"Should I take Menopause Hormone Therapy?"
This information is meant to help you:
Understand each hormone’s role.
Learn up-to-date benefits & risks of MHT
Learn a little about non-hormonal options doctors may offer
Outline a common pathway to accessing MHT.
Estradiol
Progesterone
Vaginal Estradiol Cream
>> “Skin care for down there.” Estrace
Testosterone
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
Non-Hormone 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
You identify presence of menopause symptoms that impact your quality of life.
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.
If able, once you start using MHT, your doctor may request a check-in after 3-6 months of use, and once annually after that.
Over time, dosage may need to be adjusted. Also, some symptoms may increase/decrease, or arrive/depart as time passes.
How Long Can I take MHT?
There is currently no one-size-fits-all recommendation for how long MHT can be continued. Age and time since menopause onset matter more than “number of years on MHT.” Reason for stoppage may include developing health risks that outweigh the benefits of continuing MHT, or personal choice.
Mode of delivery (oral vs. transdermal estrogen, for example), dosage, and formulation affects duration.
Purpose for MHT may change over time: starts with symptom management, and continues for health benefits.
Preventive benefits require continued use. Health & symptom benefits are lost with stoppage of MHT, but are not ‘retroactively erased.’
Struggling to Find a doctor who is up-to-date on MHT?
Check the practitioner directory at the Menopause Society: https://portal.menopause.org/NAMS/NAMS/Directory/Menopause-Practitioner.aspx
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