“The risks and benefits of MHT differ for
women during the menopause transition
compared to those for older women”.1

Umbrella
What may the Hormone Therapy Benefits and Risks Umbrella include?

Depending on the Source (DotS) this Umbrella may include:

  • HRT/HT/MHT Benefits and Risks
  • HRT/HT/MHT Health Benefits and Risks
  • HRT/HT/MHT Pros and Cons
  • HRT/HT/MHT Risks and Benefits
  • Hormone Replacement Therapy (HRT)
  • Hormone Therapy (HT)
  • Menopausal Hormone Therapy (MHT)

Date

What can it be important to be clear about with hormone therapy (HT) benefits and risks information?

It can be important to be clear about the date of all information including the date of HT benefits and risks information, because this information may have been updated.

Symptoms or Chronic Conditions

What can it also be important to be clear about with HT benefits and risks information?

It can also be important to be clear about whether HT benefits and risks information is about the use of HT for the management of menopausal symptoms such as hot flushes, night sweats and vaginal dryness or for the prevention of chronic conditions such as cardiovascular disease, cancer and osteoporosis.

Benefit/Risk Profile

For the majority of women do HT benefits outweigh the risks?

In Risks and Benefits of MHT: Key Points the Australasian Menopause Society note:

“For the majority of symptomatic women, the benefits of menopausal hormone therapy (MHT) outweigh the risks”.2

On page three in the Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause, first published 10 June 2022, Hamoda et al. also note:

“For most women, initiating HRT has a favourable benefit/risk profile. However, HRT should not be used without a clear indication and should not be used for the sole purpose of disease prevention”.3

Individual Benefits and Risks

How important is it to understand what the benefits and risks are?

In Hormone Replacement Therapy (HRT): Benefits and Risks the (United Kingdom) NHS elaborate on:

“When deciding whether to have hormone replacement therapy (HRT), it’s important to understand the benefits and risks.

Many studies on HRT published over the past 15 years highlight the potential risks. As a result, some women and doctors have been reluctant to use HRT.

But recent evidence says that the risks of HRT are small and are usually outweighed by the benefits”.4

What is HRT?

HRT can be an abbreviation for Hormone Replacement Therapy.

Benefits and Risks Differences

Can HT benefits and risks be different for different women?

Yes. HT benefits and risks can be different for different women. These differences may include:

Hormone Therapy Benefits and Risks Differences

  1. Individual Differences
  2. Product Differences
  3. Symptom Differences
  4. Age Differences
  5. Menopause Onset
  6. Risk Differences
  7. Health Conditions Differences
  8. Uterus Differences
  9. EPT and ET Differences
  10. Option Differences
  11. Duration Differences
  12. Breast Cancer Risk

1. Individual Differences

Can HT benefits and risks differ for individual women?

One of the recommendations on page two in the Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause, first published 10 June 2022, is:

  • “The decision whether to take HRT, the dose and duration of its use should be made on an individualised basis after discussing the benefits and risks with each patient. This should be considered in the context of the overall benefits obtained from using HRT including symptom control and improving quality of life as well as considering the bone and cardiovascular benefits associated with HRT use”.5

2. Product Differences

Can menopausal hormone therapy (MHT) benefits and risks be different for different hormonal products?

One of the governing principles in the International Menopause Society’s (IMS) 2016 IMS Recommendations on Women’s Midlife Health and Menopause Hormone Therapy: IMS Governing Principles on MHT, published online 12 February 2016, is:

  • “MHT includes a wide range of hormonal products and routes of administration, with potentially different risks and benefits. Thus, the term ‘class effect’ is confusing and inappropriate. However, evidence regarding differences in risks and benefits between different products is limited”.6

3. Symptom Differences

Can MHT benefits and risks differ for women with different menopause symptoms?

On page 767 in The North American Menopause Society Releases Its 2022 Hormone Therapy Position Statement: Abstract – “endorsed by more than 20 well-respected international organizations” – published July 2022, the NAMS note:

“For bothersome genitourinary syndrome of menopause symptoms not relieved with over-the-counter therapies in women without indications for use of systemic hormone therapy, low-dose vaginal estrogen therapy or other therapies (eg, vaginal dehydroepiandrosterone or oral ospemifene) are recommended”.7

4. Age Differences

Can MHT benefits and risks differ for women of different ages?

On page one in The North American Menopause Society Releases Its 2022 Hormone Therapy Position Statement, published 7 July 2022, the NAMS explain:

Hormone Therapy Benefits and Risks

  • “The benefits of hormone therapy outweigh the risks for most healthy symptomatic women who are aged younger than 60 years and within 10 years of menopause onset”.8

5. Menopause Onset

Can HT benefits and risks differ according to menopause onset?

As noted above, on page one in The North American Menopause Society Releases Its 2022 Hormone Therapy Position Statement, published 7 July 2022, the NAMS explain:

  • “The benefits of hormone therapy outweigh the risks for most healthy symptomatic women who are aged younger than 60 years and within 10 years of menopause onset”.9

6. Risk Differences

Can HT risks differ for women with different risk factors?

On page 767 in The North American Menopause Society Releases Its 2022 Hormone Therapy Position Statement: Abstract the NAMS note:

“The risks of hormone therapy differ depending on type, dose, duration of use, route of administration, timing of initiation, and whether a progestogen is used”.10

In Menopause: Menopause – Hormone Treatments the (United States) U.S. Food and Drug Administration (FDA) also note:

“In some women, Menopause Hormone Therapy may increase risks of serious side effects including blood clots, heart attacks, strokes, breast cancer, and gall bladder disease”.11

7. Health Conditions Differences

Can HT risks differ for different women with different health conditions?

In Menopause: Menopause – Hormone Treatment? the FDA explain:

“You should not take hormone therapy for menopause if:

  • You think you are pregnant
  • You have problems with vaginal bleeding
  • You have had certain kinds of cancers
  • You have had a stroke or heart attack
  • You have had blood clots
  • You have liver disease”.12

8. Uterus Differences

Can HT benefits and risks differ for women who have a uterus?

Hormone Therapy Benefits and RisksIn Menopause FAQS: Hormone Therapy – Q. What Is Hormone Therapy? the NAMS note:

“A. …Women who still have a uterus need to take a progestogen in addition to estrogen or the estrogen-SERM combination to protect against uterine cancer”.13

Hormone Therapy Benefits and RisksIf you do not have a uterus, in Menopause FAQS: Hormone Therapy – Q. What Is Hormone Therapy? the NAMS also note:

“A. …Women who have had a hysterectomy (had their uterus removed) can use estrogen alone to control their hot flashes”.14

9. ET and EPT Differences

Can HT benefits and risks differ for women who use ET and women who use EPT?

The NAMS explain:

“…you and your healthcare provider need to balance the benefits and risks you have. For example, if you don’t have a uterus and can take estrogen therapy (ET) alone, your risks are different from those of women who still have a uterus and must use estrogen plus progestogen (EPT) to protect against uterine cancer”.15

10. Option Differences

Can HT benefits and risks differ for different HT options?

On page two in Deciding About Hormone Use: Pill or Non-Pill the NAMS explain:

“Hormone therapy is available as a daily pill, but it also may be taken as a skin patch, gel, cream, spray, or vaginal ring. Non-pill forms may be more convenient. Hormone therapy pills need to be taken every day, but skin patches are changed only once or twice weekly, and the HT vaginal ring is changed only every 3 months. Hormone therapy taken in non-pill form enters your blood stream more directly, with less effect on the liver. Studies suggest that this may lower the risk of blood clots in the legs and lungs compared with HT taken as a pill”.16

11. Duration Differences

Can HT benefits and risks differ for women who choose to use HT for different durations or lengths of time?

One of the points of consensus in the Revised Global Consensus Statement on Menopausal Hormone Therapy: Section B: General Principles Governing the Use of MHT is:

  • “Duration of treatment should be consistent with the treatment goals of the individual, and the benefit/risk profile needs to be individually reassessed annually. This is important in view of new data indicating longer duration of VMS in some women”.17

In the NICE Guideline Menopause: Diagnosis and Management – Information for the Public: Treating Menopausal Symptoms the (British) National Institute for Health and Care Excellence’s (NICE) elaborate on:

“If HRT is suitable for you and you are interested in taking it, your GP should discuss the benefits and risks with you, both in the short term (the next 5 years) and in the future, before you decide to start it.

You should also be given information about:

  • Non-hormonal treatments, for example a drug called clonidine
  • Other types of treatments, such as cognitive behavioural therapy (CBT), a type of psychological therapy that helps people to manage the way they think and feel”.18

Who is a GP?

Dots and/or DotC (Depending on the Country) a GP may be a registered general practitioner, a medical practitioner, a medical doctor or a doctor.

12. Breast Cancer Risk

Can HT increase breast cancer risk?

On page one in Deciding About Hormone Use: Potential Risks the NAMS explain:

“Hormone therapy (combined estrogen and progestogen) might slightly increase your risk of breast cancer if used for more than 4 to 5 years. Using estrogen alone (for women without a uterus) does not increase breast cancer risk at 7 years but may increase risk if used for a longer time”.19

One of the recommendations on page two in the Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause is:

  • “Current evidence suggests that oestrogen alone HRT is associated with a lower risk of breast cancer than combined HRT. Breast cancer risk is duration dependent and may vary with the type of progestogen used. The risk of breast cancer should be considered in the context of the overall benefits and risks associated with HRT intake”.20

Health Care Provider

If I choose to use HT, how can I find out what my benefits and risks are?

If you choose to use HT, it may be in your best interest to also choose to talk to your health care provider about this.

In BMS & WHC’s 2020 Recommendations on Hormone Replacement Therapy In Menopausal Women the British Menopause Society and Women’s Health Concern note:

Hormone Therapy Benefits and Risks

“The decision whether to take HRT, the dose of HRT used and the duration of its use should be made on an individualised basis after discussing the benefits and risks with each patient. This should be considered in the context of the overall benefits obtained from using HRT including symptom control and improving quality of life as well as considering the bone and cardiovascular benefits associated with HRT use”.21

On page one in Deciding About Hormone Use the NAMS explain:

“Every woman is different, and you will decide about whether to use HT based on the severity of your symptoms, your personal and family health history, and your own beliefs about menopause treatments. Your healthcare professional will be able to help you with your decision”.22

In Menopause Management: Menopause Hormone Therapy (MHT) – Should You Take MHT? the (Australian) Jean Hailes for Women’s Health (JH) elaborate on:

  • “Jean Hailes strongly advocates that women take a balanced, evidence-based and informed approach to their healthcare: all risks and benefits should be considered when deciding whether to use MHT
  • Current recommendations by world experts in menopause, including our own doctors, suggest the benefits of MHT outweigh the risks for healthy menopausal women”.23

The JH also note:

  • “Jean Hailes recommends each woman discusses her decision about taking MHT with her doctor regularly and whenever there are any concerns”.24

Health Topics A-Z

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Links

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Sources

Where may I find the Sources quoted?

You may find the Sources quoted at:

Sources

  1. Baber, R. J., Panay N. and Fenton, A., the IMS Writing Group. 2016 IMS Recommendations on Women’s Midlife Health and Menopause Hormone Therapy: IMS Governing Principles on MHT. Climacteric 19:2, 110 https://www.imsociety.org/wp-content/uploads/2020/08/2016-ims-hrt-health-recommendations-english.pdf Accessed: 10 August 2022
  2. Risks and Benefits of MHT: Key Points. Content Updated January 2021. Australasian Menopause Society https://www.menopause.org.au/hp/information-sheets/risks-and-benefits-of-mht-hrt Accessed: 10 August 2022
  3. Hamoda et al. Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause. First published 10 June 2022:3. https://journals.sagepub.com/doi/full/10.1177/20533691221104879 Accessed: 10 August 2022
  4. Hormone Replacement Therapy (HRT): Benefits and Risks. Page Last Reviewed: 09 September 2019. NHS https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/risks/ Accessed: 10 August 2022
  5. Hamoda et al. Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause. First published 10 June 2022:2. https://journals.sagepub.com/doi/full/10.1177/20533691221104879 Accessed: 10 August 2022
  6. Baber, R. J., Panay N. and Fenton, A., the IMS Writing Group. 2016 IMS Recommendations on Women’s Midlife Health and Menopause Hormone Therapy: IMS Governing Principles on MHT. Climacteric 19:2, 111 https://www.imsociety.org/wp-content/uploads/2020/08/2016-ims-hrt-health-recommendations-english.pdf Accessed: 10 August 2022
  7. The 2022 Hormone Therapy Position Statement of The North American Menopause Society: Abstract. July 2022:767. North American Menopause Society https://www.menopause.org/docs/default-source/professional/nams-2022-hormone-therapy-position-statement.pdf Accessed: 10 August 2022
  8. The North American Menopause Society Releases Its 2022 Hormone Therapy Position Statement. 09 July 2022. North American Menopause Society https://www.menopause.org/docs/default-source/press-release/ht-position-statement-release.pdf Accessed: 10 August 2022
  9. The North American Menopause Society Releases Its 2022 Hormone Therapy Position Statement. 09 July 2022. North American Menopause Society https://www.menopause.org/docs/default-source/press-release/ht-position-statement-release.pdf Accessed: 10 August 2022
  10. The 2022 Hormone Therapy Position Statement of The North American Menopause Society: Abstract. July 2022:767. North American Menopause Society https://www.menopause.org/docs/default-source/professional/nams-2022-hormone-therapy-position-statement.pdf Accessed: 10 August 2022
  11. Menopause: Menopause – Hormone Treatments. Content Current As of: 22 August 2019. Food and Drug Administration https://www.fda.gov/consumers/womens-health-topics/menopause Accessed: 10 August 2022
  12. Menopause: Menopause – Hormone Treatments. Content Current As of: 22 August 2019. Food and Drug Administration https://www.fda.gov/consumers/womens-health-topics/menopause Accessed: 10 August 2022
  13. Menopause FAQS: Hormone Therapy – Q. What Is Hormone Therapy? North American Menopause Society https://www.menopause.org/for-women/menopause-faqs-hormone-therapy-for-menopause-symptoms Accessed: 10 August 2022
  14. Menopause FAQS: Hormone Therapy – Q. What Is Hormone Therapy? North American Menopause Society https://www.menopause.org/for-women/menopause-faqs-hormone-therapy-for-menopause-symptoms Accessed: 10 August 2022
  15. News You Can Use About Hormone Therapy: Benefits. North American Menopause Society https://www.menopause.org/for-women/menopauseflashes/menopause-symptoms-and-treatments/news-you-can-use-about-hormone-therapy Accessed: 10 August 2022
  16. Deciding About Hormone Therapy Use: Pill or Non-Pill. 2022:2. North American Menopause Society https://www.menopause.org/docs/default-source/professional/menonote-deciding-about-ht-2022.pdf Accessed: 10 August 2022
  17. De Villiers,  T. J., Hall, J. E., Pinkerton, J. V., Pérez, S. C., Rees, M., Yang, C. and Pierroz, D. D. Revised Global Consensus Statement on Menopausal Hormone Therapy: Section B: General Principles Governing the Use of MHT. Climacteric, 2016;19:4:314 https://www.imsociety.org/wp-content/uploads/2020/08/global-consensus-hrt-2016-06.pdf Accessed: 10 August 2022
  18. Menopause: Diagnosis and Management – Information for the Public: Treating Menopausal Symptoms. Published Date: 12 November 2015. Last Updated: 05 December 2019. National Institute for Health and Care Excellence https://www.nice.org.uk/guidance/ng23/ifp/chapter/Treating-menopausal-symptoms Accessed: 10 August 2022
  19. Deciding About Hormone Therapy Use: Potential Benefits. 2022:2. North American Menopause Society https://www.menopause.org/docs/default-source/professional/menonote-deciding-about-ht-2022.pdf Accessed: 10 August 2022
  20. Hamoda et al. Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause. First published 10 June 2022:2. https://journals.sagepub.com/doi/full/10.1177/20533691221104879 Accessed: 10 August 2022
  21. BMS & WHC’s 2020 Recommendations on Hormone Replacement Therapy In Menopausal Women. Updated March 2021. British Menopause Society and Women’s Health Concern https://thebms.org.uk/publications/consensus-statements/bms-whcs-2020-recommendations-on-hormone-replacement-therapy-in-menopausal-women/ Accessed: 10 August 2022
  22. Deciding About Hormone Therapy Use. 2022:1. North American Menopause Society https://www.menopause.org/docs/default-source/professional/menonote-deciding-about-ht-2022.pdf Accessed: 10 August 2022
  23. Menopause Management: Menopausal Hormone Therapy (MHT) – Should You Take MHT? Last Updated: 13 July 2021 | Last Reviewed: 17 December 2017. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/menopause/menopause-management/ Accessed: 10 August 2022
  24. Menopause Management: Menopausal Hormone Therapy (MHT) – Should You Take MHT? Last Updated:  13 July 2021 | Last Reviewed: 17 December 2017. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/menopause/menopause-management/ Accessed: 10 August 2022
Topic Last Updated: 10 August 2022 – Topic Last Reviewed: 31 March 2022

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