Hormone Therapy: Understanding the Benefits and Risks

The conversation around hormone therapy may be changing. Let’s explore the facts.

If you were born a woman, your body has most likely grown accustomed to the (mostly) steady presence of the hormones estrogen and progesterone for decades. Typically, in your 40s, signs of menopause—the end of your menstrual period—appear as estrogen and progesterone levels rise and fall before nearly fading altogether. Adjusting to these changes can be difficult for your body.

During the transition to menopause, known as perimenopause, and after your period stops, symptoms resulting from shifting hormones, such as sleep problems, frequent urination, hot flashes and night sweats, can turn life upside down.

As you look for relief, you may wonder if hormone therapy could be an effective solution. This treatment replaces lost estrogen and progesterone with versions of the hormones in medication form.

Hormone therapy has had a mixed reputation for more than 20 years. Recent research, however, is prompting some physicians to view hormone therapy more favorably.

The bottom line: You should discuss the risks and benefits of this treatment with your physician before deciding whether it makes sense for you.

Evolving Attitudes on a Major Menopause Treatment

The origins of many patients’ and medical providers’ concerns about hormone therapy stretch back to the early 2000s.

In 2002 and 2004, researchers halted two clinical trials that were part of the U.S. government-sponsored Women’s Health Initiative (WHI) due to safety concerns. The data collected indicated that estrogen plus progestin—a synthetic form of progesterone—and estrogen alone were associated with health risks in women, particularly older women. For years afterward, many medical providers were reluctant to prescribe hormone therapy, and many patients hesitated to take it.

In a 2024 review of long-term data collected from the WHI, however, researchers found that hormone therapy is effective for treating moderate to severe hot flashes and night sweats in women younger than 60. For women struggling with these symptoms, the benefits of hormone therapy may outweigh the risks.

Findings like those from the 2024 study, along with new types of hormone medications and different approaches to dosing, have many medical providers feeling more comfortable about recommending hormone therapy.

Every woman is different. Talk to your provider about your specific situation.

Benefits of Hormone Therapy

Also known as menopausal hormone therapy, hormone therapy may improve the health and wellness of menopausal women under 60 in several ways, including:

Bone protection. Hormone therapy can reduce the risk of bone loss. This can help protect against osteopenia (bone thinning) and osteoporosis (bone loss), two of several post-menopausal conditions that may affect women. Women may also experience improvement in joint health and mobility.
Reduced risk of certain cancers. You may have a lower risk for certain types of cancer.
Symptom relief. Vaginal dryness, hot flashes and night sweats may improve.

Risks of Hormone Therapy

Hormone therapy may benefit you, but it’s not without risk. This treatment, for example, doesn’t cause cancer, but it can lead to an increased risk of endometrial cancer and breast cancer, depending on the type of therapy, how long you take it or your individual risk factors.

Hormone therapy can also increase your risk for other conditions, including:

Deep vein thrombosis
Dementia
Gallbladder disease
Heart attack
Stroke
Urinary incontinence
Vaginal bleeding

You may have heard hormone therapy can cause weight gain, but no conclusive evidence demonstrates this. A variety of factors, including hormonal changes, aging and a less active lifestyle, may contribute to weight gain around menopause.

Factors to Consider with Your Medical Provider

Your OB-GYN or primary care provider can help you determine whether the benefits of hormone therapy outweigh the risks for you. Much depends on your unique risk factors.

If, for example, you’ve had a stroke, certain cancers, vaginal bleeding or blood clots in the past, you shouldn’t take hormone therapy due to its links to these conditions.

If you decide to try this treatment, here are some other factors to discuss with your medical provider.

Types of Menopausal Hormone Therapy

Two major types of hormone therapy are available.

Estrogen-only therapy—also known as estrogen therapy—is an option if you’ve had a hysterectomy (surgery to remove the uterus). By itself, estrogen can increase the risk of endometrial cancer, which is cancer that affects the lining of the uterus. That’s why you’ll only take estrogen alone if you don’t have a uterus.
Estrogen plus progestin therapy, or combined hormone therapy, is the option of choice if you have a uterus.

Bioidentical Hormones

While researching hormone therapy, you may come across products called bioidentical hormones.

Bioidentical hormones are plant-based or synthetic hormones that are chemically identical to the hormones naturally produced by the human body. They are often used to treat hormonal imbalances and symptoms associated with menopause, such as hot flashes, night sweats and vaginal dryness.

Types of Bioidentical Hormones

Estrogen (estradiol, estrone, estriol)
Progesterone
Testosterone

Sources of Bioidentical Hormones

Plant extracts (e.g., soy, wild yam)
Synthetic production in a laboratory

Forms of Hormone Therapy

Some forms of estrogen therapy enter your bloodstream and spread throughout your body. This is known as systemic therapy and is available as a pill, patch, spray or gel.

You may only need estrogen to target one area of the body, such as the vagina to treat vaginal dryness. In that case, you’ll take local estrogen therapy. A cream, tablet or vaginal ring can deliver this treatment.

If you also need progestin, you can find it in pill form, as a vaginal tablet or gel, or in an intrauterine device.

Side Effects

Tell your medical provider if you experience side effects from menopausal hormone therapy. These side effects may include:

Bloating
Breast tenderness
Headaches
Spotting or bleeding

Side effects are usually temporary, but your medical provider may need to adjust your dosage if they last longer than normal.

Length of Treatment

Given the potential risks, menopausal hormone therapy isn’t meant to be a long-term treatment. The goal is to find the lowest dose that works for you and take it for the shortest amount of time necessary. The American College of Obstetricians & Gynecologists recommends meeting with your medical provider every year to reevaluate whether to keep taking hormone therapy.

Hormone therapy isn’t the only way to manage menopause symptoms. If the treatment isn’t right for you or you decide to stop taking it, your medical provider can suggest alternatives, including medications that don’t contain hormones.