Hormone Replacement Therapy: What to know about use and effects
Hormone replacement therapy (HRT) refers to medical treatments that supply hormones the body no longer makes in sufficient amounts. It most commonly addresses changes that occur with menopause, but HRT approaches can vary by hormone type, route of delivery, and individual health goals. Understanding how HRT works, potential benefits, and known risks helps people make informed decisions with their clinicians.
This article is for informational purposes only and should not be considered medical advice. Please consult a qualified healthcare professional for personalized guidance and treatment.
What are hormones and how do they work?
Hormones are chemical messengers produced by glands such as the ovaries, adrenal glands, and pituitary. They travel in the bloodstream to affect tissues and organs, regulating processes like metabolism, reproductive cycles, mood, and bone maintenance. When natural hormone levels decline — for example during perimenopause and menopause — physiological changes arise. Replacing or supplementing specific hormones aims to restore balance to systems influenced by those signals, which can alleviate symptoms that result from lower hormone levels.
What is hormone therapy and how is it given?
Hormone therapy describes treatments that deliver estrogen, progestogen (a synthetic or natural progesterone), testosterone, or combinations. Delivery options include oral tablets, transdermal patches, topical gels, vaginal rings, creams, and intrauterine devices that release progestogen. Choice of formulation and dose depends on symptoms, health history, and risk profile. Local (vaginal) estrogen preparations target urogenital symptoms with lower systemic exposure, while systemic routes address hot flashes, sleep disturbance, and other widespread effects.
How does hormone therapy affect health outcomes?
Hormone therapy can relieve common menopausal symptoms and can preserve bone density, potentially reducing fracture risk. However, like all treatments, it carries possible harms. Known concerns include increased risk of venous thromboembolism with some estrogen therapies and variable effects on breast tissue depending on the type and duration of therapy. Cardiovascular risk effects depend on age at initiation, preexisting conditions, and the specific regimen. Decisions weigh symptom relief and quality of life against these potential risks, and clinicians typically reassess therapy regularly.
How does hormone therapy help with menopause symptoms?
Many women use hormone therapy to manage vasomotor symptoms (hot flashes and night sweats), sleep disruption, mood changes related to sleep loss, and urogenital symptoms such as vaginal dryness and painful intercourse. Systemic estrogen is generally the most effective treatment for vasomotor symptoms, while local estrogen products often help vaginal atrophy with minimal systemic absorption. Response varies: some people experience rapid relief, while others require dose adjustments or alternative approaches. Nonhormonal options are also available and may be appropriate for those who cannot or prefer not to use hormones.
Which women may consider hormone therapy?
Suitability is individualized. Women experiencing moderate to severe menopausal symptoms that affect daily life may consider HRT after evaluating personal and family medical history. Contraindications commonly include a history of certain hormone-sensitive cancers, unexplained vaginal bleeding, active liver disease, or a prior history of blood clots. Age, time since menopause, comorbid conditions (cardiovascular disease, stroke risk), and personal preferences also shape recommendations. Shared decision-making with a qualified clinician helps match regimen, timing, and monitoring to the person’s goals.
Regular monitoring and follow-up
Once therapy begins, clinicians usually schedule periodic reviews to assess symptom control, side effects, and the need to continue or adjust treatment. Monitoring can include discussion of symptom changes, review of blood pressure and metabolic risk factors, appropriate cancer screening such as mammography per local guidelines, and consideration of bone density testing if fracture risk is a concern. If risks emerge or the balance of benefits changes, tapering or stopping HRT may be discussed.
Conclusion
Hormone replacement therapy is a medical option for addressing changes linked to reduced hormone levels, particularly during menopause. It can offer meaningful symptom relief and health benefits for some people, but it is not without risks. Decisions about HRT are best made collaboratively with a qualified healthcare professional who can evaluate individual health history, symptom burden, and personal priorities to choose the most appropriate approach.
