Is hormone therapy for the menopause safe and worthwhile?
Hormone therapy works excellently against hot flushes and vaginal symptoms, but whether it is safe for you depends on your age, the type of therapy and how long you use it. Discuss timing, route of administration and risk factors carefully with your doctor.
Hot flushes and night sweats respond to hormone therapy more strongly than to any other treatment. This has been robustly demonstrated in large randomised studies, including the Women's Health Initiative (WHI). Vaginal dryness, painful sex and bladder problems also respond well to hormone therapy, with local vaginal oestrogens being preferred for women whose symptoms are limited to those complaints. Bone protection is an additional benefit: hormone therapy slows bone loss and reduces the risk of hip fractures.
Whether hormone therapy is safe depends strongly on the type used and the timing of initiation. Combined therapy with oestrogen and progestogen, used for longer than three to five years, increases the risk of breast cancer. In the WHI study, the likelihood was 24% higher during the treatment period. Women without a uterus who use oestrogen alone actually see that risk decrease slightly. Oral combined therapy also raises the risk of dangerous blood clots in the veins. Anyone who already has an elevated risk of clots would do better to choose a patch or gel applied through the skin: that route of administration carries virtually no additional clotting risk.
Timing may well be the most important factor. Women who start within ten years of the menopause have better cardiovascular outcomes and lower all-cause mortality than women who start later. But in women aged 70 to 79 who start (or restart) therapy, the WHI study counts 38 additional harmful events per 10,000 women per year, compared with only 12 in women aged 50 to 59. Cardiac protection is therefore not an official reason to prescribe hormone therapy, but timing does determine how the benefits and risks weigh up against each other.
Do you have symptoms but are unwilling or unable to use hormones? Low doses of certain antidepressants (paroxetine or venlafaxine) or the medication gabapentin noticeably reduce hot flushes, though less powerfully than oestrogen. Sleep problems linked to night sweats also improve with hormone therapy, but for insomnia in itself, behavioural therapy remains the best first step. Yoga, acupuncture, black cohosh and omega-3 supplements have not been convincingly shown to outperform placebo for hot flushes.
A new oral oestrogen (estetrol) shows promising properties in early research, but long-term data on the heart, blood clots and breast cancer are still lacking. It is too early to say whether it is safer than existing treatments.
Based on multiple large randomised trials (including WHI) and systematic reviews. PMIDs: 33858012, 27929271, 41303580, 24084921, 32852449, 39250810, 40488293, 32880197.
Does hormone therapy help women age more healthily?
Hormone therapy relieves menopausal symptoms well and shows positive indications for bones and metabolism, but the effects on the heart and brain are uncertain and highly individual. Whether it is worthwhile for you depends strongly on your symptoms, timing and health history: discuss it with your doctor.
Which hormone levels are tested during menopause and what do the results mean?
During menopause, the hormones measured most commonly are FSH, LH, oestradiol, progesterone, testosterone and AMH; elevated FSH combined with reduced oestradiol (below 20 pg/ml) is the most reliable sign that menopause has begun, but always have your results explained by your doctor, as body weight and background influence reference values.
Which supplements actually help with menopause?
Red clover isoflavones and black cohosh have the strongest evidence for reducing hot flashes; soy isoflavones also help to some extent. For bone health, vitamin D is well supported. The effects are modest, and for severe complaints it is best to discuss the options with your doctor.
Does my weight and metabolism change during menopause?
During menopause, your body composition changes profoundly: more abdominal fat, less muscle and a lower resting metabolic rate. Exercise and nutrition demonstrably help, and discuss hormone therapy with your doctor as an additional option.
Does the menopause disrupt my sleep, and what can help?
The menopause genuinely disrupts your sleep, primarily through hot flashes and hormonal changes. Cognitive behavioural therapy for insomnia (CBT-I) is the best first step; hormone therapy or melatonin may come into the picture after that.
What does menopause do to your risk of cardiovascular disease?
Menopause demonstrably increases your risk of cardiovascular disease, primarily through unfavourable changes in fat distribution, cholesterol, and blood pressure. If you experience early menopause or are considering hormone therapy, discuss your personal risk profile with your doctor.