Top of the pageDecision Point

Menopause: Should I Use Hormone Therapy (HT)?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Non-Interactive Decision Point

Menopause: Should I Use Hormone Therapy (HT)?

Get the facts

Your options

  • Use hormone therapy (HT).
  • Don't use HT. Try other treatment to manage your menopause symptoms.

Key points to remember

  • Hormone therapy lowers the risk of osteoporosis and possibly colon cancer. But for some women, HT may increase the risk of breast cancer, ovarian cancer, stroke, blood clots, and possibly dementia and heart attack.footnote 1, footnote 2
  • The health risks linked to HT are not high for most women. But on average, these small risks outweigh the small benefits of HT.
  • HT can help you deal with menopause symptoms such as hot flashes and sleep problems. If you decide to use it, take the lowest dose you can for the shortest possible time. See your doctor regularly to check your benefits and health risks.
  • Instead of HT, you might try other prescription medicines, black cohosh, or dietary soy to manage hot flashes. A lubricant gel or an estrogen cream, ring, or tablet may help with vaginal soreness and dryness.
  • HT helps prevent bone loss and osteoporosis. But if you are at high risk for osteoporosis, HT is only one of several treatments you could try.
FAQs

What is menopause?

Menopause is the point in a woman's life when she has not had a menstrual period for 1 year. Menopause marks the end of the childbearing years. It is sometimes called "the change of life."

For most women, menopause happens at around age 50, but every woman's body has its own time line. As you get closer to menopause, your estrogen levels go up and down unevenly. This causes changes in your period and other symptoms, such as hot flashes, headaches, and sleep problems. After your estrogen levels drop past a certain point, your menstrual cycles end.

Menopause is a natural part of growing older. You don't need treatment for it unless your symptoms bother you.

What is hormone therapy?

Hormone therapy uses a combination of two hormones, estrogen and progestin. HT comes in the form of a pill, patch, gel, spray, or vaginal ring. HT increases the estrogen and progestin levels in your body. It can prevent osteoporosis and ease menopause symptoms such as hot flashes and sleep problems.

Because of the risks from HT, many experts recommend that HT be used:

  • For short-term treatment of menopause symptoms. If you decide to take HT, use the lowest dose you can, and take it for as short a time as possible.
  • To prevent or treat osteoporosis. If you have a strong risk of osteoporosis, you might consider taking HT. The risk of osteoporosis may outweigh the risks linked to HT. But it's important to think about all possible osteoporosis treatments and to compare their risks and benefits.

What if you don't take HT?

Menopause symptoms can be upsetting and uncomfortable. But you don't have to suffer through them. There are other things besides taking HT that you can do to help.

The first step is to have a healthy lifestyle. This can reduce your symptoms and also lower your risk of heart disease and other long-term problems linked to aging. Eat a heart-healthy diet, get regular exercise, don't smoke, and limit caffeine, alcohol, and stress.

If you still need help dealing with symptoms, you might try:

  • Breathing exercises to help with hot flashes and emotional symptoms.
  • Black cohosh and dietary soy, which may reduce hot flashes.
  • Vaginal lubricants (such as Astroglide and K-Y Jelly) to help with vaginal dryness, and vaginal estrogen to relieve soreness.
  • Antidepressant medicines, a blood pressure medicine called clonidine, or gabapentin. These may lower the number of hot flashes you have. And they can make hot flashes less severe when you do have them.

To manage symptoms before you start menopause, you might think about taking low-dose birth control pills, if you don't smoke and aren't at risk for heart disease or breast cancer.

What are the benefits of taking HT?

Hormone therapy:

  • Reduces the number of hot flashes you have, and it makes them less severe when you do have them.footnote 3
  • Lowers your risk of osteoporosis. Estrogen slows bone thinning and helps increase bone thickness.footnote 3
  • Prevents vaginal dryness and soreness caused by low estrogen.
  • Slows the loss of skin collagen. Collagen puts the stretch in skin and muscle.
  • Reduces the risk of dental problems, such as tooth loss and gum disease.
  • May reduce the risk of colon cancer.footnote 4

What are the risks from HT?

Risk varies based on when you start HT in menopause and how long you take it. Short-term use of hormone therapy in early menopause has less risk than when it is started later in menopause.

Women who take HT have slightly higher rates of:footnote 1, footnote 2

  • Stroke.
  • Blood clots.
  • Heart attack.
  • Breast cancer.
  • Gallstones.
  • Ovarian cancer.
  • Dementia.
  • Urinary incontinence.

Your risk will differ based on your personal or family history.

If you have had breast cancer, taking HT isn't safe for you.

Why might your doctor recommend hormone therapy?

Your doctor may recommend HT if:

  • You have no risk factors for heart disease, blood clots, stroke, or breast or ovarian cancer; you are willing to accept the small increase in risks of cancer and heart disease; and
  • You have thought about or tried other treatments.
  • You have menopause symptoms that are lowering your quality of life.

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Take HT Take HT
  • You take daily pills or use a patch, gel, spray, or vaginal ring to increase hormone levels.
  • You take hormone therapy (HT) to relieve menopause symptoms.

Taking HT:

  • Helps you deal with hot flashes and other menopause symptoms.
  • Lowers your risk of osteoporosis.
  • Eases vaginal dryness and soreness.
  • Slows loss of skin collagen.
  • Reduces the risk of dental problems.

Side effects can include:

  • Vaginal bleeding or spotting.
  • Breast tenderness.
  • Bloating.
  • Nausea.

Women who take HT may have slightly higher rates of:

  • Stroke.
  • Blood clots.
  • Heart attack.
  • Breast cancer.
  • Gallstones.
  • Ovarian cancer.
  • Dementia.
  • Urinary incontinence.

Some risks depend on your age, when HT is started, and how long it is used.

Don't take HT Don't take HT
  • You manage menopause symptoms such as hot flashes with:
    • Breathing exercises.
    • Black cohosh and dietary soy.
    • Antidepressant medicines, blood pressure medicine (clonidine), or gabapentin.
    • Vaginal lubricants (such as Astroglide and K-Y Jelly) or low-dose vaginal estrogen.
  • You avoid the health risks from HT.
  • Your menopause symptoms may still bother you.
  • Other prescription medicines can have side effects, such as:
    • Headaches, upset stomach, and problems sleeping (antidepressants).
    • Problems linked to low blood pressure (clonidine).

Personal stories about deciding whether to take hormone therapy (HT)

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I've been very fortunate. Like my mother, I made it through menopause without hot flashes or other major discomforts. My doctor tells me that all I have to do now is be sure I get my regular checkups and exams, take calcium and vitamin D for bone health, and take good care of myself.

Karen, age 55

By the time my periods stopped, I didn't have bad hot flashes or other problems. I was pretty proud of myself for getting exercise and eating right, and thought that I was one of the lucky ones. Did I get hit, though! The night sweats started a few months after my last period, and I couldn't sleep or get through the day after that. So, I tried low-dose HT for 6 months, to get some relief. Then, I tapered off of it over a few months, and they weren't as bad. I figure I can tough it out now till my body adjusts to its new state.

Jane, age 52

My doctor told me that HT would help me in so many ways, so I started taking it after my periods stopped. The problem is, I had bleeding on and off that was like my period, and I just couldn't take it after 6 months. I haven't taken it since, and I've grown used to my body's changes. I still get hot flashes sometimes but not like I used to. When I feel one coming on, it really helps me to do relaxation breathing. I think that calming my body and mind has a big effect on making a hot flash go away.

Mary Anne, age 60

I have already had a terrible time with perimenopausal moodiness and some occasional hot flashes, and low-dose birth control pills have helped even out the hormone ups and downs. So I know what my plan is. When my doctor gives me the go-ahead around menopause age, I'm going to switch to low-dose HT. Then I'll taper off of it after a year or so. I need to be able to function!

Jenessa, age 45

There is no way I'd ever take estrogen or progestin, because of the cancer risks. There's just too much we don't know, and what we do know from recent studies scares me. I used an antidepressant when my hot flashes were bad, and that helped me a lot. Now, I just take calcium and vitamin D supplements and get regular exercise to help protect my bones.

Sondra, age 55

A girlfriend told me that she was having great results from taking black cohosh, so I tried it for the occasional hot flashes and mood swings I was having. I think it's working quite well. But it wasn't until I went for my annual gyn exam that I learned it's best to have a checkup every 6 months, like women in Germany who take it by prescription. Now I know to think of black cohosh as a prescription drug, kind of like estrogen, that's still being studied.

Sam, age 49

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to use hormone therapy

Reasons not to use hormone therapy

Other treatment hasn't helped me deal with my menopause symptoms.

I want to try other treatment before I try HT for my symptoms.

More important
Equally important
More important

The benefits of HT outweigh the risks for me.

I feel the risks from HT are too high for me.

More important
Equally important
More important

I don't mind taking medicines to help me manage my symptoms.

I don't want to take medicines if I can avoid them.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Using HT

NOT using HT

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1, Does taking HT raise your risk of health problems and disease?
2, Can HT help you deal with menopause?
3, Are there other treatments that can help with menopause symptoms?

Decide what's next

1,Do you understand the options available to you?
2,Are you clear about which benefits and side effects matter most to you?
3,Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure
2, Check what you need to do before you make this decision.

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision 

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts 

Key concepts that you understood

Key concepts that may need review

Getting ready to act 

Patient choices

What matters to you 

Print Summary

Credits and References

Credits
AuthorHealthwise Staff
Primary Medical ReviewerAnne C. Poinier, MD - Internal Medicine
Primary Medical ReviewerKathleen Romito, MD - Family Medicine
Specialist Medical ReviewerCarla J. Herman, MD, MPH - Geriatric Medicine
References
Citations
  1. North American Menopause Society (2012). The 2012 hormone therapy position statement of the North American Menopause Society. Menopause, 19(3): 257-271. http://www.menopause.org/docs/default-document-library/psht12.pdf?sfvrsn=2. Accessed August 27, 2015.
  2. North American Menopause Society (2015). The North American Menopause Society statement on continuing use of systemic hormone therapy after age 65. Menopause, 22(7): 693. http://www.menopause.org/docs/default-source/2015/2015-nams-hormone-therapy-after-age-65.pdf. Accessed August 24, 2015.
  3. Shifren JL, et al. (2010). Role of hormone therapy in the management of menopause. Obstetrics and Gynecology, 115(4): 839-855.
  4. Fritz MA, Speroff L (2011). Postmenopausal hormone therapy. In Clinical Gynecologic Endocrinology and Infertility, 8th ed., pp. 749-857. Philadelphia: Lippincott Williams and Wilkins.
Other Works Consulted
  • Nelson HD, et al. (2012). Menopausal Hormone Therapy for the Primary Prevention of Chronic Conditions: A Systematic Review to Update the U.S. Preventive Services Task Force Recommendations. Annals of Internal Medicine, 157(2): 104-113.
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Menopause: Should I Use Hormone Therapy (HT)?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the Facts

Your options

  • Use hormone therapy (HT).
  • Don't use HT. Try other treatment to manage your menopause symptoms.

Key points to remember

  • Hormone therapy lowers the risk of osteoporosis and possibly colon cancer. But for some women, HT may increase the risk of breast cancer, ovarian cancer, stroke, blood clots, and possibly dementia and heart attack.1, 2
  • The health risks linked to HT are not high for most women. But on average, these small risks outweigh the small benefits of HT.
  • HT can help you deal with menopause symptoms such as hot flashes and sleep problems. If you decide to use it, take the lowest dose you can for the shortest possible time. See your doctor regularly to check your benefits and health risks.
  • Instead of HT, you might try other prescription medicines, black cohosh, or dietary soy to manage hot flashes. A lubricant gel or an estrogen cream, ring, or tablet may help with vaginal soreness and dryness.
  • HT helps prevent bone loss and osteoporosis. But if you are at high risk for osteoporosis, HT is only one of several treatments you could try.
FAQs

What is menopause?

Menopause is the point in a woman's life when she has not had a menstrual period for 1 year. Menopause marks the end of the childbearing years. It is sometimes called "the change of life."

For most women, menopause happens at around age 50, but every woman's body has its own time line. As you get closer to menopause, your estrogen levels go up and down unevenly. This causes changes in your period and other symptoms, such as hot flashes, headaches, and sleep problems. After your estrogen levels drop past a certain point, your menstrual cycles end.

Menopause is a natural part of growing older. You don't need treatment for it unless your symptoms bother you.

What is hormone therapy?

Hormone therapy uses a combination of two hormones, estrogen and progestin. HT comes in the form of a pill, patch, gel, spray, or vaginal ring. HT increases the estrogen and progestin levels in your body. It can prevent osteoporosis and ease menopause symptoms such as hot flashes and sleep problems.

Because of the risks from HT, many experts recommend that HT be used:

  • For short-term treatment of menopause symptoms. If you decide to take HT, use the lowest dose you can, and take it for as short a time as possible.
  • To prevent or treat osteoporosis. If you have a strong risk of osteoporosis, you might consider taking HT. The risk of osteoporosis may outweigh the risks linked to HT. But it's important to think about all possible osteoporosis treatments and to compare their risks and benefits.

What if you don't take HT?

Menopause symptoms can be upsetting and uncomfortable. But you don't have to suffer through them. There are other things besides taking HT that you can do to help.

The first step is to have a healthy lifestyle. This can reduce your symptoms and also lower your risk of heart disease and other long-term problems linked to aging. Eat a heart-healthy diet, get regular exercise, don't smoke, and limit caffeine, alcohol, and stress.

If you still need help dealing with symptoms, you might try:

  • Breathing exercises to help with hot flashes and emotional symptoms.
  • Black cohosh and dietary soy, which may reduce hot flashes.
  • Vaginal lubricants (such as Astroglide and K-Y Jelly) to help with vaginal dryness, and vaginal estrogen to relieve soreness.
  • Antidepressant medicines, a blood pressure medicine called clonidine, or gabapentin. These may lower the number of hot flashes you have. And they can make hot flashes less severe when you do have them.

To manage symptoms before you start menopause, you might think about taking low-dose birth control pills, if you don't smoke and aren't at risk for heart disease or breast cancer.

What are the benefits of taking HT?

Hormone therapy:

  • Reduces the number of hot flashes you have, and it makes them less severe when you do have them.3
  • Lowers your risk of osteoporosis. Estrogen slows bone thinning and helps increase bone thickness.3
  • Prevents vaginal dryness and soreness caused by low estrogen.
  • Slows the loss of skin collagen. Collagen puts the stretch in skin and muscle.
  • Reduces the risk of dental problems, such as tooth loss and gum disease.
  • May reduce the risk of colon cancer.4

What are the risks from HT?

Risk varies based on when you start HT in menopause and how long you take it. Short-term use of hormone therapy in early menopause has less risk than when it is started later in menopause.

Women who take HT have slightly higher rates of:1, 2

  • Stroke.
  • Blood clots.
  • Heart attack.
  • Breast cancer.
  • Gallstones.
  • Ovarian cancer.
  • Dementia.
  • Urinary incontinence.

Your risk will differ based on your personal or family history.

If you have had breast cancer, taking HT isn't safe for you.

Why might your doctor recommend hormone therapy?

Your doctor may recommend HT if:

  • You have no risk factors for heart disease, blood clots, stroke, or breast or ovarian cancer; you are willing to accept the small increase in risks of cancer and heart disease; and
  • You have thought about or tried other treatments.
  • You have menopause symptoms that are lowering your quality of life.

2. Compare your options

  Take HT Don't take HT
What is usually involved?
  • You take daily pills or use a patch, gel, spray, or vaginal ring to increase hormone levels.
  • You take hormone therapy (HT) to relieve menopause symptoms.
  • You manage menopause symptoms such as hot flashes with:
    • Breathing exercises.
    • Black cohosh and dietary soy.
    • Antidepressant medicines, blood pressure medicine (clonidine), or gabapentin.
    • Vaginal lubricants (such as Astroglide and K-Y Jelly) or low-dose vaginal estrogen.
What are the benefits?

Taking HT:

  • Helps you deal with hot flashes and other menopause symptoms.
  • Lowers your risk of osteoporosis.
  • Eases vaginal dryness and soreness.
  • Slows loss of skin collagen.
  • Reduces the risk of dental problems.
  • You avoid the health risks from HT.
What are the risks and side effects?

Side effects can include:

  • Vaginal bleeding or spotting.
  • Breast tenderness.
  • Bloating.
  • Nausea.

Women who take HT may have slightly higher rates of:

  • Stroke.
  • Blood clots.
  • Heart attack.
  • Breast cancer.
  • Gallstones.
  • Ovarian cancer.
  • Dementia.
  • Urinary incontinence.

Some risks depend on your age, when HT is started, and how long it is used.

  • Your menopause symptoms may still bother you.
  • Other prescription medicines can have side effects, such as:
    • Headaches, upset stomach, and problems sleeping (antidepressants).
    • Problems linked to low blood pressure (clonidine).

Personal stories

Personal stories about deciding whether to take hormone therapy (HT)

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I've been very fortunate. Like my mother, I made it through menopause without hot flashes or other major discomforts. My doctor tells me that all I have to do now is be sure I get my regular checkups and exams, take calcium and vitamin D for bone health, and take good care of myself."

— Karen, age 55

"By the time my periods stopped, I didn't have bad hot flashes or other problems. I was pretty proud of myself for getting exercise and eating right, and thought that I was one of the lucky ones. Did I get hit, though! The night sweats started a few months after my last period, and I couldn't sleep or get through the day after that. So, I tried low-dose HT for 6 months, to get some relief. Then, I tapered off of it over a few months, and they weren't as bad. I figure I can tough it out now till my body adjusts to its new state."

— Jane, age 52

"My doctor told me that HT would help me in so many ways, so I started taking it after my periods stopped. The problem is, I had bleeding on and off that was like my period, and I just couldn't take it after 6 months. I haven't taken it since, and I've grown used to my body's changes. I still get hot flashes sometimes but not like I used to. When I feel one coming on, it really helps me to do relaxation breathing. I think that calming my body and mind has a big effect on making a hot flash go away."

— Mary Anne, age 60

"I have already had a terrible time with perimenopausal moodiness and some occasional hot flashes, and low-dose birth control pills have helped even out the hormone ups and downs. So I know what my plan is. When my doctor gives me the go-ahead around menopause age, I'm going to switch to low-dose HT. Then I'll taper off of it after a year or so. I need to be able to function!"

— Jenessa, age 45

"There is no way I'd ever take estrogen or progestin, because of the cancer risks. There's just too much we don't know, and what we do know from recent studies scares me. I used an antidepressant when my hot flashes were bad, and that helped me a lot. Now, I just take calcium and vitamin D supplements and get regular exercise to help protect my bones."

— Sondra, age 55

"A girlfriend told me that she was having great results from taking black cohosh, so I tried it for the occasional hot flashes and mood swings I was having. I think it's working quite well. But it wasn't until I went for my annual gyn exam that I learned it's best to have a checkup every 6 months, like women in Germany who take it by prescription. Now I know to think of black cohosh as a prescription drug, kind of like estrogen, that's still being studied."

— Sam, age 49

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to use hormone therapy

Reasons not to use hormone therapy

Other treatment hasn't helped me deal with my menopause symptoms.

I want to try other treatment before I try HT for my symptoms.

       
More important
Equally important
More important

The benefits of HT outweigh the risks for me.

I feel the risks from HT are too high for me.

       
More important
Equally important
More important

I don't mind taking medicines to help me manage my symptoms.

I don't want to take medicines if I can avoid them.

       
More important
Equally important
More important

My other important reasons:

My other important reasons:

  
       
More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Using HT

NOT using HT

       
Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. Does taking HT raise your risk of health problems and disease?

  • Yes
  • No
  • I'm not sure
You're right. Women who take HT have slightly higher rates of breast cancer, ovarian cancer, heart attack, stroke, blood clots, and dementia.

2. Can HT help you deal with menopause?

  • Yes
  • No
  • I'm not sure
You're right. HT can help you deal with menopause symptoms such as hot flashes and sleep problems.

3. Are there other treatments that can help with menopause symptoms?

  • Yes
  • No
  • I'm not sure
You're right. Instead of HT, you might try other prescription medicines, black cohosh, or a vaginal estrogen to help deal with symptoms.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

     
Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.
 
Credits
ByHealthwise Staff
Primary Medical ReviewerAnne C. Poinier, MD - Internal Medicine
Primary Medical ReviewerKathleen Romito, MD - Family Medicine
Specialist Medical ReviewerCarla J. Herman, MD, MPH - Geriatric Medicine
References
Citations
  1. North American Menopause Society (2012). The 2012 hormone therapy position statement of the North American Menopause Society. Menopause, 19(3): 257-271. http://www.menopause.org/docs/default-document-library/psht12.pdf?sfvrsn=2. Accessed August 27, 2015.
  2. North American Menopause Society (2015). The North American Menopause Society statement on continuing use of systemic hormone therapy after age 65. Menopause, 22(7): 693. http://www.menopause.org/docs/default-source/2015/2015-nams-hormone-therapy-after-age-65.pdf. Accessed August 24, 2015.
  3. Shifren JL, et al. (2010). Role of hormone therapy in the management of menopause. Obstetrics and Gynecology, 115(4): 839-855.
  4. Fritz MA, Speroff L (2011). Postmenopausal hormone therapy. In Clinical Gynecologic Endocrinology and Infertility, 8th ed., pp. 749-857. Philadelphia: Lippincott Williams and Wilkins.
Other Works Consulted
  • Nelson HD, et al. (2012). Menopausal Hormone Therapy for the Primary Prevention of Chronic Conditions: A Systematic Review to Update the U.S. Preventive Services Task Force Recommendations. Annals of Internal Medicine, 157(2): 104-113.
Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.

Current as of: October 6, 2017

Author: Healthwise Staff

Medical Review: Anne C. Poinier, MD - Internal Medicine & Kathleen Romito, MD - Family Medicine & Carla J. Herman, MD, MPH - Geriatric Medicine