“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”.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.

Hormone Therapy

What is hormone therapy (HT) or menopausal hormone therapy (MHT)?

Depending on the Source the definition of HT may vary. In Menopause Management Options: Menopausal Hormone Therapy (MHT) – What Is MHT? the (Australian) Jean Hailes for Women’s Health (JH) definition is:

“Menopausal hormone therapy (MHT), formerly known as hormone replacement therapy (HRT), helps manage menopausal symptoms when they interfere with your life. Menopausal symptoms are caused by lowering levels of oestrogen hormones. MHT is the medical replacement of female hormones oestrogen and progesterone, and sometimes testosterone”.2

Majority Benefits and Risks

For the majority of those who choose to use HT, do the 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”.3

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 online 10 June 2022, one of the recommendations is:

“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”.4

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

“The benefits and risks of taking HRT depend on your age, your menopause symptoms and any risk factors you have.

If you’re under 60 years old, have menopause symptoms, and are not at high risk of breast cancer or blood clots, the benefits of HRT are likely to outweigh the risks.

Talk to a GP, who will help you decide”.5

Benefits and Risks Differences

Can HT benefits and risks differ for different people?

Yes. HT benefits and risks can differ for different people. These differences may include:

Hormone Therapy Benefits and Risks Differences

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

1. Individual Differences

Can HT benefits and risks differ for individuals who choose to use HT?

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, one of the recommendations 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”.6

2. Symptom Differences

Can HT benefits and risks differ for 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 North American Menopause Society (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

3. Age Differences

Can HT benefits and risks differ for 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:

  • “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

4. Postmenopause Differences

Can HT benefits and risks differ according to if you’ve been postmenopausal for 10 years or more?

In Menopause Management Options: Menopausal Hormone Therapy (MHT) – What Are the Risks of MHT?, last updated 06 June 2023, the JH note:


Hormone Therapy Benefits and Risks“It is not recommended you start MHT if you are older than 60 years or if you’ve been postmenopausal for 10 years or more”.9

5. Side Effect Differences

Can HT benefits and risks differ for different side effects?

In Menopause: Menopause – Hormone Treatments the (United States) U.S. Food and Drug Administration (FDA) 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”.10

6. Health Conditions Differences

Can HT benefits and risks differ for different health conditions?

In Hormone Replacement Therapy (HRT): When HRT Is Not Suitable, last updated 03 November 2022, the (Scottish) NHS Inform explain:

“HRT may not be suitable, or a specialist opinion may be needed, if you:

  • Have a history of breast cancer, ovarian cancer or womb (uterus) cancer
  • Have a history of blood clots, tablet HRT is not recommended but taking HRT through the skin can be considered
  • Have a history of heart disease or stroke
  • Have untreated high blood pressure – your blood pressure will need to be controlled before you can start HRT
  • Have liver disease
  • Are pregnant or breastfeeding”.11

7. Uterus Differences

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

Hormone Therapy Benefits and RisksOn page one in Deciding About Hormone Use, published July 2022, the NAMS note:

“Because estrogen stimulates the lining of the uterus, women with a uterus need to take an additional hormone, progestogen, to protect the uterus”.12

Hormone Therapy Benefits and RisksIf you do not have a uterus, on page one in Deciding About Hormone Use, the NAMS also note:

“Women without a uterus just take estrogen”.13

8. ET and EPT Differences

Can HT benefits and risks differ for those who use ET and those 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”.14

9. Product Differences

Can HT benefits and risks differ for different HT products?

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”.15

10. Option Differences

Can HT benefits and risks differ for different HT options?

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”.16

In Menopause Management Options: Menopausal Hormone Therapy (MHT) – What Are the Risks of MHT?, last updated 06 June 2023, the JH note:

“Research shows there are some risks associated with MHT. The risks of hormone therapy differ depending on:

  • The type of medication
  • The dose given
  • How long the medication is used for
  • How the medication is given (e.g. patch or tablet)
  • When medication is started
  • Whether a progestogen is used
  • The type of progestogen used”.17

11. Duration Differences

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

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

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 one of the recommendations 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

What 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.

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


Hormone Therapy Benefits and Risks“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”.21

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In Health Topics A-Z you may find:

Links

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Sources

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You may find the Sources quoted at:

Sources

  1. Hamoda, H., Mukherjee, A., Morris, E., Baldeweg, S. E., Jayasena, C. N., Briggs, P., Moger, S. 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 Online 10 June 2022:2. https://journals.sagepub.com/doi/full/10.1177/20533691221104879 Accessed: 07 August 2023
  2. Menopause Management Options: Menopausal Hormone Therapy (MHT) – What Is MHT? Last Updated: 08 June 2023 | Last Reviewed: 19 August 2022. Jean Hailes for Women’s Health https://www.jeanhailes.org.au/health-a-z/menopause/menopause-management Accessed: 07 August 2023
  3. 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: 07 August 2023
  4. Hamoda, H., Mukherjee, A., Morris, E., Baldeweg, S. E., Jayasena, C. N., Briggs, P., Moger, S. 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 Online 10 June 2022:3. https://journals.sagepub.com/doi/full/10.1177/20533691221104879 Accessed: 07 August 2023
  5. Hormone Replacement Therapy (HRT): Benefits and Risks of Hormone Replacement Therapy (HRT). Page Last Reviewed: 08 February 2023. NHS https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/benefits-and-risks-of-hormone-replacement-therapy-hrt/ Accessed: 07 August 2023
  6. Hamoda, H., Mukherjee, A., Morris, E., Baldeweg, S. E., Jayasena, C. N., Briggs, P., Moger, S. 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 Online 10 June 2022:2. https://journals.sagepub.com/doi/full/10.1177/20533691221104879 Accessed: 07 August 2023
  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: 07 August 2023
  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: 07 August 2023
  9. Menopause Management Options: Menopausal Hormone Therapy (MHT) – What Are the Risks of MHT? Last Updated: 08 June 2023 | Last Reviewed: 19 August 2022. Jean Hailes for Women’s Health https://www.jeanhailes.org.au/health-a-z/menopause/menopause-management Accessed: 07 August 2023
  10. 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: 07 August 2023
  11. Hormone Replacement Therapy (HRT): When HRT Is Not Suitable. Last Updated 03 November 2022. NHS Inform https://www.nhsinform.scot/tests-and-treatments/medicines-and-medical-aids/types-of-medicine/hormone-replacement-therapy-hrt/ Accessed: 07 August 2023
  12. 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: 07 August 2023
  13. 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: 07 August 2023
  14. 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: 07 August 2023
  15. 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: 07 August 2023
  16. 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: 07 August 2023
  17. Menopause Management Options: Menopausal Hormone Therapy (MHT) – What Are the Risks of MHT? Last Updated: 08 June 2023 | Last Reviewed: 19 August 2022. Jean Hailes for Women’s Health https://www.jeanhailes.org.au/health-a-z/menopause/menopause-management Accessed: 07 August 2023
  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: 07 August 2023
  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: 07 August 2023
  20. Hamoda, H., Mukherjee, A., Morris, E., Baldeweg, S. E., Jayasena, C. N., Briggs, P., Moger, S. 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 Online 10 June 2022:2. https://journals.sagepub.com/doi/full/10.1177/20533691221104879 Accessed: 07 August 2023
  21. 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: 07 August 2023
Topic Last Updated: 18 September 2023 – Topic Last Reviewed: 07 August 2023

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