What Is Hormone Replacement Therapy? - Types, Risks, Pros & Cons

Instructor: Amy Messex

Amy has a master's degree in social work (MSW) and has taught social work theory and practice at the University level.

Learn about hormone replacement therapy (HRT) and find out about different types. You'll also get information about some of the risks and benefits of hormone treatment.

Why HRT Is Used

Menopause is a natural transition for women in midlife, and it is a period of gradual hormonal changes. For many women, menopause brings with it some very uncomfortable symptoms that interfere with their quality of life.

Imagine that you are in the middle of an important presentation at work. Suddenly you are having a hot flash - you are red-faced with sweat dripping down your face, and you feel miserable. Or imagine that for several months you haven't been able to sleep for more than four hours each night; you wake up around 2am feeling restless, uncomfortable and unable to fall back asleep. For these reasons (and many more), some women find it helpful to use hormone replacement therapy (HRT) to manage menopausal symptoms.

Types of HRT

Estrogen and progestin (which is also known as progesterone) are the two main hormones that regulate a woman's reproductive system. During menopause, those hormones gradually decrease, and this causes those difficult symptoms. Therefore, the most common kind of HRT simply replaces the missing hormones with a combination of estrogen and progestin.

The changing level of estrogen alone is responsible for the worst menopause symptoms (remember those sweaty work meetings and sleepless nights?), but adding progestin to the estrogen helps protect the uterus from cancer. Some women have had their uteruses removed for various reasons, and for those women, it is considered safe to use estrogen-only HRT.

HRT can be administered in different ways:

  • Orally as a medication in pill or tablet form
  • Transdermally with patches or gels that carry medication through the skin
  • Vaginally with a topical cream or ring used to help with dryness or other discomfort

Illustration of a correctly-placed hormone patch
Hormone patch illustration

Some Risks of HRT

While menopausal symptoms can be very unpleasant, there are serious health risks to consider with the use of HRT. The most common risks include an increased chance of breast cancer, stroke, heart disease, and blood clots. For estrogen-only HRT, there is an increased risk of uterine cancer too. Much of the information about these risks came from large research projects done in the 1990s as part of the Women's Health Initiative. Those studies discovered the association between some major health concerns and HRT, and the research had to stop early due to the risk to the participants.

However, more recent research changes our understanding about the risks of HRT. When you look at a woman's age, stage of menopause, and length of HRT use, the risks aren't always so severe. Right now, there is follow-up research underway, and researchers are predicting that the risks might be smaller when HRT is used early in menopause and for shorter periods.

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