Types of Menopause Hormone Therapy and How To Choose What’s Right for You
From estrogen pills to vaginal creams, here’s how doctors match therapy to symptoms
Struggling with distressing menopause symptoms? So many of us are. In a 2023 survey, 81 percent of menopausal and postmenopausal women reported having hot flashes. Plus, over half experienced night sweats, sleep difficulties and mood changes, while 50 percent suffered from vaginal dryness. Fortunately, menopause hormone therapy can help.
But choosing the type that’s appropriate for you can prove tricky. So we asked Amy Cantor, MD, MPH, FAAFP, a menopause specialist and family physician at Oregon Health & Science University, to cut through the confusion. Read on to learn about the different types of hormone therapy treatment options that can make your menopause journey more manageable.
What is hormone therapy for menopause?
Most women think of hormone therapy during menopause as something called hormone replacement therapy (HRT). But these days, the preferred term is menopausal hormone therapy or menopause hormone therapy. The reason: “Hormone replacement therapy is really just that—it’s for someone who either underwent premature menopause or is missing a hormone that needs to be replaced,” explains Dr. Cantor. “But with menopausal hormone therapy you may still have some circulating hormones. It doesn’t necessarily mean you’re lacking them entirely.”
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For women who are in perimenopause or menopause, hormone therapy is an FDA-approved treatment for symptoms such as hot flashes, night sweats and vaginal dryness. And as Dr. Cantor adds, women who are on hormone therapy may also notice benefits in terms of other common menopause symptoms, including sleep disturbances, mood changes and muscle or joint pain.
Plus, research published in The Journal of Clinical Endocrinology & Metabolism found that when used appropriately, the same hormone therapy used to treat menopause symptoms can actually boost bone density.
Still, hormone therapy isn’t a one-size-fits all strategy; its benefits and risks can vary from woman to woman, and not everyone is a candidate for every type. Here’s what to know about your options.
The 2 main types of hormone therapy for menopause
Menopausal hormone therapy is available in two main types: estrogen-only and combination therapy (estrogen plus progesterone). Estrogen-only therapy is reserved for women who no longer have a uterus, since unopposed estrogen can increase the risk of uterine cancer.
But for women who still have a uterus, combining estrogen with progesterone can be an appropriate option. Progesterone helps protect the uterine lining from the abnormal cell growth estrogen can cause, explains Dr. Cantor. And in a Journal of the National Cancer Institute study, combination therapy actually reduced women’s uterine cancer risk.
Systemic vs. local menopausal hormone therapy
Hormone therapy for menopause symptoms also varies by the way it’s delivered. And again, there are two main types: Systemic, which circulates hormones throughout the body, and local, which delivers hormones to specific tissues.
Systemic therapy
This type of treatment is typically delivered via oral pills and transdermal patches, gels and sprays. According to Dr. Cantor, “It’s effective for treating symptoms such as hot flashes and night sweats that affect the whole body.” But she cautions that you may not be a candidate for systemic menopausal hormone therapy if you have a history of conditions such as uterine cancer, breast cancer, heart attack, stroke or blood clots.
Local delivery
“What we’re really referring to is vaginal estrogen therapy,” Dr. Cantor explains. Available as creams, gels, suppositories and an estrogen-containing ring, this type of hormone therapy delivers estrogen to localized tissues only, relieving symptoms such as vaginal dryness, pain during intercourse and urinary incontinence. And as experts at Washington University School of Medicine note, vaginal estrogen may decrease the risk of frequent urinary tract infections that often accompany menopause.
“Unlike systemic estrogen, vaginal estrogen doesn’t require the addition of progesterone to protect the uterus,” Dr. Cantor says. A report published in the journal Menopause found that vaginal estrogen wasn’t associated with increased uterine cancer risk. Nor did it raise women’s risks of breast cancer, heart attack or stroke.
Choosing the menopause hormone therapy that’s right for you
“Symptoms of menopause should never be ignored, and for many women the benefits of menopausal hormone therapy outweigh the risks,” assures Dr. Cantor. But determining what’s best in your personal case involves consulting a healthcare provider who’s well-versed in hormone therapy and its various types.
Her advice: “You should work with your clinician to figure out your personal goals, your medical history and your family history so that together you can find the best fit.” Need help finding a clinician to work with? Dr. Cantor recommends checking the “Find a Healthcare Practitioner” directory at Menopause.org to get started.
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