If you’ve been—or are going—through menopause, you know it can be a doozy, between the acne, sleep difficulties, cognitive symptoms and let’s not forget the hot flashes. One treatment for these symptoms is menopausal hormone therapy (MHT)—which you might know by the name hormone replacement therapy, a treatment that replaces the hormones that your body isn’t making enough of, thereby improving menopause symptoms like vaginal dryness and changes in mood. I checked in with Dr. Mary Jacobson, MD, to learn more about MHT, including benefits, risks and alternatives.
Everything You've Ever Wanted to Know (But Were Scared to Ask) About Menopausal Hormone Therapy
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Published May 24, 2024
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Meet the Expert
Dr. Mary Jacobson, MD, is the Chief Medical Officer of Hello Alpha, which aims to empower women to take control of their personal healthcare by providing patients with access to simple, everyday medical needs. Dr. Jacobson is an accomplished academic, board-certified obstetrician and gynecologist and minimally invasive surgeon with extensive experience in clinical care, medical education, hospital operations and research.
What Is Hormone Replacement therapy? How Is It Different from Hormone Therapy?
First things first, Dr. Jacobson tells me that hormone replacement therapy is an outdated phrase “based on the mistaken belief that female menopause signified a hormone deficiency.” Instead, she says, “The phrase, menopausal hormone therapy (MHT) or hormone therapy (HT), albeit nuanced, recognizes menopause as a natural stage of reproductive life.”
What Forms Does Hormone Therapy Come In?
Hormone therapy comes in many forms, including:
- Pills that you swallow
- Patches you stick on your skin
- Gels you apply to the skin
- Tablets you insert vaginally
How Can Hormone Therapy Help During Menopause?
Per Dr. Jacobson, menopausal hormone therapy treats:
- Vasomotor symptoms (VMS): hot flashes, night sweats, sleep disturbances
- Vaginal symptoms: dryness, painful sexual intercourse
- Mood: anxiety, depressive symptoms, irritability
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What Are the Benefits of Hormone Therapy During Menopause?
Dr. Jacobson tells me that MHT is FDA-approved for:
- Moderate to severe VMS
- Prevention of osteoporosis in postmenopausal women
- Treatment of low estrogen levels due to hypogonadism (when your body does not produce enough sex hormones), removal of both ovaries, or primary ovarian insufficiency
- Treatment of moderate to severe vulvovaginal symptoms
What Are the Risks of MHT?
The risks of hormone therapy differ depending on type, dose, duration of use, route of administration, timing of initiation and whether a progestin is used, Dr. Jacobson explains. “Risks of systemic estrogen therapy alone and combination estrogen and progestin include increased risk for venous thromboembolism and gallbladder disease.” Additionally, she says, the combination estrogen and progestin carries a rare but increased risk for stroke and breast cancer. “Patients with a uterus who take estrogen without an adequate amount of progestin are at increased risk of endometrial hyperplasia and endometrial cancer.”
Is There Anyone Who Shouldn't Consider MHT? If So, Are There Any Alternatives?
While MHT is appropriate for many symptomatic women, Dr. Jacobson says that there are some contraindications that would rule out hormone therapy as a treatment for menopause symptoms. These include a history of an estrogen-sensitive cancer (like breast cancer), coronary heart disease, heart attack, stroke and venous thromboembolism or inherited high risk of thromboembolic (blood clotting disease).
If you have one of these contraindications but are still looking for relief from menopause symptoms, don’t fret; Dr. Jacobson tells me that there are a number of other medications that can help with symptoms, including the antidepressants paroxetine (Brisdelle) and Venlafaxine (off-label), which provide mild to moderate improvements in vasomotor symptoms. Also, “Gabapentin is associated with improvements in the frequency and severity of vasomotor symptoms. Fezolinetant (VEOZAH) is a novel, non-hormonal medication which treats moderate-severe vasomotor symptoms. Fezolinetant modulates neuronal activity in the thermoregulatory center of the hypothalamus in the brain.”
Additionally, Dr. Jacobson says folks can try the below non-prescription based methods to manage their symptoms.
- For VMS:
- Cognitive-behavioral therapy
- Clinical hypnosis
- Weight loss
- Stellate ganglion block (an injection of medication into a collection of nerves at the bottom of the front side of then neck)
- For Vaginal Symptoms:
- Over the counter vaginal lubricants (e.g., Astroglide, O’My, K-Y Brand, Liquid Silk, Yes!, Pjur, Pink, Wet Platinum)
- Over the counter vaginal moisturizers (e.g., Luvena, Replens)
- Topical anesthetics
- Psychotherapy (sex therapy)
- Pelvic floor exercises
- Vaginal dilator therapy
The Bottom Line
Menopausal hormone therapy is one of a number of treatments—in addition to lifestyle changes, supplements, integrative therapies and prescription medications—that can ease vasomotor, vaginal and mood symptoms associated with menopause. While it’s helpful to read up on your options, only you and your doctor can determine what course of action is right for you.
