"Should I take Menopause Hormone Therapy?"

This information is meant to help you:

  • Learn the benefits & risks of MHT

  • Outline a common pathway to accessing & using MHT.

  • Understand the influences of aging vs. estrogen loss (menopause) on performance and body composition.

  • Understand which health, body composition, and performance factors MHT can support and which depend on training and nutrition.

Benefits of MHT

Manages Menopause Symptoms

  • Vasomotor Menopause Symptoms (hot flashes, night sweats, heart palpitations, chills, sweating & shivering)

  • Muscle + tendon + joint aches and pain. Mitigates bone loss.

  • Genitourinary symptoms (dryness, UTIs, leaking, pain)

  • Mild anxiety & depression symptoms

  • Poor Sleep

Improves Health Biomarkers

Women who take MHT (vs. those who don't take MHT) have:

  • Lower A1C, 

  • Lower Cholesterol Markers

  • Lower Fasting Glucose

  • Better insulin sensitivity

  • Lower Lp(a) -- genetically influenced indicator of heart attack or stroke

*Mode of estrogen replacement (oral vs. transdermal) and individual fat mass to fat free mass ratio inform the influence on these markers.

Body Fat

Total body fat still tends to increase with age, regardless of MHT use. PMID: 24834015, PMID: 8440839

Visceral (between organs) : subcutaneous (pinchable under skin fat) ratio is lower in MHT users, decreasing associated health risks. PMID: 18332882, PMID: 7885283, PMID: 24834015

MHT doesn't prevent body fat increases, just the location of accumulation. PMID: 32219014

Bone Density & Elasticity

Estrogen promotes collagen & calcium formation and slows loss. Without it through menopause, bones lose both density and elasticity.

MHT influences bone density primarily by reducing bone resorption, not by directly stimulating new bone formation. Its effect is meaningful but limited, and best understood as rate-modifying, not bone-building.

Prescription drugs taken for osteoporosis and osteopenia increase calcium content (the measurable part of a DEXA scan), but isn't able to restore/maintain the "willow tree-like" collagen content of a bone, so while these drugs can decrease breakdown, they also cause bones to become more brittle over time.

MHT Promotes Muscle Improvements

With strength training, MHT enhances or preserves gains, muscle quality, connective tissue, recovery, and response to training. (PMID: 33542694)

Women who use MHT and don't strength train lose muscle at about the same rate to women who neither use MHT nor strength train. In other words, MHT alone doesn’t preserve muscle.  PMID: 31461147

RISKS of MHT

Vaginal bleeding

Estrogen + Progesterone therapies can cause breakthrough bleeding, especially in the first 6-12 months of use. PMID: 30495192

Prolonged or new-onset bleeding in women on MHT is not automatically dangerous, but biopsy is warranted to exclude pathology.

If you have a Mirena, it can help mitigate increased bleeding. PMID: 17531609

Breast cancer

WIthout previous breast cancer: Combined estrogen + micronized progesterone (current standard) appears not increase breast cancer risk. Longer use still may carry some risk. PMID 35675607, PMID 27456847

With personal history of cancer: MHT is not considered safe or routine therapy after breast cancer occurrence because of evidence of possible increased recurrence risk and the lack of strong data showing safety in this group.

https://www.bcrf.org/about-breast-cancer/hrt-breast-cancer-risk/?utm_source=chatgpt.com

In BRCA1/BRCA2 gene carriers:

Observational data suggest no significant increase in breast cancer incidence with MHT use (including estrogen + progestogen) after surgical menopause (oophorectomy); estrogen‑alone regimens may even show reduced incidence in some studies. PMID: 41403285

 Stroke & Venous Thromboembolism (VTE)

In healthy women who initiate menopausal hormone therapy before age 60 and/or within 10 years of menopause onset, major cardiovascular risk is not significantly elevated and may be lower overall, though some risks such as VTE persist. PMID: 25754617, 40488293

Hormone-Free Options:

Birth Control Pill

Combined Oral Contraceptives are effective for managing erratic cycles and heavy or unpredictable peri-menopausal bleeding. It may also manage night sweats and hot flashes in some people. It is not useful for other vasomotor symptoms. Some people develop other symptoms with this path (migraines, nausea).

It’s not designed to provide the same long-term health support that menopausal hormone therapy can. PMIDs: 25534509, 41307293, 11521120, 11521120,

Anti-Depressants & Anti-Anxiety Drugs

Although antidepressants and anxiolytics are effective for treating mood disorders, they do not address the broader menopause-related physiological changes that menopausal hormone therapy can target, such as vasomotor symptoms, sleep disruption related to hot flashes, bone health, and genitourinary symptoms.

MHT is not an antidepressant.
But in menopause-related mood symptoms, it may play a supportive role.

PMIDs: 37603881, 25203891, 22132727

About Bio-identical Hormones Estrogen + Progesterone

“Bio-identical” ≠ “custom compounded”

Bio-identical refers to the hormone itself, and not how it’s made and packaged.

Bio-identical. These hormones are molecularly identical to human hormones, but are manufactured, FDA-tested, and regulated like other prescription medications. They are likely to be covered by insurance, and any doctor who is eligible to prescribe is able to. Major guidelines (NAMS, IMS, BMS, Endocrine Society) prefer FDA-approved bio-identical hormones (17β-estradiol and micronized progesterone) when MHT is indicated.

The most common delivery method combo are the estradiol transdermal patch (due to lower VTE risk & avoids ‘1st pass liver metabolism’) and the micronized progesterone pill (due toendometrial protection & favorable breast and cardiovascular risk profile compared to synthetic progestins).

Example: (Patches) Climara, Vivelle-Dot, Minivelle, (Gels) Divigel, EstroGel, Evamist, and (Progesterone Micronized Pils) Prometrium + generic progesterone options.

Custom Compounded These may also use bio-identical molecules, but are mixed by compounding pharmacies. Compounded hormone therapies are typically paid for out of pocket and are prescribed by a smaller subset of clinicians, as they are not FDA-approved and are not recommended as first-line therapy in most clinical guidelines.

How to Explore MHT Use for Yourself

  1. You identify presence of menopause symptoms that impact your quality of life.

  2. Have a conversation with your doctor. Your health (current and Hx), individual risk factors, and family history will be considered for eligibility, and if eligible, which formulation and dose may be suitable.

  3. Once you start using MHT, your doctor may request a check-in after 3-6 months of use, and once annually after that.

Is it Aging? Or is it Menopause?

Generally, aging is the mechanism for decline in muscle mass, strength, and power output, and for an increase in relative and absolute body fat.

Estrogen loss via Menopause is the cause for the change in fat accumulation location, plus muscle quality.

Menopause is also directly responsible for bone mass decreases. MHT will minimally attenuate bone loss, and mechanical loading (lifting, jumping, etc.) is required for meanigfully maintaining bone.

We can also assume MHT mitigates the impact of the Musculoskeletal Syndrome of Menopause (low threshold for inflammation in any tissue but often tendons & joints, joint or general body pain/aches, arthritis onset, and muscle tissue quality loss)

MHT Vs. Resistance Training Vs. Nutrition

Disclaimer:

The info on this website is for informational purposes only. Though I did my very best to minimize this, there are likely omissions, human errors, and things left unsaid. Despite all that, I hope this info is a helpful start for you.

Also, note that research at the population level & note that individual outcomes may differ.

Please reach out if you have questions, comments, suggestions for additions, or (corroborated) corrections: Anne@HomegrownFit.com