Is hormone replacement therapy right for you?

Jonathan Hufford, MD

Obstetrics and Gynecology

When many think of hormone replacement therapy, or HRT, they think of menopause. However, hormone replacement therapy, also called hormone therapy, can be beneficial for many different individuals and help to alleviate the symptoms of multiple conditions.

Jonathan Hufford, MD, explained which medical conditions might be treated with HRT and the side effects of hormone replacement therapy to watch for.

What is hormone replacement therapy?

Hormone replacement therapy is a general term used to describe the use of any specific hormones, usually estrogen and/or progesterone, to replace a decrease or lack in the body’s usual circulating hormone levels. This helps to reduce uncomfortable or painful symptoms.

What medical conditions can be treated with hormone replacement therapy?

“The most common indication that HRT might need to be considered for treatment is symptoms of perimenopause and menopause,” said Dr. Hufford. “Hot flashes, night sweats, pain during sex, vaginal dryness … all of these symptoms can often be treated with hormone therapy, and it will help to improve sleep and sexual function as well as overall quality of life.”

There are a few other reasons to use hormone therapy:

• Preventing (but not treating) osteoporosis
• Starting puberty in someone whose puberty was delayed
• Gender transitioning
• Treatment for infertility
• As part of a treatment plan for certain types of pre-cancer

Are hormone levels tested before prescribing HRT?

“In most cases, hormone levels don’t need to be tested before or during treatment,” said Dr. Hufford. “The American Congress of Obstetricians and Gynecologists recommends against testing in most cases, as there isn’t any evidence that one specific level is better than another.”

Most HRT is guided not by levels of hormone but by how well the symptoms being treated are controlled. A physician treating a patient with hormone replacement therapy will attempt to use the smallest effective dose for the shortest amount of time, balancing the benefits of hormone therapy with its risks.

What side effects are common with hormone replacement therapy?

The most common side effects of hormone therapy include:

• Vaginal spotting
• Headaches
• Breast tenderness or soreness
• Nausea
• Fluid retention

“Some of these side effects can be decreased by changing the dose or delivery method of hormone therapy,” said Dr. Hufford. “If you have any concerns or issues while being treated with HRT, it’s important to talk to your prescriber about them to see what steps we can take to help lessen their severity.”

Can hormone replacement therapy have serious negative side effects?

The most widely discussed potential risk of HRT involves an increased risk of blood clots. HRT can also cause an increased risk of gallbladder disease and, for those taking estrogen and progesterone, a small increase in risk of breast cancer. Women who undergo hormone therapy who still have a uterus increase their risk of uterine cancer if they do not use progesterone.

“There may also be an increase in the risk of heart attack for women taking HRT,” said Dr. Hufford, “but this depends on when someone starts hormone therapy and how long she takes it.”

The risks of HRT tend to increase with age, and most doctors do not recommend taking hormones indefinitely. Some of the risks can be lessened through different ways of taking HRT, but they cannot be completely negated.

Is there anyone who should not use hormone therapy?

“For patients with a history of endometrial cancer, hormone-responsive breast cancer, heart attack or stroke, blood clots or a clotting disorder and those who have liver disease, the risks of HRT simply outweigh the benefits and HRT should not be used for those individuals,” said Dr. Hufford.

Fortunately, there are other medications to treat the most common symptoms caused by a decrease in hormones. Those other medications may be tried instead of HRT or used when hormones are no longer safe based on a change in health status.

These other medications can often be taken for longer than hormone therapy, as they don’t have the same risk for aging patients.

Is estrogen always used in hormone therapy?

“Hormone therapy is going to be individualized to the patient’s specific medical history,” said Dr. Hufford. “Patients who have had a hysterectomy and no longer have a uterus can receive estrogen therapy alone, for example, while those who still have a uterus would need a combination of estrogen and progesterone replacement.”

The addition of progesterone helps to reduce the increased risk of endometrial cancer caused by estrogen therapy.

How do you receive hormone replacement therapy?

“Hormone therapy isn’t always a pill,” said Dr. Hufford. “Some patients use a patch, a cream or gel, vaginal suppositories or a vaginal ring.”

What options will be used depends on the specific patient’s needs and how best their symptoms can be treated while decreasing the risk of negative side effects.