Types of Hormone Therapy

Hormone therapy (HT) uses one or more hormones to treat symptoms of menopause. HT uses estrogen, progestin (a type of progesterone), or both. Sometimes testosterone is also added.

Menopause and Hormones Forms of Hormone Therapy How you Will Take Hormones

Menopause symptoms include:

Hot flashes
Night sweats
Sleep problems
Vaginal dryness
Anxiety
Moodiness
Less interest in sex

After menopause, your body stops making estrogen and progesterone. HT can treat menopause symptoms that bother you.

HT does have some risks. It may increase your risk for:

Despite these concerns, for many women, HT is a safe and effective way to treat menopause symptoms.

Currently, experts are unclear on how long you should take HT. Some professional groups suggest that you can take HT for menopause symptoms for longer periods if there is no medical reason to discontinue the medicine. For many women, low doses of HT may be enough to control troublesome symptoms. Low doses of HT tend to have few side effects. These are all issues to discuss with your health care provider.

HT comes in different forms. You may need to try different types before finding one that works best for you.

Estrogen comes in:

Nasal spray
Pills or tablets, taken by mouth
Skin gel
Skin patches, applied to the thigh or belly
Vaginal creams or vaginal tablets to help with dryness and pain with sexual intercourse
Vaginal ring

Most women who take estrogen and who still have their uterus also need to take progestin. Taking both hormones together lowers the risk of endometrial (uterine) cancer. Women who have had their uterus removed cannot get endometrial cancer. So, estrogen alone is recommended for them.

Progesterone or progestin comes in:

Pills
Skin patches
Vaginal creams
Vaginal suppositories
Intrauterine device or intrauterine system

The type of HT your provider prescribes may depend on what menopause symptoms you have. For example, pills or patches can treat night sweats. Vaginal rings, creams, or tablets help relieve vaginal dryness.

Discuss the benefits and risks of HT with your provider.

When taking estrogen and progesterone together, your provider may suggest one of the following schedules:

Cyclic hormone therapy is often recommended when you start menopause.

You take estrogen as a pill or use it in patch form for 25 days.
Progestin is added between days 10 and 14.
You use estrogen and progestin together for the remainder of the 25 days.
You don’t take any hormones for 3 to 5 days.
You may have some monthly bleeding with cyclic therapy.

Combined therapy is when you take estrogen and progestin together every day.

You may have some unusual bleeding when starting or switching to this HT schedule.
Most women stop bleeding within 1 year.

Your provider may prescribe other medicines if you have severe symptoms or have a high risk of osteoporosis. For example, you may also take testosterone, a male hormone, to improve your sex drive.

Side Effects of Hormone Therapy When to Call the Doctor Alternative Names

HT can have side effects, including:

Bloating
Breast soreness
Headaches
Mood swings
Nausea
Water retention
Irregular bleeding

Tell your provider if you notice side effects. Changing the dose or type of HT you take may help reduce these side effects. Do not change your dose or stop taking HT before talking with your doctor.

If you have vaginal bleeding or other unusual symptoms during HT, contact your provider.

Be sure to continue seeing your provider for regular checkups when taking HT.

HRT- types; Estrogen replacement therapy – types; ERT- types of hormone therapy; Hormone replacement therapy – types; Menopause – types of hormone therapy; HT – types; Menopausal hormone types

References

ACOG committee opinion no. 565: Hormone therapy and heart disease. Obstet Gynecol. 2013;121(6):1407-1410. PMID: 23812486 pubmed.ncbi.nlm.nih.gov/23812486/.

de Villiers TJ, Hall JE, Pinkerton JV, et al. Revised global consensus statement on menopausal hormone therapy. Climacteric. 2016;19(4):313-315. PMID: 27322027 pubmed.ncbi.nlm.nih.gov/27322027/.

LeBoff MS, Greenspan SL, Insogna KL et al. The clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int. 2022 Oct;33(10):2049-2102. PMID: 35478046 pubmed.ٍncbi.nlm.nih.gov/35478046/.

Lobo RA. Menopause and care of the mature woman: endocrinology, consequences of estrogen deficiency, effects of hormone therapy, and other treatment options. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 14.

Panay N. Menopause and hormone replacement therapy. In: Magowan B, ed. Clinical Obstetrics and Gynaecology. 5th ed. Elsevier; 2023:chap 9.

Stuenkel CA, Davis SR, Gompel A, et al. Treatment of symptoms of the menopause: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015;100(11):3975-4011. PMID: 26444994 pubmed.ncbi.nlm.nih.gov/26444994/.

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Types of Hormone Therapy

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