Hormone Therapy Benefits and Risks

“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?

I think 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?

I think 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.

Potential Benefits

What are potential HT benefits?

On page one in Deciding About Hormone Therapy Use: Potential Benefits published in June 2017, the North American Menopause Society (NAMS) explain:

“Hormone therapy is one of the most effective treatments available for bothersome hot flashes and night sweats. If night sweats are waking you throughout the night, HT may improve sleep and fatigue, mood, ability to concentrate, and overall quality of life. Treatment of bothersome hot flashes and night sweats is the principal reason women use HT. Hormone therapy also treats vaginal dryness and painful sex associated with menopause. Hormone therapy keeps your bones strong by preserving bone density and decreasing your risk of osteoporosis and fractures. If preserving bone density is your only concern, and you do not have bothersome hot flashes, other treatments may be recommended instead of HT”.2

Benefits and Risks Differences

Can hormone therapy (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. Product Differences
  2. Symptom Differences
  3. Individual Differences
  4. Age Differences
  5. Time Since Menopause Differences
  6. Risk Factor Differences
  7. Health Conditions Differences
  8. Uterus Differences
  9. EPT and ET Differences
  10. Option Differences
  11. Duration Differences

1. 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”.3

2. Symptom Differences

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

One of the points of consensus in the Revised Global Consensus Statement on Menopausal Hormone Therapy: Section A: Benefit/Risk Profile of MHT is:

  • “Local low-dose estrogen therapy is preferred for women whose symptoms are limited to vaginal dryness or associated discomfort with intercourse or for the prevention of recurrent urinary tract infections”.4

3. Individual Differences

Can MHT benefits and risks differ for individual women?

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:

  • “The option of MHT is an individual decision in terms of quality of life and health priorities as well as personal risk factors such as age, time since menopause and the risk of VTE, stroke, ischemic heart disease and breast cancer. MHT should not be recommended without a clear indication for its use”.5

What is VTE?

VTE can be an abbreviation for Venous Thromboemolism.

4. Age Differences

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

One of the governing principles in the 2016 IMS Recommendations on Women’s Midlife Health and Menopause Hormone Therapy: IMS Governing Principles on MHT is:

Hormone Therapy Benefits and Risks

  • “The risks and benefits of MHT differ for women during the menopause transition compared to those for older women”.6

One of the points of consensus in the Revised Global Consensus Statement on Menopausal Hormone Therapy: Section A: Benefit/Risk Profile of MHT is:

  • “MHT, including tibolone and the combination of conjugated equine estrogens and bazedoxifene (CE/BZA), is the most effective treatment for vasomotor symptoms (VMS) associated with menopause at any age, but benefits are more likely to outweigh risks if initiated for symptomatic women before the age of 60 years or within 10 years after menopause”.7

What are vasomotor symptoms?

The International Menopause Society explain:

“Hot flushes and night sweats are also referred to as Vasomotor Symptoms (VMS)”.8

5. Time Since Menopause Differences

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

As noted above, one of the points of consensus in the Revised Global Consensus Statement on Menopausal Hormone Therapy: Section A: Benefit/Risk Profile of MHT is:

  • “MHT, including tibolone and the combination of conjugated equine estrogens and bazedoxifene (CE/BZA), is the most effective treatment for vasomotor symptoms (VMS) associated with menopause at any age, but benefits are more likely to outweigh risks if initiated for symptomatic women before the age of 60 years or within 10 years after menopause”.9

6. Risk Factor Differences

Can HT risks differ for women with different risk factors?

On page one in the NAMS 2017 Position Statement Updates Guidelines for Hormone Therapy Use published on 20 June 2017, the NAMS elaborate on:

  • “The risks of HT differ for different women, depending on type, dose, duration of use, route of administration, timing of initiation, and whether a progestogen is needed. Treatment should be individualized using the best available evidence to maximize benefits and minimize risks, with periodic reevaluation for the benefits and risks of HT continuation”.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:

Hormone Therapy Benefits and RisksHormone Therapy Benefits and Risks“…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 women who choose to use different HT options?

The NAMS explain:

  • “ET delivered through the skin (by patch, cream, gel, or spray) and low‐dose oral estrogen may have lower risks of blood clots and stroke than standard doses of oral estrogen, but all the evidence is not yet available”.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

The NAMS explain:

  • “How long you should take HT is different for EPT and ET”.18

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”.19

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.

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 Hormone Replacement Therapy (HRT): Risks the (United Kingdom) NHS (National Health Service) elaborate on:

Hormone Therapy Benefits and Risks

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

It’s also important to consider HRT as only 1 of a range of options to improve menopausal and postmenopausal health and wellbeing”.20

One of the governing principles in the 2016 IMS Recommendations on Women’s Midlife Health and Menopause Hormone Therapy: IMS Governing Principles on MHT is:

  • “Consideration of MHT should be part of an overall strategy including lifestyle recommendations regarding diet, exercise, smoking cessation and safe levels of alcohol consumption for maintaining the health of peri- and postmenopausal women”.21

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

“Every woman is different—and you must make a decision 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 provider 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

In Menopause: Diagnosis & Treatment: Treatment – Hormone Therapy the Mayo Clinic note:

“Before deciding on any form of treatment, talk with your doctor about your options and the risks and benefits involved with each. Review your options yearly, as your needs and treatment options may change”.25

Health Topics A-Z

Where may I find Health Topics related to Hormone Therapy Benefits and Risks?

In Health Topics A-Z you may find:

Health Topics A-Z

Links

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  1. 9 Myths and Misunderstandings About Menopausal Hormone Therapy (MHT): 6. Myth – Complementary Medicines and Therapies Are As Effective As MHT and Safer
  2. 9 Myths and Misunderstandings About Menopausal Hormone Therapy (MHT): 7. Myth – Compounded Bioidentical Hormone Therapy Is Safer Than Conventional MHT
  3. Bioidentical Hormone Therapy
  4. Bioidentical Hormones Explained – A British Menopause Society Video
  5. Bioidentical Hormones: Are They Safer?
  6. Combined Menopausal Hormone Therapy (MHT)
  7. Complementary Medicine Options for Menopausal Symptoms
  8. Complementary and Alternative Therapies Explained – A British Menopause Society Video
  9. Deciding About Hormone Therapy
  10. Deciding About Hormone Therapy Use
  11. Decidir Sobre La Hormonoterapia
  12. Early Menopause: Experiences and Perspectives of Women and Health Practitioners – Women’s Profiles
  13. Estrogen & Hormones
  14. Estrogen & Hormones: Estrogen and the Cardiovascular System
  15. Estrogen & Hormones: Postmenopausal Hormone Replacement Therapy
  16. Family History
  17. HRT
  18. HRT and Breast Cancer: Overall Risks and Benefits Explained – A British Menopause Society Video
  19. HRT and the Risk of Breast Cancer Explained – A British Menopause Society Video
  20. HRT: The History
  21. Hormone Replacement Therapy
  22. Hormone Replacement Therapy (HRT)
  23. Hormone Replacement Therapy (HRT) Explained – A British Menopause Society Video
  24. Hormone Replacement Therapy (HRT): Overview – Benefits of HRT
  25. Hormone Replacement Therapy (HRT): Overview – Who Can Take HRT
  26. Hormone Replacement Therapy (HRT): Risks
  27. Hormone Replacement Therapy (HRT): Types
  28. Hormone Replacement Therapy Safe, Despite Rare Blood Clot Risks From Tablets
  29. Index To Drug-Specific Information [United States]
  30. Information About Menopause [Multiply Languages] [Videos]
  31. MHT and Breast Cancer Risk
  32. Making Choices At Menopause
  33. Making Sense of Menopausal Hormone Therapy Means Understanding the Benefits As Well As the Risks
  34. Menopause
  35. Menopause
  36. Menopause
  37. Menopause
  38. Menopause & Hormones: Questions To Ask Your Doctor
  39. Menopause FAQs: Hormone Therapy for Menopause Symptoms
  40. Menopause Hormone Therapy and Your Heart
  41. Menopause Management: Hormone Replacement Therapy (HRT) – Benefits & Risks of HRT
  42. Menopause Management: Hormone Replacement Therapy (HRT) – What Are the Risks of HRT?
  43. Menopause Matters
  44. Menopause Symptoms and Relief
  45. Menopause Treatment
  46. Menopause – Is Menopausal Hormone Therapy (HRT) Safe? [Multiply Languages] [Video]
  47. Menopause – What Is Menopausal Hormone Therapy (HRT)? [Multiply Languages] [Video]
  48. Menopause: Diagnosis & Treatment
  49. Menopause: Diagnosis and Management – Information for the Public: Benefits and Risks of HRT [NICE Guideline]
  50. Menopause: Diagnosis and Management – Information for the Public: Questions To Ask About Menopause [NICE Guideline]
  51. Menopause: Medicines To Help You
  52. Menopause: Menopause – Hormone Treatments
  53. Menopause: What Are the Benefits and Risks of Long-Term Hormone Therapy?
  54. Misinterpretation of WHI Results Decreased Use of Hormones, Even In Women Not At Risk [Women’s Health Initiative]
  55. NAMS 2017 Position Statement Updates Guidelines for Hormone Therapy Use
  56. National Center for Complementary and Integrative Health: Herbs At A Glance
  57. National Center for Complementary and Integrative Health: Know the Science: How Medications and Supplements Can Interact
  58. National Center for Complementary and Integrative Health: Menopausal Symptoms In Depth
  59. National Center for Complementary and Integrative Health: Natural Doesn’t Necessarily Mean Safer, or Better
  60. Non-Hormonal Treatment Options for Menopausal Symptoms
  61. NonHormonal Treatments for Menopausal Symptoms
  62. Oestrogen Only Menopausal Hormone Therapy
  63. Practical Prescribing Explained – A British Menopause Society Video
  64. Risks and Benefits of MHT/HRT
  65. Tipos de Hormonoterapia
  66. Types of Hormone Therapy
  67. Urogenital Atrophy Explained – A British Menopause Society Video
  68. Urogenital Problems
  69. Vaginal Dryness
  70. Vaginal Dryness Alternative Treatments
  71. Venous Thrombosis/Thromboembolism Risk and Menopausal Treatments
  72. Video Series-2018 – Moisturizers, Lubricants, and Prasterone
  73. Video Series-2019 – What Is New In Hormone Therapy?
  74. Video Series-2020 – TSECs—A New Treatment for Hot Flashes and Night Sweats
  75. Video Series-2020 – What You Need To Know About Bioidentical Hormone Therapy
  76. What Is MHT and Is It Safe? What Is Menopausal Hormone Therapy (MHT) and Is It Safe?
  77. Vietnamese: What Is Menopausal Hormone Therapy (MHT) and Is It Safe?
  78. Women Can Breathe Sigh of Relief When Using Vaginal Estrogen To Treat Menopause Symptoms
  79. Women’s Wellness: Treating Hot Flashes and Night Sweats Without Hormones [+ Video Courtesy: Mayo Clinic News Network]

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/manage/images/pdf/4429e3dd302aac259ad68c3be7f60599.pdf Accessed: 16 October 2020
  2. Deciding About Hormone Therapy Use: Potential Benefits. 2017:1. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/menonote-deciding-about-ht-2017.pdf Accessed: 16 October 2020
  3. 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/manage/images/pdf/5aa613a059b5d11934333ff0ecc0da26.pdf Accessed: 16 October 2020
  4. 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 A: Benefit/Risk Profile of MHT. Climacteric, 2016;19:4:313 https://www.imsociety.org/manage/images/pdf/ba6379e868044bec13015ac2b84f2753.pdf Accessed: 16 October 2020
  5. 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/manage/images/pdf/ba6379e868044bec13015ac2b84f2753.pdf Accessed: 16 October 2020
  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, 110 https://www.imsociety.org/manage/images/pdf/4429e3dd302aac259ad68c3be7f60599.pdf Accessed: 16 October 2020
  7. 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 A: Benefit/Risk Profile of MHT. Climacteric, 2016;19:4:313 https://www.imsociety.org/manage/images/pdf/ba6379e868044bec13015ac2b84f2753.pdf Accessed: 16 October 2020
  8. Hot Flushes and Night Sweats – Background Information: What Are Hot Flushes and Night Sweats? October 2011:1. International Menopause Society https://www.imsociety.org/downloads/world_menopause_day_2011/wmd_media_backgrounder.pdf Accessed: 16 October 2020
  9. De Villiers, T. J, Hall,  J. E., Pinkerton, JV, Pérez, S. C., Rees, M., Yang, C, and Pierroz, D. D. Revised Global Consensus Statement on Menopausal Hormone Therapy: Section A: Benefit/Risk Profile of MHT. Climacteric, 2016;19:4:313 https://www.imsociety.org/manage/images/pdf/ba6379e868044bec13015ac2b84f2753.pdf Accessed: 16 October 2020
  10. NAMS 2017 Position Statement Updates Guidelines for Hormone Therapy Use. 20 June 2017:1. North American Menopause Society https://www.menopause.org/docs/default-source/default-document-library/ht-press-release-061917.pdf Accessed: 16 October 2020
  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: 16 October 2020
  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: 16 October 2020
  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: 16 October 2020
  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: 16 October 2020
  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: 16 October 2020
  16. Hormone Therapy for Women In 2012. 2012:2. North American Menopause Society https://www.menopause.org/docs/default-document-library/psht12patient.pdf?sfvrsn=2 Accessed: 16 October 2020
  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/manage/images/pdf/ba6379e868044bec13015ac2b84f2753.pdf Accessed: 16 October 2020
  18. Hormone Therapy for Women In 2012. 2012:2. North American Menopause Society https://www.menopause.org/docs/default-document-library/psht12patient.pdf?sfvrsn=2 Accessed: 16 October 2020
  19. 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: 16 October 2020
  20. Hormone Replacement Therapy (HRT): Risks. Page Last Reviewed: 09 September 2019. NHS (National Health Service) https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/risks/ Accessed: 16 October 2020
  21. 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/manage/images/pdf/4429e3dd302aac259ad68c3be7f60599.pdf Accessed: 16 October 2020
  22. Deciding About Hormone Therapy Use. 2017:1. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/menonote-deciding-about-ht-2017.pdf Accessed: 16 October 2020
  23. Menopause Management: Menopausal Hormone Therapy (MHT) – Should You Take MHT? Last Updated: 30 July 2020 | Last Reviewed: 17 December 2017. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/menopause/menopause-management/ Accessed: 16 October 2020
  24. Menopause Management: Menopausal Hormone Therapy (MHT) – Should You Take MHT? Last Updated:  30 July 2020 | Last Reviewed: 17 December 2017. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/menopause/menopause-management/ Accessed: 16 October 2020
  25. Menopause: Diagnosis & Treatment – Treatment: Hormone Therapy. 14 October 2020. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/menopause/diagnosis-treatment/drc-20353401 Accessed: 16 October 2020

Topic Last Updated: 16 October 2020 – Topic Last Reviewed: 16 October 2020
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