Menopausal hormone therapy (MHT) or hormone therapy (HT) can help treat your symptoms. HT or MHT are used to replenish estrogen levels in the body, which helps to ease the symptoms of menopause and improve your quality of life. Women with a uterus also require a progesterone-like hormone along with estrogen to protect the lining of the uterus. In addition to an improvement in menopause symptoms, HT can have additional benefits, including a lower risk of mortality, a protective effect on bone density, and potentially a decrease in the risk of heart disease in young postmenopausal women.

Adverse effects may include an increased risk of clots, breast cancer, heart disease and stroke in older women. Speak with your doctor about any questions or concerns you have and to evaluate all the available therapy options. The benefits and risks of HT vary significantly based on your age and specific medical conditions. Therefore, the decision to use HT must be carefully considered for each individual woman.

There are several conditions that can adversely impact HT. Your healthcare provider may not recommend HT if the following contraindications are present:

• Breast Cancer
• Endometriosis or endometrial cancer
• Liver Disease
• Porphyria (a rare hemoglobin disease)
• Blood Clots
• Vaginal Bleeding
• Coronary Artery Disease
• Stroke

Hormone therapy may not be the best option for the treatment of your menopausal symptoms, depending on your medical history and other factors. Specifically, if you have had breast cancer, HT is not right for you. Selective serotonin reuptake inhibitors (SSRIs) and selective serotonin-norepinephrine reuptake inhibitors (SNRIs) are effective options for treatment of hot flashes and night sweats. Some other non-hormone treatment options include gabapentin, oxybutynin, and clonidine. Discuss with your health care provider if any of these may be suitable for you.

Many herbal preparations and dietary supplements have been used to treat menopausal symptoms. However, these products have not been shown to be effective or safe. As such, the FDA has not approved these products for the treatment of menopausal symptoms and does not regulate them. These include black cohosh, red clover, evening primrose, vitamin B, soy products, dong quai, and many others.
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Bioidentical hormones refer to hormones that are identical to and have the exact same chemical and molecular structure as hormones that are produced in the human body. This includes commercially available hormones that are approved by the FDA as well as custom-compounded preparations made in pharmacies that are not regulated by the FDA. “Bioidentical” is a marketing term rather than a medical term and is promoted by marketing agencies to imply superiority to the FDA-approved hormone formulations. The term is meant to convey meanings such as “natural,” “organic,” and “plant-derived.” However, it has not been proven that custom-compounded bioidentical hormone therapy is more effective or safer than the FDA-approved hormone preparations.

Unfortunately, there is a huge demand for custom-compounded bioidentical hormones based on misleading marketing and public perception that these formulations may be safer. The media often promotes these products as a remedy and a preventive strategy for several conditions, including sexual problems, aging, dementia, and cancer. Some of these products are also marketed as being safer in terms of long-term risks of hormone therapy, including breast cancer. However, there has not been evidence found to support these claims. In fact, quality control of these preparations is limited and there can be significant batch-to-batch variation in the amount of the active drug. If you use these hormones, you run the risk of receiving a lower dose, or worse, a higher than intended dose. The purity of these formulations is also questionable. As such, these preparations are potentially unsafe for patients. The need for “natural” hormones can be met with FDA-approved formulations instead.

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Regardless of your symptoms, a healthy lifestyle is a positive step you can take toward controlling menopause symptoms. Regular exercise and a healthy diet help lessen heart disease risk. Other lifestyle changes to consider include:

• Stop smoking
• Lower alcohol consumption (no more than an average of one drink per day—a drink being equal to a 12-ounce can or bottle of beer, a 4-ounce glass of wine, or 1 ounce of liquor)
• Manage weight
• Manage stress

Whether your goal is to lower your risk for future health problems or to improve your quality of life during the menopause transition, a variety of menopause treatments exist. Talk to your doctor about the best treatment options for your specific needs.

For women in postmenopausal years, disease prevention becomes even more important—in particular, lowering the risks for heart disease and osteoporosis. Important questions to ask your doctor about when or whether to stop hormone therapy or other medication therapies if you take those. Stopping medications and herbal and dietary supplements can cause menopause symptoms to return. Going off estrogen therapy can trigger new hot flashes, for example. Also, some symptoms become more prominent as women advance through the postmenopausal years, including vaginal dryness and sexual complaints.