Who should avoid hormone therapy?
Women with current or a past history of breast cancer, ovarian cancer, endometrial cancer, blood clots to the legs or lungs, or stroke should usually not take hormone therapy. Women taking hormone therapy should not smoke.
Women who aren't bothered by menopause symptoms and started menopause after age 45 do not need hormone therapy to stay healthy. Instead, talk to your doctor about strategies to reduce the risk of conditions such as osteoporosis and heart disease, which might include lifestyle changes and medications other than hormone therapy for long-term protection.
If you take hormone therapy, how can you reduce risk?
Talk to your doctor about these strategies:
- Find the best product and delivery method for you. You can take estrogen in the form of a pill, patch, gel, vaginal cream, or slow-releasing suppository or ring that you place in your vagina. If you experience only vaginal symptoms related to menopause, estrogen in a low-dose vaginal cream, tablet or ring is usually a better choice than an oral pill or a skin patch.
- Minimize the amount of medication you take. Use the lowest effective dose for the shortest amount of time needed to treat symptoms, unless you're younger than age 45, in which case you need enough estrogen to provide protection against long-term health effects of estrogen deficiency. If you have lasting menopausal symptoms that significantly impair your quality of life, your doctor may recommend longer-term treatment.
- Seek regular follow-up care. See your health care provider regularly to ensure that the benefits of hormone therapy continue to outweigh the risks, and for screenings such as mammograms and pelvic exams.
- Make healthy lifestyle choices. Include physical activity and exercise in your daily routine, eat a healthy diet, maintain a healthy weight, don't smoke, limit alcohol, manage stress, and manage chronic health conditions such as high cholesterol or high blood pressure.
If you haven't had a hysterectomy and are using systemic estrogen therapy, you'll also need a progestin. Your doctor can help you find the delivery method that offers the most benefits and convenience with the least risks and cost.
What can you do if you can't take hormone therapy?
You may be able to manage menopausal hot flashes with healthy lifestyle approaches, such as keeping cool, limiting caffeinated beverages and alcohol, and by practicing paced relaxed breathing or other relaxation techniques. For vaginal concerns, such as vaginal dryness or painful intercourse, a vaginal moisturizer or lubricant may provide relief. You might also ask your doctor about the prescription medication ospemifene (Osphena), which may help with episodes of painful intercourse.
There are also alternative medicine approaches — such as tai chi, yoga and acupuncture — that you can try. Work with your doctor to find a healthy, effective approach that works for you.
The bottom line: Hormone therapy isn't all good or all bad
To determine if hormone therapy is a good treatment option for you, talk to your doctor about your individual symptoms and health risks. Be sure to keep the conversation going throughout your menopausal years.
As researchers learn more about hormone therapy and other menopausal treatments, recommendations may change. If you continue to have bothersome menopausal symptoms, review treatment options with your doctor on a regular basis.
April 14, 2015
See more In-depth
- Facts about menopausal hormone therapy. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/resources/heart/menopausal-hormone-therapy-facts. Accessed Feb. 21, 2015.
- De Villiers TJ, et al. Global consensus statement on menopausal hormone therapy. Climacteric. 2013;16:203.
- ACOG Practice Bulletin No. 141: Management of menopausal symptoms. Obstetrics and Gynecology. 2014;123:202.
- Martin KA, et al. Menopausal hormone therapy: Benefits and risks. http://www.uptodate.com/home. Accessed Feb. 22, 2015.
- Martin KA, et al. Treatment of menopausal symptoms with hormone therapy. http://www.uptodate.com/home. Accessed Feb. 22, 2015.
- Kling JM, et al. Endothelial function in women of the Kronos Early Estrogen Prevention Study. Climacteric. In press. Accessed Jan. 14, 2015.
- AskMayoExpert. Menopausal hormone therapy: What factors influence the risk to benefit ratio associated with menopausal hormone therapy? Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2014. Accessed Feb. 24, 2015.
- The 2012 hormone therapy position statement of The North American Menopause Society. Menopause: The Journal of the North American Menopause Society. 2012;19:257.
- Lindh-Astrand L, et al. Hormone therapy might be underutilized in women with early menopause. Human Reproduction. 2015;0:1.
- Thielen JM (expert opinion). Mayo Clinic, Rochester, Minn. March 4, 2015.