You don’t have to get treatment just because you’re going through menopause. But if you have hot flashes, problems sleeping, and mood changes that bother you, the treatment that works best is menopausal hormone therapy (MHT). If you want to treat vaginal dryness only, topical treatments (like gels and creams) that you put on your skin or in your vagina (like tablets) work well.
What is menopausal hormone therapy (MHT)?
Menopausal hormone therapy (MHT) works by replacing 2 hormones that your ovaries stop making when you’re going through perimenopause and menopause: estrogen and progesterone. They’re like the hormones in some birth control methods.
There are two different kinds of hormone therapy: estrogen only, or estrogen with a progestogen.
This is the best treatment for hot flashes, night sweats, and vaginal dryness. People who had surgery to remove their uterus, called a hysterectomy, only need to take estrogen and don’t need to take combined hormone therapy.
Combined hormone therapy:
If you have a uterus, your doctor may prescribe combined hormone therapy. This is estrogen and artificial progesterone (called progestogen) taken together. Combined hormone therapy may lower your risk of getting uterine cancer and colon cancer.
Hormone therapy can help with:
- hot flashes
- vaginal dryness
- sleep problems
- urinary tract infections
- sudden urges to pee
- lowering your risk of osteoporosis, colon cancer, and diabetes
- lowering your risk of heart disease if you start MHT within 10 years of menopause
How do you take MHT?
Some of the options for how to take hormone therapy are like the options for taking hormonal birth control. These options are:
- vaginal creams (best for people who only have vaginal dryness as a symptom)
What are the side effects of MHT?
Side effects of MHT, if you have them, vary based on what kind of hormone(s) you’re taking. Side effects usually don’t last long or need to be treated. They may include:
- water retention in your arms and legs
- tender breasts
- irregular vaginal bleeding
- mood swings
- weight gain
What are the risks of MHT?
Hormone therapy can have some risks, depending on your personal medical history and your family’s medical history.
MHT may increase your risk for:
- blood clots: if you take MHT by mouth;
- breast cancer: if you take MHT for more than 5 years or if you take combined MHT (estrogen and progestogen);
- heart disease: if you start MHT after age 60 or more than 10 years after menopause
- cancer in the uterus: if you take estrogen-only MHT;
- cancer in the ovaries
- gallbladder disease and gallstones
If you have a uterus, you may take MHT with 1 or both hormones (estrogen and progestogen). If you’ve had a hysterectomy (a surgery that removes the uterus) you only need to take one hormone: estrogen. Hormones that you swallow in pill form increase some of these risks.
If you’re thinking about taking hormone therapy, talk with the staff at your nearest Planned Parenthood health center. They can help you decide if the benefits are worth the risks.
Are there other treatment options for menopause symptoms?
People sometimes choose other methods of treating menopause symptoms if they’re worried about the risks of hormone therapy.
Some other methods are:
- herbal treatments
These therapies can have side effects, and research hasn’t proven that they're effective. So if you want to go in that direction, consult someone who’s skilled and experienced. They can help you decide if their method is right for you and help you do it safely. If you do choose one of these methods to treat your symptoms, be sure to let your nurse or doctor know.
What if I don’t want treatment?
You may choose not to take MHT. Depending on your symptoms, changes to your lifestyle or other medicines may help. If you need birth control and have hot flashes, combined hormonal birth control — like the pill, patch, or ring — may be the best choice as long as you don't smoke or have certain health problems. You can contact your nearest Planned Parenthood health center to talk about any of these options and get help with deciding what to do.
Where can I get treatment or more information?
Contact your nearest Planned Parenthood health centers for help going through perimenopause and menopause.
You can also contact the North American Menopause Society.