Hormone Therapy in Menopause

Hormone therapy in menopause is the administration of oestrogen (combined with a progestogen in people who have a uterus) to reduce menopause-related symptoms. The balance of benefit and risk varies from person to person and is assessed together with the doctor. The information below provides a general framework; it does not replace an individual diagnosis or treatment recommendation.

What is hormone therapy in menopause?

Oestrogen production by the ovaries declines in menopause. Hormone therapy is based on giving external oestrogen to ease the complaints caused by this deficiency. Both hormonal and non-hormonal options can reduce menopause symptoms; which route is suitable is determined by discussing the person's complaints, health history and preference with the doctor.

For which symptoms might hormone therapy be considered?

Hormone therapy is most often considered for hot flushes and night sweats, sleep disturbance, and genitourinary symptoms such as vaginal dryness, pain during sex and urinary complaints. It is considered one of the effective treatment options for hot flushes and genitourinary symptoms. Starting it is not mandatory for someone with no symptoms or only mild complaints; the decision belongs to the individual.

How are oestrogen and progestogen given?

The hormones used in treatment belong to the oestrogen and progestogen classes. Oestrogen can be given orally, through the skin (such as a patch or gel), or vaginally. Oral and transdermal forms act on the whole body; vaginal administration is mostly directed at local symptoms and is a separate concept from systemic treatment. The dose, duration and route of administration are chosen for the individual and reviewed again at regular intervals.

Why is progestogen added in people who have a uterus?

In a woman with a uterus, using oestrogen alone can thicken the lining of the uterus (the endometrium), and this increases the risk of endometrial cancer. Progestogen is added to oestrogen to protect this lining. Adding progestogen also affects the overall risk profile of treatment; for this reason, the presence of the uterus is one of the key points of the treatment plan.

What are the benefits of hormone therapy?

In a suitable patient, hormone therapy can reduce the frequency and severity of hot flushes. Improved sleep and relief of vaginal dryness and urinary complaints are also among the expected benefits. The response varies from person to person.

How does hormone therapy affect bone health?

Hormone therapy has been found effective in reducing bone loss and fracture risk, and it is mentioned as one of the options in osteoporosis management. However, whether it should be started for bone protection is decided by weighing the person's other risk factors and alternative treatments together.

What are the risks of hormone therapy?

The level of risk varies according to the type of hormone, the dose, the duration, the route of administration, the timing of starting, and whether a progestogen is used. For this reason, a single numerical risk figure does not reflect an individual's situation; detailed figures should be discussed with the doctor.

Does hormone therapy increase breast cancer risk?

Oestrogen-only use is associated with little or no change in breast cancer risk; combined use of oestrogen and progestogen can increase the risk. This increase is related to the duration of use and decreases after stopping treatment. Assessment is carried out even more carefully in people with a personal history of breast cancer or a strong family history.

How does hormone therapy affect blood clot and stroke risk?

Oral oestrogen increases the risk of blood clots in the veins above the normal level. Standard-dose oestrogen applied through the skin does not increase this risk above the normal level. Oral oestrogen is also associated with a small increase in stroke risk; use through the skin has not been associated with this increase. If your clot risk is high, use through the skin is considered.

How do the timing and route of hormone therapy affect the risk balance?

The balance of benefit and risk depends on age and the time elapsed since menopause. In symptomatic women who start treatment close to menopause and have no contraindications, the balance is generally assessed as favourable; starting long after menopause requires more careful assessment. A low dose and transdermal administration can reduce the risk of blood clots and stroke. The approach differs in early menopause or ovarian insufficiency and is assessed separately.

Who cannot use hormone therapy, or needs extra caution?

In some situations, hormone therapy is not recommended, or is considered only with the opinion of the relevant specialist. These include unexplained vaginal bleeding, certain cancer histories, a past or active vascular event such as a blood clot or stroke, and severe liver disease. In people with a history of cancer, the decision is made together with the doctors managing that treatment. Managed cardiovascular risk factors alone are not considered a barrier, but each person needs to be assessed individually.

How is treatment monitored, and how is it stopped?

After hormone therapy is started, the benefit, side effects and need for continuing are regularly reassessed. Side effects such as breast tenderness, nausea and irregular bleeding can occur; these should be reported to the doctor. The duration of treatment is not fixed in advance for everyone; it is determined according to the course of symptoms, the person's risk status and preference. Rather than stopping treatment or changing the dose on your own, a planned review with the doctor is appropriate. Mammography and other screening tests continue separately, according to the person's age and risk status.

What options are available apart from hormone therapy?

Non-hormonal options exist for women who cannot or do not wish to use hormone therapy. Lifestyle adjustments, certain prescription medicines, and hormone-free moisturisers for vaginal symptoms are among these options. Which one is suitable is determined with the doctor according to the type of complaint and the person's situation.