Hormone Therapy Benefits. Your Questions Answered by our Internal Specialist, Dr. Mera

Hormone therapy (HT) is one of the government-approved treatments for relief of menopausal symptoms. These symptoms, caused by lower levels of estrogen at menopause, include hot flashes, sleep disturbances, and vaginal dryness. HT is also approved for the prevention of osteoporosis. Today, clinicians prescribe much lower doses for much shorter terms (3-5 years) than before 2002.

To begin this discussion about the benefits and risks of menopausal HT, here is some background information.

There are three benchmark stages of natural menopause:

• Perimenopause (or the menopause transition) is the span of time between the start of symptoms (such as erratic periods) and 1 year after the final menstrual period.
• Menopause is confirmed 1 year (12 months) after the final menstrual period.
• Postmenopause is all the years beyond menopause.

There are two basic types of HT:

• ET means estrogen-only therapy. Estrogen is the hormone that provides the most menopausal symptom relief. ET is prescribed for women without a uterus due to a hysterectomy.
• EPT means combined estrogen plus progestogen therapy. Progestogen is added to ET to protect women with a uterus against uterine (endometrial) cancer from estrogen alone.

There are two general ways to take HT:

• Systemic products circulate throughout the bloodstream and to all parts of the body. They are available as an oral tablet, patch, gel, emulsion, spray, or injection and can be used for hot flashes and night sweats, vaginal symptoms, and osteoporosis.
• Local (nonsystemic) products affect only a specific or localized area of the body. They are available as a cream, ring, or tablet and can be used for vaginal symptoms.

Current prescribing practice:

Begin HT with the lowest effective dose for the shortest amount of time consistent with their individual goals. The benefit-risk ratio is favorable for women who initiate HT close to menopause (ages 50-59, typically) but becomes riskier with time since menopause and advancing age.

Women with early menopause before age 40 without a history of breast cancer risk can take HT until the typical age of menopause at 51 if there is no reason not to take it.

Clinicians will recommend an individualized plan for each woman. There is no “one size fits all” therapy