For years, many women avoided hormone replacement therapy (HRT) because of concerns about its risks. Today, however, experts are taking a more nuanced view, weighing those risks against the significant impact menopause symptoms can have on daily life.
According to Alexandra Fenton, MD, a gynecologist and director of the Menopause Clinic at University of Vermont Health – University of Vermont Medical Center, growing awareness of women’s health issues has helped change the conversation. “We're really now focused on the fact that women's lives matter. Their quality of life matters,” Dr. Fenton says. “Now we understand that there’s a real cost to untreated menopausal symptoms.”
That shift reflects a broader understanding of menopause as more than an inevitable stage women simply have to endure. For many, symptoms can interfere with sleep, work, relationships and overall well-being.
What symptoms can hormone therapy treat?
Many people associate menopause with hot flashes, but Dr. Fenton says the effects of declining estrogen levels can be much more wide-ranging, and they develop gradually and asynchronously.
We're really now focused on the fact that women's lives matter. Their quality of life matters. Now we understand that there’s a real cost to untreated menopausal symptoms.
Hormone therapy can help relieve symptoms such as Hot flashes and night sweats
- Sleep disruption
- Mood changes and irritability
- Brain fog and cognitive changes
- Joint pain and headaches
- Heart palpitations
- Weight gain
Because these symptoms can develop gradually, many women don’t immediately connect them to menopause. Left untreated, they can affect productivity, self-esteem and overall happiness.
Is hormone replacement therapy safe?
Much of the concern about HRT stems from a Women’s Health Initiative (WHI) study published in 2002 and 2004 that linked hormone therapy with an increased risk of cardiovascular disease and breast cancer in some patients.
Since then, researchers have gained a better understanding of who may benefit most from treatment, when treatment should ideally be started and how individual risk factors influence outcomes.
“It used to be that if you have any risk factors, we wouldn’t recommend HRT just because of your risk,” Dr. Fenton says. “Now we're really recognizing how important it is to treat these symptoms of menopause."
She notes that cardiovascular risk is influenced by such factors as obesity, smoking, diabetes, untreated hypertension, high cholesterol and age. Research has also shown that cardiovascular disease may be lower when menopause hormone therapy is started before age 60 or within 10 years of being in menopause.
In addition to symptom relief, studies have found that HRT can reduce the risk of osteoporosis, colorectal cancer, dementia and overall mortality.
Potential risks of hormone therapy
As with any medical treatment, hormone therapy is not without risk. Potential concerns may include:
- Breast cancer
- Cardiovascular disease
- Deep vein thrombosis (DVT)
- Stroke
- Pulmonary embolism
Dr. Fenton emphasizes that treatment decisions should always be based on an individual’s personal and family history.
Who should avoid hormone therapy?
Hormone therapy is generally not recommended for patients with:
- A personal history of breast cancer
- Certain genetic mutations, such as BRCA mutations
- A personal history of blood clots
- A personal history of stroke
What types of hormone therapy are available?
Estrogen, the hormone primarily responsible for relieving menopausal symptoms offered in several forms, including pills, skin patches, gels, sprays and vaginal rings.
For patients who still have a uterus, progesterone is typically prescribed alongside estrogen because it protects against endometrial cancer.
Are there non-hormonal alternatives for menopause symptoms?
Women who cannot take or prefer not to use hormones still have treatment options.
Prescription medications such as Veozah (fezolinetant) and Lynkuet (elinzanetant) can help reduce hot flashes, with Lynkuet also improving sleep for some people. Other medications, including certain antidepressants and gabapentin can provide some modest reduction in symptoms as well.
While these treatments can be effective, Dr. Fenton notes they generally do not address the full range of symptoms that hormone therapy can help manage.
When should you talk to your doctor about menopause symptoms
Many women assume they are not candidates for hormone therapy or that their symptoms are simply something they must tolerate. Dr. Fenton encourages anyone experiencing significant menopause symptoms to start a conversation with their health care professional. She says ultimately the decision to start HRT is based on individualized care and shared decision making between the provider and patient. “I think I would encourage anybody who is having significant symptoms of menopause to have a consultation with their gynecologist,” she says. “I think a lot of people would be surprised who is a good candidate.”
