Hormone Replacement Therapy: Uses, Types & Contraindications

Hormone replacement therapy (HRT) is a treatment used to relieve menopause symptoms, such as hot flashes, vaginal dryness, and mood changes. It can also help prevent bone loss by replacing hormones, particularly estrogen, that naturally decrease during menopause.

Also called menopausal hormone therapy, this treatment can be given in different forms, including pills, skin patches, gels, creams, vaginal tablets, and vaginal rings. Depending on the treatment, it may contain estrogen alone or estrogen combined with progesterone or another progestogen.

Hormone replacement therapy should be prescribed by a healthcare provider based on factors such as age, symptoms, symptom severity, medical history, and individual health needs. The length of treatment varies and should be determined individually based on the benefits, risks, and continued need for symptom relief.

HRT for menopause

Hormone replacement therapy for menopause may be recommended to:

• Relieve vasomotor symptoms, such as hot flashes, night sweats, or heart palpitations

• Prevent bone loss and osteoporosis

• Treat symptoms of genitourinary syndrome of menopause, such as vaginal dryness, pain during sex, or recurrent vaginal infections

This treatment replaces hormones, mainly estrogen and progesterone, to help relieve moderate to severe menopause symptoms.

According to The Menopause Society, hormone therapy generally has a favorable benefit-risk profile for most healthy women with bothersome symptoms when started before age 60 or within 10 years of menopause onset. Treatment should be individualized based on medical history and other health factors.

How do I know if I'm in menopause?

To find out whether you are in menopause, you should see a healthcare professional, who can review your symptoms, menstrual history, and age. Additional testing may be recommended in some cases.

According to the National Institute on Aging, menopause is considered to have occurred after 12 consecutive months without a menstrual period.

Before starting HRT, your healthcare professional will assess your overall health and individual risk factors to determine whether treatment is appropriate. Additional tests or routine screenings may be recommended depending on your needs.

Types of HRT

Hormone replacement therapy for menopause can be administered orally or through the skin using patches or gels. Vaginal creams, tablets, inserts, or rings may also be prescribed, depending on the symptoms being treated and a healthcare provider's recommendations.

The main types of hormone replacement therapy for menopause include:

1. Estrogen and progesterone therapy

Hormone replacement therapy that combines estrogen with natural progesterone or another progestogen may be recommended for women who still have a uterus. Adding progesterone or a progestogen helps reduce the increased risk of endometrial cancer associated with using systemic estrogen alone in women with an intact uterus.

This type of HRT can be given using combination medications such as estradiol and progesterone (Bijuva) or estradiol and norethindrone acetate (Activella), for example.

2. Estrogen therapy

Estrogen-only hormone replacement therapy uses medications that contain estrogen and is generally recommended for women who have had their uterus removed.

This type of hormone replacement therapy may be given as conjugated estrogens in tablet form, such as Premarin, or estradiol through a transdermal patch, such as Vivelle-Dot, for example.

Vaginal estrogen may also be prescribed as a cream, tablet, insert, or vaginal ring. These products deliver small amounts of estrogen directly to vaginal tissues and may be especially useful when symptoms are limited to the genitourinary tract.

3. Progesterone therapy

A progestogen such as medroxyprogesterone acetate (Provera) may also be prescribed along with systemic estrogen for women who still have a uterus.

Natural hormone replacement

Natural hormone replacement therapy may include medicinal plants and supplements such as black cohosh, chasteberry, black mulberry, and sage. These have traditionally been used to help relieve menopause symptoms, and some contain plant compounds that may have estrogen-like activity.

However, these herbal products are not FDA-approved treatments for menopause, and evidence supporting their effectiveness and safety varies. They should not replace hormone replacement therapy or other treatments recommended by a healthcare professional.

Contraindications for use

In some cases, the potential risks of hormone replacement therapy may outweigh its benefits. Systemic hormone therapy may not be recommended in situations such as:

• A personal history of breast cancer or another estrogen-dependent cancer

• Liver disease or impaired liver function

• Unexplained vaginal bleeding

• Current or previous venous thromboembolism, such as deep vein thrombosis or pulmonary embolism

• A history of stroke or heart attack

• Certain blood-clotting disorders, such as known thrombophilia

According to the FDA, hormone therapy should not be used in people with certain conditions, including unexplained vaginal bleeding, certain cancers, a history of blood clots, stroke or heart attack, or liver disease.

The risks and benefits of treatment depend on factors such as medical history, age, type of hormone therapy, dose, and route of administration. If systemic hormone therapy is not appropriate, other treatments may be recommended to manage menopause symptoms.

Does HRT cause weight gain?

Hormone replacement therapy is not generally considered a direct cause of weight gain.

However, changes in metabolism and body composition commonly occur with aging and during the menopause transition. These changes can make weight gain more likely and may also increase fat accumulation around the abdomen.