Hormone therapy and menopause: what you need to know

Since the 1960s, hormone therapy has been widely used as a treatment for relieving all kinds of menopausal symptoms. According to various international organisations, including the North American Menopause Society, hormone therapy remains the most effective treatment for vasomotor symptoms (VMS) of menopause, such as hot flashes. Symptoms should begin to improve within several days of use. Hormone therapy can help with: 

• Vasomotoric symptoms (such as hot flashes and night sweats).
• Vaginal discomfort such as dryness, itching or pain. 
• Sleep problems. 
• Control and prevention of osteoporosis. 
• In some women, hormone therapy has also proven to be beneficial for symptoms such as heavy menstrual bleeding, migraine and mental problems (e.g., mood swings, stress and gloominess). 

Hormone therapy is generally recommended for women with severe symptoms who are not in a risk group (see section ‘Potential risks and side effects'). The doctor or specialist will need to examine you to rule out an underlying condition and to determine whether hormone therapy is the right choice.

Recent studies show that hormone therapy is a safe and adequate solution for treating menopausal symptoms in most women. HRT has various health benefits, in particular for younger women. There is increasing evidence in the literature that it not only relieves menopausal symptoms, but that it may also reduce the risk of cardiovascular disease, diabetes and various forms of cancer. According to experts, hormone therapy remains the most effective treatment for the relief of troublesome symptoms of menopause. 

Nevertheless, hormone therapy and its associated health effects, risks and side effects have been the subject of debate for decades. A 2002 study that gained worldwide attention linked hormone therapy to a higher chance of negative health impacts, such as an increased risk of breast cancer. As a result, hormone therapies got a bad rap for quite some time. 

However, evidence has since shown that the risks are not as alarming as the study suggested. Also, new developments and improvements in HRT treatments have been introduced. Researchers and doctors agree that hormone therapy can be used safely and without risk by most women, especially if you start it when you're relatively younger.  

Does this mean that hormone therapy is entirely risk free? No, this is not altogether true. According to researchers, balancing the risks and benefits of HRT use is a complex process. For example, older women may be more prone to side effects of hormone therapy because their body is already used to lower hormone levels. Experts agree that it has more risks than benefits in the majority of women when started over the age of 60 years.  

Hormone therapy is considered the most effective treatment for menopausal symptoms, but it is not without risk. However, this applies mostly to women who begin hormone therapy more than 10 years from the onset of menopause. The risks can include: 

• Increased risks of breast cancer and endometrial cancer with long-term use (five years or more).  
• A small increase in the risk for heart and vascular disease (e.g., thrombosis).  
• A small increase in the risk of experiencing stroke. Smoking and having high blood pressure or high cholesterol increases this risk. 

Also, it is common to have side effects in the first few months of taking HRT. Once you are on the right dose, the side effects should go away. These side effects can include:  

• Headache 
• Nausea 
• Breakthrough bleeding 
• Breast tenderness or soreness 

Hormone therapy is not recommended in women with a known or past history of breast cancer or other hormone-related cancer, thrombosis, liver disease or abnormal menstrual bleeding, or who have had a previous stroke. 

Hormone therapy replaces the sex hormones oestrogen and progesterone that your body produces less of as you go through the menopausal transition. By stabilising hormone levels and reducing hormonal fluctuations, the symptoms that you are experiencing will reduce or even go away altogether. 

HRT medicines contain both female sex hormones: oestrogen (oestradiol) and progesterone. They reduce menopausal symptoms by replenishing oestrogen. However, oestrogen also builds up the lining of the uterus. Progesterone protects the lining of the uterus from the stimulating effects of oestrogen. This is important, because a surplus of oestrogen can cause heavy bleeding and increase the risk of endometrial cancer. Are you postmenopausal or have you had a hysterectomy? Then it may not be necessary to take progesterone. 

You and your doctor will determine what dose you need to reduce or eliminate your symptoms. The goal is to prescribe the lowest dose to treat your symptoms for as short as necessary. Usually, the therapy is started at a low dose and gradually increased until menopausal symptoms have been contained. Also, recommendations are continually being evaluated and updated based on scientific findings. Bear in mind that it can take several months to find the right type and dose. 

There is no set length of time you should take HRT for. The duration of treatment is highly individual and depends on your personal situation and symptoms. The average length of time that women use HRT to ease menopausal symptoms is around five years. Doctors usually treat for as long as necessary and recommend gradually decreasing the dose over time once the symptoms are under control. 

There are different types of hormone therapy and they can contain different types of oestrogen and progesterone:  

• Bioidentical hormones: hormones that have the same (identical) chemical composition as those produced by the body itself. They have similar effects as our natural hormones and are broken down in the same way.  
• Synthetic hormones: artificial hormones that resemble our natural hormones but have a different biochemical structure (contraceptive pills also contain synthetic hormones).  

Most treatments that are prescribed contain bioidentical oestrogen (oestradiol), which has exactly the same effect as natural oestradiol. They often also contain a bioidentical progesterone or a synthetic progestogen (such as levonorgestrel or dydrogesterone). It is difficult to say what type of HRT will work best. Some women may respond better to bioidentical hormonal options, others to synthetic options or a combination of both. 

The hormones can come in three dosage forms. 

1. Topical (gels, ointments and patches) 
2. Oral (tablets and capsules)  
3. Vaginal (creams and vaginal suppositories)  

The choice of dosage form depends on the nature of your symptoms. It’s best to treat the symptoms locally, if possible. This is because you can apply less and the medicine goes straight into your bloodstream, bypassing your liver, which reduces the risk of thrombosis.  

If you suffer from vaginal discomfort, such as dryness and itching, then the vaginal route of administration is often preferred. In this case, a low dose of the medication is inserted into the vaginal cavity to alleviate symptoms without subjecting the rest of the body to high levels of hormones. 

If you do not tolerate or want to use hormones, there are other ways to support your hormonal balance and reduce menopausal symptoms. You can opt for a non-hormonal medicine (for weight gain or hot flashes). We also offer premium nutritional supplements which influence the production, conversion or breakdown of hormones, which can help improve hormonal balance*. For example, you could consider taking magnesium, omega-3, Vitamin D and a vitamin and mineral complex. Highly recommended by hormone therapists! Also, the impact of diet and lifestyle on menopausal health should not be underestimated.  

* Health claim pending approval by the European Commission.