Menopause: Should I use hormone replacement therapy (HRT)?

Get the facts
Compare your options
What matters most to you?
Where are you leaning now?
What else do you need to make your decision?

1. Get the Facts

Your options

Use hormone replacement therapy (HRT).
Don't use HRT. Try other treatment to manage your menopause symptoms.

Key points to remember

HRT lowers the risk of osteoporosis and possibly colon cancer.^1,² But women who take HRT have slightly higher rates of breast cancer, ovarian cancer, heart attack, stroke, blood clots, and Alzheimer's disease.^2,^3,⁴
The health risks linked to HRT are not high for most women. But on average, these small risks outweigh the small benefits of HRT.
HRT can help you deal with menopause symptoms such as hot flashes and sleep problems. If you decide to use it, take the lowest dose you can for the shortest possible time. See your doctor regularly to check your benefits and health risks. Experts say you shouldn't take HRT for more than 4 years.
Instead of HRT, you might try other prescription medicines, black cohosh, or dietary soy to manage hot flashes. A lubricant gel or an estrogen cream, ring, or tablet can help with vaginal soreness and dryness.⁵
HRT helps prevent bone loss and osteoporosis. But if you are at high risk for osteoporosis, HRT is only one of several treatments you could try.

FAQs

What is menopause?

Menopause is the point in a woman's life when she has not had a menstrual period for 1 year. Menopause marks the end of the childbearing years. It is sometimes called "the change of life."

For most women, menopause happens at around age 50, but every woman's body has its own timeline. As you get closer to menopause, your estrogen levels go up and down unevenly. This causes changes in your period and other symptoms, such as hot flashes, headaches, and sleep problems. After your estrogen levels drop past a certain point, your menstrual cycles end.

Menopause is a natural part of growing older. You don't need treatment for it unless your symptoms bother you.

What is hormone replacement therapy?

Hormone replacement therapy (HRT) uses a combination of two hormones, estrogen and progestin. You can take the hormones as pills, use a patch, or use a vaginal ring. HRT increases the estrogen and progestin levels in your body. It can prevent osteoporosis and ease menopause symptoms such as hot flashes and sleep problems.

Because of the risks of HRT, the U.S. Food and Drug Administration (FDA) recommends that it only be used:

For short-term treatment of menopause symptoms. If you decide to take HRT, use the lowest dose you can, and take it for as short a time as possible. You shouldn't take HRT for longer than 4 years.
To prevent or treat osteoporosis. If you have a strong risk of osteoporosis, you might consider taking HRT. The risk of osteoporosis may outweigh the risks linked to HRT.⁶ But it's important to think about all possible osteoporosis treatments and to compare their risks and benefits.⁷ For more information, see the topic Osteoporosis.

What if you don't take HRT?

Menopause symptoms can be upsetting and uncomfortable. But you don't have to suffer through them. There are other things besides taking HRT that you can do to help.

The first step is to have a healthy lifestyle. This can reduce your symptoms and also lower your risk of heart disease and other long-term problems linked to aging. Eat a heart-healthy diet; get regular exercise; don't smoke; and limit caffeine, alcohol, and stress.

If you still need help dealing with symptoms, you might try:

Breathing exercises to help with hot flashes and emotional symptoms.
Black cohosh and dietary soy, which may reduce hot flashes.
Vaginal lubricants (such as Astroglide and K-Y Jelly) to help with vaginal dryness, and vaginal estrogen to relieve soreness.
Antidepressant medicines or blood pressure medicine. These can lower the number of hot flashes you have. And they can make hot flashes less severe when you do have them.

To prevent symptoms before you start menopause, you might think about taking low-dose birth control pills, if you don't smoke and aren't at risk for heart disease or breast cancer.

What are the benefits of taking HRT?

HRT:^2, ¹

Reduces the number of hot flashes that you have, and it makes them less severe when you do have them.¹
Lowers your risk of osteoporosis. Estrogen slows bone thinning and helps increase bone thickness.¹
Prevents vaginal dryness and soreness caused by low estrogen.
Slows the loss of skin collagen. Collagen puts the stretch in skin and muscle.
Reduces the risk of dental problems, such as tooth loss and gum disease.
May reduce the risk of colon cancer.²

What are the risks of HRT?

Hormone replacement therapy (HRT) lowers the risk of osteoporosis and possibly colon cancer.^1, ² But a large study of the risks and benefits of HRT, called the Women's Health Initiative, found that women who take HRT have slightly higher rates of:^2, ^3, ⁴

These problems occurred in a small but important number of women within the first 1 to 4 years of using HRT. No particular form or dose of HRT has been proved safer than another.⁸

If you have no personal or family history of breast cancer, ovarian cancer, heart attack, stroke, blood clots, or dementia, your increased HRT risks are likely to be small. Having a family history means that you have one or more close relatives with one of these health problems, such as a parent, sister, or brother. If you do have a personal or family history of these health problems, your HRT risks are likely to be higher than average. This may make the risks of HRT outweigh the benefits for you.

If you have had breast cancer, taking HRT is not safe for you.

Why might your doctor recommend hormone replacement therapy?

Your doctor may recommend HRT if:

You have no risk factors for heart disease, blood clots, stroke, or breast or ovarian cancer; are willing to accept the small increase in risks of cancer and heart disease;and
Have thought about or tried other treatments.
Have menopause symptoms that are lowering your quality of life.

2. Compare Options

	Take HRT	Don't take HRT
What is usually involved?	You take daily pills or use a patch or a vaginal ring to increase hormone levels. You take hormone replacement therapy (HRT) to relieve menopause symptoms for no more than 4 years.	You manage menopause symptoms such as hot flashes with: Breathing exercises. Black cohosh and dietary soy. Antidepressant medicines or blood pressure medicine (clonidine). Vaginal lubricants (such as Astroglide and K-Y Jelly) or low-dose vaginal estrogen.
What are the benefits?	Taking HRT: Helps you deal with hot flashes and other menopause symptoms. Lowers your risk of osteoporosis. Eases vaginal dryness and soreness. Slows loss of skin collagen. Reduces the risk of dental problems. May reduce the risk of colon cancer.	You avoid the health risks of HRT.
What are the risks and side effects?	Side effects can include: Vaginal bleeding or spotting. Breast tenderness. Bloating. Nausea. Women who take HRT have slightly higher rates of: Breast cancer. Ovarian cancer. Heart attack. Stroke. Blood clots. Alzheimer's disease.	Your menopause symptoms may still bother you. Other prescription medicines can have side effects, such as: Headaches, upset stomach, and problems sleeping (antidepressants). Problems linked to low blood pressure (clonidine).

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

For more information, see the topic Menopause and Perimenopause.

Personal stories about deciding whether to take hormone replacement therapy (HRT)

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

" I've been very fortunate. Like my mother, I made it through menopause without hot flashes or other major discomforts. My doctor tells me that all I have to do now is be sure I get my regular checkups and exams, take calcium and vitamin D for bone health, and take good care of myself."

— Karen, age 55

" By the time my periods stopped, I didn't have bad hot flashes or other problems. I was pretty proud of myself for getting exercise and eating right, and thought that I was one of the lucky ones. Did I get hit, though! The night sweats started a few months after my last period, and I couldn't sleep or get through the day after that. So, I tried low-dose HRT for 6 months, to get some relief. Then, I tapered off of it over a few months, and they weren't as bad. I figure I can tough it out now till my body adjusts to its new state."

— Jane, age 52

" My doctor told me that HRT would help me in so many ways, so I started taking it after my periods stopped. The problem is, I had bleeding on and off that was like my period, and I just couldn't take it after 6 months. I haven't taken it since, and I've grown used to my body's changes. I still get hot flashes sometimes but not like I used to. When I feel one coming on, it really helps me to do relaxation breathing. I think that calming my body and mind has a big effect on making a hot flash go away."

— Mary Anne, age 60

" I have already had a terrible time with perimenopausal moodiness and some occasional hot flashes, and low-dose birth control pills have helped even out the hormone ups and downs. So I know what my plan is. When my doctor gives me the go-ahead around menopause age, I'm going to switch to low-dose HRT. Then I'll taper off of it after a year or so. I need to be able to function!"

— Jenessa, age 45

" There is no way I'd ever take estrogen or progestin, because of the cancer risks. There's just too much we don't know, and what we do know from recent studies scares me. I used an antidepressant when my hot flashes were bad, and that helped me a lot. Now, I just take calcium and vitamin D supplements and get regular exercise to help protect my bones."

— Sondra, age 55

" A girlfriend told me that she was having great results from taking black cohosh, so I tried it for the occasional hot flashes and mood swings I was having. I think it's working quite well. However, it wasn't until I went for my annual gyn exam that I learned it's best to have a checkup every 6 months, like women in Germany who take it by prescription. Now I know to think of black cohosh as a prescription drug, kind of like estrogen, that's still being studied. "

— Sam, age 49

3. Your Feelings

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to use hormone replacement therapy

Reasons not to use hormone replacement therapy

Other treatment hasn't helped me deal with my menopause symptoms.

I want to try other treatment before I try HRT for my symptoms.

More important

Equally important

More important

The benefits of HRT outweigh the risks for me.

I feel the risks of HRT are too high for me.

More important

Equally important

More important

I don't mind taking medicines to help me manage my symptoms.

I don't want to take medicines if I can avoid them.

More important

Equally important

More important

My other important reasons:

More important

Equally important

More important

4. Your Decision

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Using HRT

NOT using HRT

Leaning toward

Undecided

Leaning toward

5. Quiz Yourself

Check the facts.

1. Does taking HRT raise your risk of health problems and disease?

Yes
No
I'm not sure

You're right. Women who take HRT have slightly higher rates of breast cancer, ovarian cancer, heart attack, stroke, blood clots, and Alzheimer's disease.

2. Can HRT help you deal with menopause?

Yes
No
I'm not sure

You're right. HRT can help you deal with menopause symptoms such as hot flashes and sleep problems.

3. Are there other treatments that can help with menopause symptoms?

Yes
No
I'm not sure

You're right. Instead of HRT, you might try other prescription medicines, black cohosh, or a vaginal estrogen to help deal with symptoms.

Decide what's next.

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty.

1. How sure do you feel right now about your decision?

Not sure at all

Somewhat sure

Very sure

2. Check what you need to do before you make this decision.

Nothing. I'm ready to take action.
I want to discuss the options with others.
I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

References

Citations

Speroff L, Fritz MA (2005). Menopause and the perimenopausal transition. In Clinical Gynecologic Endocrinology and Infertility, 7th ed., pp. 621–688. Philadelphia: Lippincott Williams and Wilkins.
Rossouw JE, et al. (2002). Risks and benefits of estrogen plus progestin in healthy postmenopausal women. Principal results from the Women's Health Initiative randomized controlled trial. JAMA, 288(3): 321–333.
Chlebowski T, et al. (2003). Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women: The Women's Health Initiative randomized trial. JAMA, 289(24): 3243–3253.
Shumaker SA, et al. (2003). Estrogen plus progestin and the incidence of dementia and mild cognitive impairment in postmenopausal women. The Women's Health Initiative memory study: A randomized controlled trial. JAMA, 289(20): 2651–2662.
North American Menopause Society (2004). Treatment of menopause-associated vasomotor symptoms: Position statement of the North American Menopause Society. Menopause, 11(1): 11–33.
National Heart, Lung, and Blood Institute (2007). Postmenopausal hormone therapy: Questions and answers about estrogen-plus-progestin hormone therapy. Available online: http://www.nhlbi.nih.gov/health/women/q_a.htm.
American College of Obstetricians and Gynecologists (2003). Statement of the American College of Obstetricians and Gynecologists on hormone therapy for the prevention and treatment of postmenopausal osteoporosis. ACOG News Release. Available online: http://www.acog.com/from_home/publications/press_releases/nr10-07-03.cfm.
North American Menopause Society (2007). Position statement: Estrogen and progestogen use in peri- and postmenopausal women: March 2007 position statement of the North American Menopause Society. Menopause, 14(2): 168–182.