina. So if systemic hormones aren’t an option for you, but you’re experiencing uncomfortable genitourinary symptoms, it’s worth having a conversation with your doctor about vaginal estrogen therapy.
What else do I need to know?
After decades of being largely ignored, more menopause research is finally happening (!!!) and current guidelines are bound to change as the scientific process unfolds and we learn more about the impacts of menopause hormone therapy.
There have been major research developments that impact our understanding of how long it’s safe for women to be on hormone therapy as well as findings regarding the role of progesterone and breast cancer risk. It will be interesting to see how these new findings impact future guidelines for menopause hormone therapy.
Next up in this series on hormone therapy is the breast cancer scare in 2002 that led to nearly all women being immediately taken off hormone therapy and how it still impacts you today.
xo, Rebecca
P.S. Don’t threaten me with a good time.