Hormones and Menopause

Tips from the National Institute on Aging

NATIONAL INSTITUTE ON AGING

NATIONAL INSTITUTES OF HEALTH

Department of Health and Human Services

Cathy had been waking up during the night 

feeling hot and sweaty. That left her tired all 

day. Then she began to feel hot on and off 

during the day also, so she went to see her 

doctor. The doctor told her she was having 

hot flashes—a sign that she was going through 

perimenopause, the time around menopause. 

Her doctor talked about different ways to 

control the symptoms. One was using estrogen 

for a short time. Cathy and her doctor talked 

about the risks, as well as the benefits. Cathy 

said she remembered something in the news 

about using hormones around menopause. 

She was uncertain. What’s a woman to do?

A hormone is a chemical substance made 

by a gland or organ to regulate various body 

functions. To help control the symptoms 

of menopause some women can take hormones, called menopausal hormone therapy 

(MHT). MHT used to be called hormone 

replacement therapy or HRT. Some women 

should not use MHT. There are many things 

to learn about hormones before you make 

the choice that is right for you.

Cathy’s doctor told her to call back for a 

prescription if she decided to try using 

hormones to control her symptoms. After 

reading pamphlets from her doctor’s office, 

Cathy talked to her friends. Lily, who had 

surgery to remove her uterus and ovaries, 

has been taking estrogen since the operation. 

Sandy said she’s had a few hot flashes, but 

isn’t really uncomfortable enough to want 

treatment. Melissa’s doctor thinks she should 

not use estrogen because her younger sister 

has breast cancer. Each friend had a different 

story. Cathy needed more information.

Which hormones are used for 

menopause?

Cathy has a lot of questions, starting with the 

basics—what is menopausal hormone therapy? 

During perimenopause, the months or years 

right before menopause, levels of two female 

hormones, estrogen and progesterone, in a 

woman’s body go up and down irregularly. 

This happens as the ovaries struggle to keep 

up with the body’s needs. The symptoms of 

menopause might result from these changing hormone levels. After menopause, when 

a woman’s ovaries make much less estrogen 

and progesterone, the symptoms of menopause may continue. Menopausal hormone 

therapy may help control these symptoms. A 

woman whose uterus has been removed can 

Tips
HORMONES AND MENOPAUSE

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use estrogen alone to control her symptoms. 

But a woman who still has a uterus must take 

progesterone or a progestin (a synthetic progesterone) along with the estrogen. This will 

prevent unwanted thickening of the lining 

of the uterus and also cancer of the uterus, 

an uncommon, but possible result of using 

estrogen alone.

Why take these hormones? 

Why not?

Cathy’s doctor said the plus side of taking estrogen is that it is the most effective treatment 

for hot flashes, night sweats, and vaginal dryness. And it will help keep her bones strong. 

Cathy thought that those certainly seemed 

like good reasons to use MHT. But she wondered, is there a down side? 

Menopause is a normal part of life. It is not 

a disease that has to be treated. Women may 

decide to use menopausal hormone therapy 

because of its benefits, but there are also 

side effects and risks to consider. Two good 

reasons to think about menopausal hormone 

therapy are:

treating some of the bothersome 

symptoms of menopause, 

preventing or treating osteoporosis. 

But for some women there are noticeable 

side effects: 

breast tenderness,

spotting or a return of monthly periods, 

cramping,

bloating.

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By changing the type or amount of the 

hormones, the way they are taken, or the 

timing of the doses, your doctor may be able 

to control these side effects. Or, over time, 

they may go away on their own.

For some women there are also serious risks 

(see chart). These risks are why you need 

to think a lot before deciding to use menopausal hormone therapy. 

Although the risks are small for any one 

woman, you need to take them into account. 

Much of the following chart on benefits and 

risks is based on one important clinical trial, 

the Women’s Health Initiative (WHI). This 

study looked at estrogen (conjugated equine 

estrogens) used alone or with a particular 

progestin (medroxyprogesterone acetate). 

Some other types of estrogen, progesterone, 

or progestin may have been tested in smaller 

clinical trials to see if they have an effect on 

heart disease, breast cancer, or dementia. 

Others have not. 

Because the average age of women participating in the trial was 63, more than 10 years 

past the average age of menopause, some 

experts now question whether the WHI 

results apply to women around the time of 

menopause. The WHI study found that in 

every 10,000 women using estrogen plus 

progestin, there would be 7 more heart 

attacks than in every 10,000 women not 

using these hormones. Other research has 

suggested that if MHT is begun around 

the time of menopause, it might provide 

protection from heart disease, but not if a 

woman waits too long. This is a subject for 

further study. 
TIPS FROM THE NATIONAL INSTITUTE ON AGING

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Women with a Uterus

Estrogen + Progestin

Women Without a Uterus*

Estrogen Only

BENEFITS

Relieves hot flashes/night sweats Yes Yes

Relieves vaginal dryness Yes Yes

Reduces risk of bone fractures Yes Yes

Improves cholesterol levels Yes Yes

Reduces risk of colon cancer Yes Don’t know

RISKS

Increases risk of stroke Yes Yes

Increases risk of serious blood clots Yes Yes

Increases risk of heart attack Yes No

Increases risk of breast cancer Yes Possibly

Increases risk of dementia, when begun 

 by women age 65 and older Yes Yes

Unpleasant side effects, such as bloating 

 and tender breasts Yes Yes

Pill form can raise level of triglycerides 

 (a type of fat in the blood) Yes Yes

Benefits and Risks of Menopausal Hormone Therapy—July 2006

Here is what scientists can say right now about the benefits and risks of MHT. Remember—which 

hormones you use, the way you take them, and the dose—might affect these benefits and risks. 

*Women who have had a hysterectomy have had their uterus removed.
HORMONES AND MENOPAUSE

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How would I use the hormones?

Cathy’s friend Lily takes her estrogen in pill 

form, but Cathy has trouble swallowing pills. 

She hasn’t yet decided whether or not to use 

hormones, but if they only come as a pill, that 

would be part of her decision.

Estrogen comes in many forms and dosages. 

You could use a skin patch or vaginal tablet 

or cream, take a pill, or get an implant, shot, 

or vaginal ring insert. Progesterone or progestin is often taken as a pill, sometimes in 

the same pill as the estrogen. It also comes 

as a patch, shot, IUD (intrauterine device), 

vaginal gel, or suppository.

The form your doctor suggests may depend 

on your symptoms. For example, patches or 

pills can relieve hot flashes, night sweats, and 

vaginal dryness. They will also slow or prevent bone loss and help delay osteoporosis 

while you are using them. Other forms—

vaginal creams, tablets, or rings—are used for 

vaginal dryness. The vaginal ring insert might 

also help some urinary tract symptoms. But, 

the dose found in these other forms is probably too low to relieve hot flashes. 

What are natural hormones? 

Cathy’s friend Susan thinks she is not at risk 

for side effects from menopausal hormone 

therapy because she uses “natural hormones” 

to treat her hot flashes and night sweats. 

Cathy asked her doctor about them.

The natural hormones Susan uses are 

estrogen and progesterone made from plants 

such as soy or yams. Some people also call 

them bioidentical hormones because they 

are supposed to be chemically the same as 

the hormones naturally made by a woman’s 

body. So-called natural hormones are put 

together (compounded) by a compounding 

pharmacist. This pharmacist follows a formula decided on by your doctor.

Drug companies also make estrogens and 

progesterone from plants like soy and yams. 

Some of these are also chemically identical 

to the hormones made by your body. You 

get these from any pharmacy with a prescription from your doctor.

One difference between the natural 

hormones prepared by a compounding 

pharmacist and those made by a drug 

company is that the compounded natural 

hormones are not regulated and approved 

by the U.S. Food and Drug Administration 

(FDA). So, we don’t know much about how 

safe or effective they are or how the quality 

varies from batch to batch. Hormones 

made by drug companies are regulated 

and approved by the FDA. 

There are also “natural” treatments for the 

symptoms of menopause that are available 

over-the-counter, without a prescription. 

Some of these are also made from soy or 

yams. They are not regulated or approved by 

the FDA. 

Cathy’s doctor told her that there is very little 

reliable scientific information from clinical 

trials about the safety of bioidentical hormones, how well they control the symptoms of 

menopause, and whether they are as good or 

better to use than FDA-approved estrogens, 

progesterone, and progestins. 
TIPS FROM THE NATIONAL INSTITUTE ON AGING

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What’s right for me?

There is no “one size fits all” answer for all 

women who are trying to decide whether to 

use menopausal hormone therapy (MHT). 

You have to look at your own needs and 

weigh your own risks. 

Ask yourself and your doctor these questions:

How much are you bothered by menopausal 

symptoms such as hot flashes or vaginal dryness? Like many women your hot flashes or 

night sweats will likely go away over time, 

but vaginal dryness may not. MHT can 

help if your symptoms are troubling you.

Are you at risk for developing osteoporosis? 

Estrogen might protect bone mass while 

you use it. However, there are other drugs 

that can protect your bones without the 

same risks as MHT.

Do you have a history of heart disease? 

Using estrogen and progestin can increase 

your risk. 

Do you or others in your family have a history of breast cancer? If you have a family 

history of breast cancer, check with your 

doctor about your risk.

Do you have a history of gall bladder disease 

or high levels of triglycerides? Some experts 

think that using a patch will not make your 

triglyceride (a type of fat in the blood)level 

go up or increase your chance of gall bladder 

problems. Using an estrogen pill might.

Do you have liver disease or a history of 

stroke or blood clots in your veins? MHT 

might not be safe for you to use. 

Are you over age 65 and thinking about using 

MHT to prevent dementia? Estrogen and 

progestin could actually increase your risk of 

dementia. Estrogen alone might do that also.

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Then, like Cathy, talk to your doctor about 

how best to treat or prevent your symptoms 

or the diseases for which you are at risk. 

Ask about your other choices. Remember, 

these too may have risks and benefits. If you 

decide to use MHT, the FDA suggests that 

you use the lowest dose that works for the 

shortest time needed. 

If you are already using menopausal hormone 

therapy and think you would like to stop, first 

ask your health care provider how to do that. 

Some doctors suggest tapering off slowly.

Whatever decision you make now about 

using MHT is not final. You can start or end 

the treatment at any time. If you stop, your 

risks will probably lessen over time, but so 

will the protection. Discuss your decision 

about menopausal hormone therapy each year 

with your doctor at your annual checkup. 

Unanswered Questions

Don’t forget at your checkup to ask your 

doctor about any new study results. Research 

on menopause is ongoing. Scientists are looking for answers to questions such as: 

How long can a woman safely use menopausal hormone therapy?

Are some types of estrogen or progesterone 

safer than others? 

Is one form of hormone therapy (patch, pill, 

or cream, for example) better than another? 

Is MHT safer if you start it around the time 

of menopause instead of when you are older? 

For now, we know that each woman is different, and the decision for each one will 

probably also be different. But, almost every 

study gives women and their doctors more 

information to answer the question: Is 

menopausal hormone therapy right for me?

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National Institutes of Health

Menopausal Hormone Therapy

Information

www.nih.gov/PHTindex.htm

National Library of Medicine

MedlinePlus

Search for:

“Menopausal Hormone Therapy”

“Menopause”

www.medlineplus.gov

American College of Obstetricians 

and Gynecologists

409 12th Street, SW

Box 96920

Washington, DC 20090-6920

202-638-5577

www.acog.org

North American Menopause Society

P.O. Box 94527

Cleveland, OH 44101

440-442-7550

800-774-5342 (toll-free)

www.menopause.org

For more information on health and aging, 

including menopause, contact:

National Institute on Aging 

Information Center

P.O. Box 8057

Gaithersburg, MD 20898-8057

800-222-2225 (toll-free)

800-222-4225 (TTY/toll-free)

www.nia.nih.gov

For More Information Other resources on menopausal hormone therapy include:

To order publications (in English or Spanish) or sign up for regular email alerts, go to:

www.nia.nih.gov/HealthInformation

Visit NIHSeniorHealth.gov (www.nihseniorhealth.gov), a senior-friendly website from the National Institute on 

Aging and the National Library of Medicine. This simple-to-use website features popular health topics for older 

adults. It has large type and a talking function that “reads” the text out loud.

JULY 2006