Hormones and Menopause

by National Institute on Aging

Cathy had been waking up during the night feeling hot and sweaty. That left her tired all day. Then she began to feel hot on and off during the day also, so she went to see her doctor. The doctor told her she was having hot flashes - a sign that she was going through perimenopause, the time around menopause. Her doctor talked about different ways to control the symptoms. One was using estrogen for a short time. Cathy and her doctor talked about the risks, as well as the benefits. Cathy said she remembered something in the news about using hormones around menopause. She was uncertain. What's a woman to do?

A hormone is a chemical substance made by a gland or organ to regulate various body functions. To help control the symptoms of menopause some women can take hormones, called menopausal hormone therapy (MHT). MHT used to be called hormone replacement therapy or HRT. Some women should not use MHT. There are many things to learn about hormones before you make the choice that is right for you.

Cathy's doctor told her to call back for a prescription if she decided to try using hormones to control her symptoms. After reading pamphlets from her doctor's office, Cathy talked to her friends. Lily, who had surgery to remove her uterus and ovaries, has been taking estrogen since the operation. Sandy said she's had a few hot flashes, but isn't really uncomfortable enough to want treatment. Melissa's doctor thinks she should not use estrogen because her younger sister has breast cancer. Each friend had a different story. Cathy needed more information.

Which hormones are used for menopause?

Cathy has a lot of questions, starting with the basics - what is menopausal hormone therapy? During perimenopause, the months or years right before menopause, levels of two female hormones, estrogen and progesterone, in a woman's body go up and down irregularly. This happens as the ovaries struggle to keep up with the body's needs. The symptoms of menopause might result from these changing hormone levels. After menopause, when a woman's ovaries make much less estrogen and progesterone, the symptoms of menopause may continue. Menopausal hormone therapy may help control these symptoms. A woman whose uterus has been removed can use estrogen alone to control her symptoms. But a woman who still has a uterus must take progesterone or a progestin (a synthetic progesterone) along with the estrogen. This will prevent unwanted thickening of the lining of the uterus and also cancer of the uterus, an uncommon, but possible result of using estrogen alone.

Why take these hormones? Why not?

Cathy's doctor said the plus side of taking estrogen is that it is the most effective treatment for hot flashes, night sweats, and vaginal dryness. And it will help keep her bones strong. Cathy thought that those certainly seemed like good reasons to use MHT. But she wondered, is there a down side?

Menopause is a normal part of life. It is not a disease that has to be treated. Women may decide to use menopausal hormone therapy because of its benefits, but there are also side effects and risks to consider. Two good reasons to think about menopausal hormone therapy are: treating some of the bothersome symptoms of menopause, preventing or treating osteoporosis.

But for some women there are noticeable side effects: breast tenderness, spotting or a return of monthly periods, cramping, bloating.

By changing the type or amount of the hormones, the way they are taken, or the timing of the doses, your doctor may be able to control these side effects. Or, over time, they may go away on their own.

For some women there are also serious risks. These risks are why you need to think a lot before deciding to use menopausal hormone therapy.

Although the risks are small for any one woman, you need to take them into account. Much of the following chart on benefits and risks is based on one important clinical trial, the Women's Health Initiative (WHI). This study looked at estrogen (conjugated equine estrogens) used alone or with a particular progestin (medroxyprogesterone acetate). Some other types of estrogen, progesterone, or progestin may have been tested in smaller clinical trials to see if they have an effect on heart disease, breast cancer, or dementia. Others have not.

How would I use the hormones?

Cathy's friend Lily takes her estrogen in pill form, but Cathy has trouble swallowing pills. She hasn't yet decided whether or not to use hormones, but if they only come as a pill, that would be part of her decision.

Estrogen comes in many forms and dosages. You could use a skin patch or vaginal tablet or cream, take a pill, or get an implant, shot, or vaginal ring insert. Progesterone or progestin is often taken as a pill, sometimes in the same pill as the estrogen. It also comes as a patch, shot, IUD (intrauterine device), vaginal gel, or suppository.

The form your doctor suggests may depend on your symptoms. For example, patches or pills can relieve hot flashes, night sweats, and vaginal dryness. They will also slow or prevent bone loss and help delay osteoporosis while you are using them. Other forms - vaginal creams, tablets, or rings - are used for vaginal dryness. The vaginal ring insert might also help some urinary tract symptoms. But, the dose found in these other forms is probably too low to relieve hot flashes.

About the Author

www.nia.nih.gov
NIA, one of the 27 Institutes and Centers of NIH, leads a broad scientific effort to understand the nature of aging and to extend the healthy, active years of life. In 1974, Congress granted authority to form NIA to provide leadership in aging research, training, health information dissemination, and other programs relevant to aging and older people.