Hormone Replacement Therapy for Menopause

Hormone replacement therapy for menopause at a glance

  • Hormone replacement therapy for menopause is a means of treating the symptoms of menopause by replacing the female hormones a woman’s body stops producing after menopause.
  • The treatment primarily administers estrogen, or estrogen with progesterone, to replace those hormones that regulate the menstrual cycle and enable a woman to carry a pregnancy, functions that cease at menopause.
  • This form of menopause treatment manages troublesome menopause symptoms of hot flashes, night sweats, vaginal discomfort and thinning of the bones.
  • Hormone replacement therapy is not for every woman who suffers excessively from menopause symptoms, and each woman should discuss this option with her physician.

What is hormone replacement therapy for menopause?

A woman is said to reach menopause 12 months after she has stopped having her periods, and the concurrent change in hormone levels can cause symptoms that are difficult for some women to bear. In menopause, the body no longer needs the hormones estrogen and progesterone that were produced to regulate the menstrual cycle in preparation for the woman to carry a pregnancy.

Perimenopause (“around menopause”) occurs before menopause and can last from a few months to six years before actual menopause. Perimenopause, in which hormone levels begin to fluctuate, can cause women to experience symptoms of menopause. Perimenopausal women can also benefit from hormone replacement therapy.

Benefit of hormone therapy replacement for menopause

Many women in menopause have few symptoms or may experience symptoms that go away over time. Others have difficulty with menopause symptoms that can be effectively treated by hormone therapy, easing a woman’s transition into menopause. These symptoms include:

  • Hot flashes – getting very warm in the face, neck and chest; can cause sweating, be intense, last for 5 minutes or more, and occur many times a day.
  • Night sweats – this nighttime equivalent of hot flashes can disturb sleep and cause tiredness, stress and tension
  • Vaginal alterations – such as dryness, burning, itching, pain during sex
  • Mood swings
  • Thinning of the bones and possible osteoporosis
  • Urinary leakage
  • Urinary tract infections (UTIs).

Hormone therapy for menopause involves medications that contain estrogen, progesterone (progestin is the synthetic version), or estrogen and progestin, a combination that is used by women who have not had a hysterectomy. Androgens, such as the male hormone testosterone, may be used to improve sexual interest. Estrogen is the primary hormone administered because it addresses hot flashes, night sweats and vaginal issues.

Hormone therapy medications may be administered by:

  • Pills
  • Pellets placed under the skin
  • Skin creams, gels, patches
  • Vaginal cream, tablet, ring
  • Intrauterine device (IUD) with progestin.

The purpose for the replacement therapy will generally dictate the way the hormones are delivered. For example, a vaginal cream can treat dryness but will not have an effect on hot flashes. The medications can be taken daily (known as continuous use) or on certain days only (cyclic).

How long a woman may use hormone replacement therapy for menopause depends on several factors that she and her physician will discuss in depth. Some may choose a short course of hormone therapy, some may taper off after assessing the effects on symptoms. Other women may continue the therapy for a longer course. As long as ongoing monitoring of the woman’s health occurs, hormone replacement therapy can be continued indefinitely.

Hormone pellets for menopause symptoms versus alternative therapies

Hormone pellets are one form of hormone replacement therapy that are made from compounds that come from plants. Hormone pellets exactly match human hormones. Because of this, hormone pellets are often described as bioidentical hormone therapy. Pellets are placed under the skin by a physician via a small, relatively painless incision, usually near the buttocks.

We may recommend the use of hormone pellets for women who have not experienced relief from menopause symptoms with other forms of hormone replacement therapy. While we offer these other forms of treatment, including pills, creams and patches, we often find that hormone pellets provide our patients with the greatest improvement in quality of life. Our patients frequently note a significant alleviation of menopausal symptoms, such as insomnia, loss of libido, hot flashes, poor memory and difficulty concentrating after the insertion of pellets.

Hormone pellets are a time release form of therapy, which means they continuously release hormones over the course of several months. This allows for a more consistent and gradual release of hormones when compared with other hormone replacement therapies. There is no age limit to those who can use hormone pellets and no identified negative effects for using pellets continuously.

While many companies offer hormone pellets, not all are medically based. This means they often make claims about the benefits of hormone pellets that are not accurate. Creation and use of hormone pellets are not regulated by the Food and Drug Administration (FDA), so it’s essential to undergo this form of hormone therapy at a medical practice or institution.

At SMFI, we offer hormone pellets that use only nonsynthetic ingredients. Our physicians evaluate all patients before placing hormone pellets and recommend routine check-ups to monitor their effects. Additionally, we provide a number of educational resources to patients interested in this service, so they can learn more about the science that makes pellets an effective treatment option for many women suffering from menopause symptoms.

Interested in hormone pellets? Make an appointment to learn about your options and complete our hormone evaluation questionnaire.

Risks of hormone replacement therapy for menopause

Fertility physicians periodically hear about alarming clinical trials claiming an increased risk of breast cancer and blood clots from hormone replacement therapy. We never hear about the other studies that claim the opposite. Science and experience have shown that estrogen does not cause breast cancer but may stimulate an existing breast tumor. Therefore, at Servy Massey Fertility Institute (SMFI) we request a yearly mammography on all patients taking hormone therapy. Long-term studies and statistics have shown that 10 to 12 percent of women living in Western countries will develop breast cancer whether or not they are on, or have been on, hormone therapy.

The Food and Drug Administration (FDA) states that hormone therapy for menopause symptoms is appropriate for many women. Every woman considering hormone therapy for menopause should have a thorough discussion with her physician about risks and benefits.

The FDA says hormone therapy for menopause may not be appropriate for women who:

  • Have had a heart attack or a stroke
  • Have vaginal bleeding issues
  • May be pregnant (possible for women in perimenopause)
  • Have had certain types of cancer
  • Have blood clots
  • Have liver disease.

At SMFI we have well-established guidelines in place to completely monitor women receiving hormone therapy for menopause. We administer periodic tests to monitor hormone levels in the blood.

For women who have not had a hysterectomy, biopsies of the uterine lining may be conducted to detect abnormal cells. Pap tests may also be recommended, as well as cholesterol and other blood chemistry tests and mammograms.

It has been proven that estrogen stimulates the production of collagen, which consists of 75 percent of the body’s natural protein and is located in every part of the body (skin, hair, nails, bones, muscles, blood vessels and brain). In conclusion, hormone therapy is not a fountain of youth, as claimed by some, but it definitely slows the aging process.

Resources on hormone therapy & hormone pellets

Scientific article: The Use of Implantable Hormone Pellets in Perimenopausal and Postmenopausal Women by Victor A. Soto Velazquez

Research study: Subcutaneous Estradiol Implants: An Efficacious, Safe, and Underutilized Method of Estrogen Replacement Therapy in the Postmenopausal Woman by Briana DiSilvio