The Benefits and Risks of Using Hormone Therapy for Menopause

Menopause is an expected, natural part of life for every person born with ovaries. However, just because it’s a universal experience, doesn’t mean menopause symptoms are always easy to manage.

75% of individuals going through menopause say symptoms impact their daily lives, and 25% say they suffer from severe symptoms. This can have a profound impact on your quality of life, as well as your health.

Hormone fluctuations during the menopause transition can lead to symptoms like hot flashes, mood changes, sleep disturbances, and vaginal dryness. If these hormone fluctuations are left unmanaged, they could potentially contribute to other health issues, such as:

Osteoporosis: Decreases in estrogen levels during the menopause transition can lead to a decrease in bone density, which increases the risks of osteoporosis and fractures.

Cardiovascular Disease: It’s believed that estrogen has a protective effect on the heart. Therefore, reduced estrogen levels during the menopause transition may contribute to an increased risk of cardiovascular issues.

Mental Health Issues: Menopause symptoms like mood swings and sleep disturbances can impact your mental health, which can potentially lead to anxiety and depression if unaddressed.

This page will talk about one of the treatment options that can be considered to reduce and control the severity of your ongoing menopause symptoms - hormone therapy.

What Are the Two Basic Types of Hormone Therapy?

There are two basic types of hormone therapy that can be suggested for menopause treatments:

Estrogen Therapy

This form of treatment is primarily used for people that have had a hysterectomy (surgical removal of the uterus) and therefore do not need to protect against endometrial cancer.

Estrogen Plus Progesterone Therapy (EPT)

This form of therapy combines both estrogen and progesterone together, and it’s used for individuals that still have an intact uterus.

This approach is taken to prevent endometrial hyperplasia, which is an excessive thickening of the uterine lining. It’s also used to prevent endometrial carcinoma, a type of cancer of the uterine lining. These conditions can result from estrogen treatments administered without progesterone, to people who still have an intact uterus.

If you’d like to learn more about the two types of hormone treatments available, and whether one of them might be right for you, complete an assessment with a Felix healthcare practitioner.

What Are the Benefits of Hormone Therapy?

One of the major benefits of hormone therapy is that it reduces the frequency and severity of vasomotor symptoms associated with menopause (i.e., hot flashes, night sweats, excessive sweats, feeling overheated).

In addition to this, there are other positive health benefits to using hormone therapy during menopause for symptom relief:

Relief from Vaginal Symptoms

Hormone therapy can help alleviate vaginal dryness, pain during sexual activities, as well as other urinary symptoms.

Improved Bone Health

Not only does hormone therapy help prevent bone loss, but also reduces the risk of fractures.

Reduced Mood Changes & Sleep Disturbances

Hormone therapy can help improve overall mood, as well as reduce mood swings caused by fluctuating hormones. It can also aid in getting a better sleep, through reducing bothersome symptoms like night sweats and hot flashes.

Lowered Risks of Heart Disease & Diabetes

While further studies are needed to determine the link, there is a potential for reduction in both heart disease and diabetes, when hormone therapy is started shortly after the start of the menopause transition. 

If you’d like to learn more about the potential benefits of hormone treatments for menopause symptoms, talk to a Felix healthcare practitioner. They’ll be able to answer any other questions you may have.

Understanding the Potential Risks of Hormone Therapy

It’s important to note that while hormone therapy is the most effective treatment for menopause symptoms, there are potential risks, as with any other medication.

As a society, we have difficulty interpreting risks effectively especially when it comes to our health. All you have to do is look at the WHI study on menopause to see how a few misinterpreted risks can lead to widespread misinformation.

For menopausal individuals that start appropriately-dosed MHT treatments under the age of 60, or within the last ten years of their period, the benefits to their health can far outweigh the risks. These risks are all considered very rare (1/1000-1/10,000 or less than 0.1%), and many can be further reduced by using transdermal hormone therapy (gel, spray, or patch).

With that in mind, these rare risks include:

Blood Clots:

• Risks of deep vein thrombosis and pulmonary embolisms increase if you take hormones orally.
• The risk increase is 0.1% for people 45-55 and increases to 0.2% for people 56-64.
• The risk may be lower if you use a transdermal estrogen, such as a patch, gel, or spray.

Breast Cancer:

• Using MHT for longer than 5 years is associated with the greatest risks of breast cancer, but the relative risk increase is still less than 0.1% or an additional 1 in 10,000 people per year.
• The risks are higher for women starting hormone therapy over the age of 65, meaning the benefits of hormone therapy are greatest within the first 10 years of postmenopause.
• The risk is lower when you’re not using progesterone in combination with estrogen, or using estrogen-only treatments, but these types of treatments are only recommended for people that have had a hysterectomy.

Cholesterol:

• Oral estrogen - may worsen triglycerides, but it improves HDL-C, LCL-C, as well as total cholesterol in your body.
• Transdermal estrogen - has no impact on triglycerides or cholesterol.
• As we age, many people struggle with triglycerides and cholesterol due to diet and lifestyle. These factors can have more impact on our long-term health than the risks posed by hormone therapy.

Gallbladder:

• The risk of gallbladder disease increases by 0.5%-0.6% for individuals taking oral estrogen therapy.
• Transdermal estrogen use is associated with a lower risk of gallbladder disease than oral forms of estrogen.

Heart Health:

• MHT can increase the risks of heart disease in menopausal individuals starting MHT over age 60, or if they are more than 10 years after the start of menopause.
• When starting MHT before 60, or within the first 10 years of menopause, this risk is not increased.
• Maintaining strong heart health as we age requires living a healthy lifestyle including: not smoking, eating well, and getting regular exercise (with strength-training). It’s important to incorporate these lifestyle changes, in order to help maintain your health as you age.

Dementia:

• MHT can potentially increase the risks of dementia in individuals starting hormone therapy over age 65.

Strokes:

• Oral MHT has been shown to increase the risks of stroke by 0.1%.
• However, that risk goes away soon after you stop taking hormones.
• Transdermal therapy carries a lower risk of stroke than oral formulations.

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TO SUMMARIZE: These conditions are all rare, but they highlight the importance of having a full discussion with your healthcare practitioner; especially if you’re experiencing moderate to severe symptoms of menopause, or you’d like to learn more about the benefits and risks of using hormone therapy for menopause.

Individualization is key, and your MHT treatment plan should be reassessed (at least) once a year to monitor your health, as well as ensure that you are on the correct dosage and formulation.

Your practitioner can help you find balance between treating your symptoms safely, and avoiding increased risks.

Who Can Benefit from Hormone Therapy?

Anyone with moderate to severe menopause symptoms (i.e., hot flashes, night sweats, vaginal dryness, etc.) might benefit from hormone therapy; especially if your symptoms are impacting  your health or quality of life.

People that have been diagnosed with Early Menopause or Premature Ovarian Insufficiency may also benefit from hormone therapy, because it can help replace hormones in your body until you reach the natural age of menopause (age 51 in Canada).

People in postmenopause have a higher risk of osteoporosis, which can result in bone loss or bone fractures and may also benefit from hormone therapy.

How Do I Know if Hormone Therapy is Right for Me?

There are a few different ways to determine whether hormone therapy might be right for you. Let’s discuss them:

Evaluate Your Personal Risks vs Benefits of Hormone Therapy

No one knows your personal and family medical history better than you.

Consider the potential risks that you could be facing, based on your personal and family’s history of heart disease, breast cancer, stroke, and blood clots. Be sure to share these with your healthcare practitioner.

Consider Your Age & How Long Since Menopause Started

Hormone therapy offers the highest level of benefit for people, before the age of 60 or within 10 years of the onset of menopause.

So, if you’re wondering whether hormone therapy for menopause symptoms could benefit you, talk to your healthcare practitioner sooner than later.

Regular Monitoring with Your Practitioner

It’s vital that you have regular check-ups with your healthcare practitioner, so that they can keep an eye on how your treatments are working for you.

This gives them the opportunity to make adjustments to your treatments as needed, so that you can minimize your symptoms, as well as your potential risks.

Keep Up with Testing

Because menopause marks a time of change both physically and emotionally, ensure that you are keeping up to date with other testing including: 

• Cervical cancer screening
• Breast cancer screening
• Colorectal cancer screening
• Cardiovascular risk assessment: Cholesterol levels, blood sugar, blood pressure monitoring

Talk to a Practitioner

Talking to a healthcare practitioner is the best way to see whether hormone therapy is the right treatment option for you.

Menopause is not a phase to be feared, but one that marks a new chapter of life. A chapter that will hopefully be filled with experiences that you have yet to discover and celebrate.

‍Complete an assessment with a practitioner from Felix, and our team can help you take back control of your menopause symptoms. With Felix in your corner, you can get back to living life on your terms, the way it should be.

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While our use of the term 'women' when talking about the menopause transition is based on existing scientific research and literature, we recognize this is not inclusive of everyone's experience. To the transgender men and non-binary folx who will experience menopause, and the transgender women who won't — know that we see you and are continuing to work toward a way to create space for everyone in this conversation.