Hormone replacement therapy (HRT) helps treat symptoms of menopause like vaginal dryness and hot flashes. Your age, family medical history, personal medical history and severity of your symptoms are factors that may affect your decision to take hormone therapy. Talk with your healthcare provider about the benefits and risks of HRT, the different forms of HRT and alternative options.
Hormone replacement therapy, or HRT, is a treatment that helps people with symptoms of menopause.
Healthcare providers also call it hormone therapy (HT), especially when you receive treatment after age 50. Most often, hormone replacement therapy (HRT) is the term providers use when you receive the treatment at a younger age, especially before age 40.
As you transition to menopause, your ovaries stop making high levels of estrogen. This can cause uncomfortable symptoms like:
HRT replaces the hormones that your body isn’t making enough of. Once your hormone levels rise, most people find relief from their symptoms. HRT can also help with bone loss (osteoporosis and osteopenia), a common condition in people assigned female at birth (AFAB) who don’t have enough estrogen.
Whether you should consider taking HRT is a discussion to have with your healthcare provider. While hormone therapy reduces menopausal symptoms, it comes with risks. You should discuss the risks and benefits of hormone therapy with your provider to determine if it’s right for you.
When treating symptoms of menopause, your provider may use the terms interchangeably. But there can be slight differences between the two.
Hormone therapy (HT) is a broader term, which means it may apply to any type of treatment involving hormones. For example, hormone therapy for cancer or to treat certain hormonal imbalances. When people say hormone replacement therapy, they’re usually talking about menopause. But when people say hormone therapy, they aren’t always talking about menopause.
The term your provider uses may also have something to do with your age. When you’re closer to the natural age of menopause, they may use the term hormone therapy.
On the other hand, hormone replacement therapy (HRT) usually means the hormones are replacing the natural hormones your body is no longer making, especially for people in their 30s or early 40s. The important difference is that HRT can have different risks depending on your age.
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There are two main types of HRT: estrogen therapy and combination therapy (estrogen and progesterone). Your healthcare provider will discuss each type with you and recommend what form will work best for you based on your symptoms, medical history and preferences.
Estrogen therapy involves taking only estrogen. Healthcare providers most often prescribe a low dose of estrogen to begin with. Estrogen comes in many forms, like:
If you’ve had a hysterectomy (surgery to remove your uterus), your provider typically recommends estrogen-only therapy. This is mainly because estrogen taken alone has fewer long-term risks than HT which uses a combination of estrogen and progesterone.
This form of HRT combines doses of estrogen and progesterone (also called progestin, which is the name for all hormones that act like progesterone, including synthetic ones). People who still have a uterus need a progestin.
Progestins help reduce your risk of uterine cancer, which is higher when you take estrogen only. During your reproductive years, cells from your uterine lining shed during menstruation. When you stop getting your period and the lining stops shedding, estrogen can cause an overgrowth of cells in your uterus, a condition that can lead to cancer.
Combination therapy typically comes in a pill or skin patch, but can also come in an IUD (intrauterine device) that your provider places inside your vagina.
There are two additional terms that describe how you take hormone therapy: systemic and local.
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As you approach menopause, your ovaries shrink and stop producing estrogen and progesterone. Not having enough of these hormones in your body is what causes your menopausal symptoms. HRT works by giving you those lost hormones back. But HRT comes with both health benefits and risks, which may be higher in some people. Your healthcare provider can help determine if the benefits of HRT outweigh the risks.
You typically begin with the lowest effective dose, which means the lowest dose that helps your symptoms. People who lose estrogen too early (before age 40) are usually given higher doses to replace what their ovaries would typically produce for their age.
Estrogen-only therapy is daily. How you apply it (or take it) depends on which type of product you and your provider choose. They’ll make sure you know when and how to use it.
Combined therapy is a little different and you can take it as either continuous-combined therapy or cyclic therapy:
There isn’t a one-size-fits-all approach to HRT. Rather, your healthcare provider will work on a treatment plan unique to you, your symptoms and your health history.
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A main benefit of HRT is that it relieves uncomfortable symptoms of menopause. This can lead to a better quality of life and allow you to get back to activities that you enjoy.
If HRT works for you, it can help with:
Other health benefits of taking HRT include:
While hormone replacement therapy (HRT) can help you get through menopause, it may come with risks. Possible health risks include:
Many of these possible risks also have to do with your overall health and family history of health conditions. It’s important to discuss your individual risk with your provider.
Risks of HRT are generally lower if you:
If you’re thinking about hormone therapy, it’s important to learn as much as you can from your provider. HRT should be an individualized treatment that your provider evaluates often to make sure the benefits outweigh the risks.
If HRT doesn’t work for you or your provider believes you won’t benefit from HRT, there are alternative options that may help your symptoms. Ask your healthcare provider if any of the following could work for you instead:
Your healthcare provider may decide HRT isn’t for you if you:
The most common side effects of hormone replacement therapy are:
Less common side effects of hormone replacement therapy include:
Typically, side effects resolve on their own within a few months. In most cases, these side effects are mild and don’t require stopping your HRT. If your symptoms bother you, ask your healthcare provider about adjusting either the dosage or the form of the HRT to reduce the side effects. Never make changes to your medication or stop taking it without talking to your provider.
Generally, most people take HRT for five years or less. But there’s no set length of time, and it can vary depending on the severity of your symptoms, what type of HRT you take and your preferences.
Your provider will continue to monitor you and reevaluate your treatment plan. If you develop a new medical condition while taking HRT, see your provider to discuss if it’s still safe to continue taking HRT.
Taking combined hormone therapy may increase your risk of developing breast cancer, but most studies show that the increase is small (less than 1 in 1,000). Typically, breast cancer risk doesn’t increase until after five years of use. Several factors determine breast cancer risk other than taking HRT.
It’s always best to discuss your personal risk factors for cancer with your provider. They’re the best person to help you understand your individual risk for cancer and other conditions.
Scientists continue to learn about the effects of hormones on your heart and blood vessels. Most studies say that when you start hormone therapy closer to menopause (like in your early 50s), there’s less risk of heart disease compared to starting HT after age 60.
Because early loss of estrogen increases the risks of many conditions, including cardiovascular disease, people who lose their estrogen before age 40 are at risk for heart disease if they don’t use hormone replacement therapy (HRT).
This is a complex issue because your risk of heart disease depends on many factors, not just whether you take hormones. Examples include your family history and if you have conditions like high blood pressure or high cholesterol.
It’s always best to talk to your healthcare provider because they can recommend treatment based on your health history.
Contact your healthcare provider if you have symptoms of menopause that are disrupting your daily life. Your provider can explain treatment options to you, including hormone replacement therapy. It’s important that your provider helps you understand the pros and cons of HRT and how they apply to your unique situation.
Whatever you decide, make sure you arrive at a decision after getting all your questions answered.
The decision to take hormone replacement therapy is highly personal and complex. It depends on many factors like your health history, your age and your symptoms. Healthcare providers know the risks and benefits of HRT and how to apply them to your unique case.
With that being said, there are times when healthcare providers don’t recommend HRT after evaluating your situation. It’s important to know that they aren’t against HRT because they want you to experience discomfort. Rather, they’re aware of the risks and how those risks may apply to you. If your provider thinks HRT isn’t the right treatment for you, discuss alternative options with them.
Bioidentical hormones are a type of HRT. Compared to other synthetic hormones, they more closely match your body’s natural estrogen and progesterone. There are multiple FDA-approved options to get bioidentical hormones. Sometimes, bioidentical hormones are compounded at a pharmacy. This is called a custom compounded hormone. Compounded hormones aren’t well-studied and healthcare providers are unsure of their long-term effects. For this reason, many providers don’t recommend them.
Still, the decision on which one you should take (or which one is better) is highly personal and based on your symptoms, medical history and what your provider believes is best for you.
A note from Cleveland Clinic
If you’re experiencing symptoms of menopause that are impacting your quality of life, you may be wondering if hormone therapy is an option for you. The decision to try hormone therapy is a personal one. HRT is complex and not for everyone.
It’s important to arrive at your decision to take hormone therapy after discussions with your healthcare provider. Discuss the risks and benefits at an office visit dedicated to this conversation. You’ll need the time to address all your questions and make a decision that’s best for you. Be sure to talk about the pros and cons of the different types and forms of HRT. Even if HRT isn’t right for you, there are other treatment options that your provider may recommend to help treat your menopause symptoms.
Last reviewed on 03/12/2024.
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Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy