Everything You've Ever Wanted to Know (But Were Scared to Ask) About Menopausal Hormone Therapy

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.