“Hormone therapy is available as a daily pill, but it also may be taken as a skin patch, gel, cream, spray, or vaginal ring”.1

Umbrella
What may the Hormone Therapy Options Umbrella include?

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

  • HRT/HT/MHT Dose
  • Hormone Replacement Therapy (HRT) Forms/Medicines/Options/Preparations/Types/Ways To Take
  • Hormone Therapy (HT) Forms/Medicines/Options/Preparations/Types/Ways To Take
  • Menopausal Hormone Therapy (MHT) Forms/Medicines/Options/Preparations/Types/Ways To Take

Options

What are some hormone therapy (HT) options?

In Hormone Replacement Therapy (HRT): Types – Ways of Taking HRT the (United Kingdom) NHS (National Health Service) elaborate on some ways of taking HRT such as:

“HRT comes in several different forms. Talk to a GP about the pros and cons of each option.

  • Tablets…
  • Skin Patches…
  • Oestrogen Gel…
  • Implants…
  • Vaginal Oestrogen
  • Testosterone…”.2

Who is a GP?

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

On page two in Deciding About Hormone Therapy Use: Pill or Non-Pill the North American Menopause (NAMS) explain note:

“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”.3

Differences

What can be some different HT option differences?

Some points of consensus about menopausal hormone therapy (MHT) in the Revised Global Consensus Statement on Menopausal Hormone Therapy: Section B: General Principles Governing the Use of MHT – endorsed by seven menopause-related organizations – published online 20 June 2016, are:

  • “MHT includes a wide range of hormonal products and routes of administration, including tibolone (where available) or CE/BZA, with potentially different risks and benefits. However, evidence regarding differences in risks and benefits between different products is limited
  • The type and route of administration of MHT should be consistent with treatment goals, patient preference and safety issues and should be individualized. The dosage should be titrated to the lowest appropriate and most effective dose”.4

What is CE/BZA?

CE/BZA can be an abbreviation for Conjugated Equine Estrogens and Bazedoxifene.

What can titrated mean?

DotS titrated can mean accurately measured.

Dose

What is recommended about the dose of HT?

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

“Menopause Hormone Therapy should always be used at the lowest dose that helps and for the shortest time that you need it”.5

Changes

Can HT require changes?

Yes. In Menopause Management: Menopausal Hormone Therapy (MHT) – How Long Do You Take MHT? the (Australian) Jean Hailes for Women’s Health explain:

Hormone Therapy Options

“Dosages and methods of administration vary according to each woman’s needs and responses to MHT. Changes may be needed before a satisfactory method and dose is found for each woman, and such changes should be made under the close supervision of your doctor. It can sometimes take up to six months to find the right combination. As a general rule when using MHT in midlife:
  • Start low
  • Go slow
  • Review often”.6

In Hormone Replacement Therapy (HRT): Overview – How To Get Started on HRT the NHS also note:

“You’ll usually start with a low dose, which may be increased at a later stage. It may take a few weeks to feel the effects of treatment and there may be some side effects at first. A GP will usually recommend trying treatment for 3 months to see if it helps. If it does not, they may suggest changing your dose, or changing the type of HRT you’re taking”.7

Breakthrough Bleeding

What if a woman who chooses to use HT experiences breakthrough bleeding?

If you choose to use HT, it may be in your best interest to also choose to ask your health care provider about breakthrough bleeding, so you know what to do if the need arises. The JH explain:

  • “Some women experience vaginal bleeding in the first six months after starting MHT. In most cases this can be helped by changing the dose or type of MHT”.8

The JH also note:

  • “Persistent, unexplained, unscheduled vaginal bleeding should be investigated”.9

Vaginal Dryness

What if a women’s menopause symptoms are limited to vaginal dryness?

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”.10

In Menopause Management: Menopause Hormone Therapy (MHT) – Managing Vaginal Problems: Dry Vagina Treatments – Vaginal Oestrogen the JH include:

  • “Oestrogen can be applied directly to the vagina in the form of a cream, tablet or pessary
  • This may be the only treatment required if a woman has only vaginal/vulval or bladder symptoms…”.11

Health Care Provider

What if I would like help to choose what HT to use?

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

On page two in Deciding About Hormone Therapy Use: Hormone Therapy Options the NAMS explain:

“Each woman must make her own decision about HT with the help of her healthcare provider. If you decide to take HT, the next step is to choose between the many HT options available to find the best dose and route for you. With guidance from your health care provider, you can try different forms of HT until you find the type and dose that treats your symptoms with few side effects”.12

What if I have any concerns about HT?

In Menopause Management: Menopausal Hormone Therapy (MHT) – Should You Take MHT? the JH elaborate on:

  • “Jean Hailes recommends each woman discusses her decision about taking MHT with her doctor regularly and whenever there are any concerns”.13

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”.14

Health Topics A-Z

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Sources

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Sources

  1. Deciding About Hormone Therapy Use: Pill or Non-Pill. 2017:2. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/menonote-deciding-about-ht-2017.pdf Accessed: 10 May 2020
  2. Hormone Replacement Therapy (HRT): Types – Ways of Taking HRT. Page Last Reviewed: 09 September 2019. NHS (National Health Service) https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/types/#ways-of-taking-hrt Accessed: 10 May 2020
  3. Deciding About Hormone Therapy Use: Pill or Non-Pill. 2017:2. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/menonote-deciding-about-ht-2017.pdf Accessed: 10 May 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 B: General Principles Governing the Use of MHT. Climacteric, 2016;19:4:314 https://www.imsociety.org/manage/images/pdf/ba6379e868044bec13015ac2b84f2753.pdf Accessed: 10 May 2020
  5. Menopause: Menopause – Hormone Treatments. Content Current As of: 22 August 2019. Food and Drug Administration https://www.fda.gov/ForConsumers/ByAudience/ForWomen/WomensHealthTopics/ucm117978.htm Accessed: 10 May 2020
  6. Menopause Management: Menopausal Hormone Therapy (MHT) – How Long Do You Take MHT? Last Updated: 07 April 2020 | Last Reviewed: 17 December 2017. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/menopause/menopause-management/ Accessed: 10 May 2020
  7. Hormone Replacement Therapy (HRT): Overview – How To Get Started on HRT. Page Last Reviewed: 09 September 2019. NHS (National Health Service) https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/#how-to-get-started-on-hrt Accessed: 10 May 2020
  8. Menopause Management: Menopausal Hormone Therapy (MHT) – Possible Side Effects of MHT: Break Through Bleeding. Last Updated: 07 April 2020 | Last Reviewed: 17 December 2017. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/menopause/menopause-management Accessed: 10 May 2020
  9. Menopause Management: Menopausal Hormone Therapy (MHT) – Possible Side Effects of MHT: Break Through Bleeding. Last Updated: 07 April 2020 | Last Reviewed: 17 December 2017. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/menopause/menopause-management Accessed: 10 May 2020
  10. 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;19:4:314 https://www.imsociety.org/manage/images/pdf/ba6379e868044bec13015ac2b84f2753.pdf Accessed: 10 May 2020
  11. Menopause Management: Menopausal Hormone Therapy (MHT) – Managing Vaginal Problems: Dry Vagina Treatments – Vaginal Oestrogen. Last Updated: 07 April 2020 | Last Reviewed 17 December 2017. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/menopause/menopause-management/ Accessed: 10 May 2020
  12. Deciding About Hormone Therapy Use: Hormone Therapy Options. 2017:2. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/menonote-deciding-about-ht-2017.pdf Accessed: 10 May 2020
  13. Menopause Management: Menopausal Hormone Therapy (MHT) – Should You Take MHT? Last Updated: 07 April 2020 | Last Reviewed: 17 December 2017. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/menopause/menopause-management/ Accessed: 10 May 2020
  14. 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: 10 May 2020
Topic Last Updated: 21 May 2020 – Topic Last Reviewed: 10 May 2020
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