Hormone Therapy Risks

“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”.1

Umbrella
What may the Hormone Therapy Risks Umbrella include?

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

  • Hormone Replacement Therapy (HRT) Risks
  • Hormone Therapy (HT) Risks
  • Menopausal Hormone Therapy (MHT) Risks

Date

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

It can be important to be clear about the date of all information including the date of HT 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 risks information?

It can also be important to be clear about whether HT 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.

One Size Fits All

Is HT one size fits all?

No. In HRT: Types, Doses and Regimes the (British) Women’s Health Concern explain:

“Many types of HRT are available and there is not one type, dose or regimen which suits all women. It is important to understand which hormones are used, why and how so that for each woman who chooses to take HRT, the treatment is individualised to best suit her needs, taking into account types of symptoms, medical history, period pattern if present and current national recommendations and guidelines”.2

Uterus or No Uterus

Hormone Therapy RisksCan the risks of HT differ for women who have a uterus
and women who do not a uterus?

Yes.

Different Differences

What are some other HT risks differences?

On page one in the NAMS 2017 Position Statement Updates Guidelines for Hormone Therapy Use the North American Menopause Society (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”.3

Risks

Are the risks of HT small and usually outweighed by the benefits?

In Hormone Replacement Therapy (HRT): Risks the (United Kingdom) NHS note:

“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

In Risks and Benefits of MHT: Supporting Women Making A Decision the Australasian Menopause Society elaborate on:

  • “The risks of MHT must be considered in perspective for each woman and balanced against the benefits, particularly the severity of symptoms
  • Management of menopausal symptoms should be tailored to the individual woman to effectively manage her symptoms and minimise risks
  • For some women any extra risk will be unacceptable but others may feel that the benefits outweigh the risks
  • Some women may be unable to take systemic MHT”.5

NICE Guidelines

What did the (British) National Institute for Health and Care Excellence’s (NICE) guidelines note about the benefits and risks of hormone replacement therapy (HRT)?

In Menopause: Diagnosis and Management – Information for the Public: Benefits and Risks of HRT the NICE explain and elaborate on:

“NICE looked at the risks of the following conditions in women taking HRT compared with women of menopausal age in the general population. Your GP should explain that the risks of the conditions described below vary from one woman to another and depend on many risk factors. In cases where HRT is said to increase risk this usually means a very small increase in most women.

  • Blood Clots (Venous Thromboembolism)…
  • Heart Disease and Stroke (Cardiovascular Disease)…
  • Breast Cancer…
  • Type 2 Diabetes…
  • Osteoporosis…
  • Loss of Muscle Strength…
  • Dementia…”.6

Revised Global Consensus Statement

What is one of the points of consensus about menopausal hormone therapy (MHT) and risk?

One of the points of consensus in the Revised Global Consensus Statement on Menopausal Hormone Therapy: Section A: Benefit/Risk Profile of MHT – endorsed by seven menopause-related organizations – published online 20 June 2016, 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?

DotS the definition of vasomotor symptoms may vary. The NAM’s definition is:

“Vasomotor symptoms. Also known as hot flashes and night sweats, common symptoms during perimenopause and early postmenopause”.8

Before Age 60

Before age 60, can age and time since menopause matter?

On page one in the NAMS 2017 Position Statement Updates Guidelines for Hormone Therapy Use the NAMS note:

  • “For women aged younger than 60 years or who are within 10 years of menopause onset and have no contraindications, the benefit-risk ratio appears favorable for treatment of bothersome hot flashes and for those at elevated risk of bone loss or fracture. Longer duration may be more favorable for estrogen-alone therapy than for estrogen-progestogen therapy, based on the Women’s Health Initiative randomized, controlled trials”.9

On page one in Deciding About Hormone Therapy Use: Potential Risks published in June 2017, the NAMS also explain:

“As with all medications, HT is associated with some potential risks. For healthy women aged younger than 60 years with bothersome hot flashes who are within 10 years of menopause, the benefits of HT generally outweigh the risks. Hormone therapy might slightly increase your risk of stroke or blood clots in the legs or lungs (especially if taken in pill form)”.10

After Age 60

After age 60, can age and time since menopause matter?

On page one in the NAMS 2017 Position Statement Updates Guidelines for Hormone Therapy Use the NAMS note:

Hormone Therapy Risks

  • “For women who initiate HT more than 10 or 20 years from menopause onset or when aged 60 years or older, the benefit -risk ratio appears less favorable than for younger women because of greater absolute risks of coronary heart disease, stroke, venous thromboembolism, and dementia”.11

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

“If started in women aged older than 65 years, HT might increase the risk of dementia. If you have a uterus and take estrogen with progestogen, there is no increased risk of cancer of the uterus. 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”.12

At Risk

What are some contraindications to taking HT?

In Menopause Management: Menopausal Hormone Therapy (MHT) – Contraindications To Taking MHT the (Australian) Jean Hailes for Women’s Health (JH) elaborate on these and more contraindications:

  • “Current, past or suspected breast cancer
  • Known or suspected oestrogen-dependent cancer, such as breast and uterine cancers
  • Undiagnosed vaginal bleeding
  • Untreated uterine lining thickening, which could develop into cancer
  • Current thrombosis or DVT (deep vein thrombosis), but a past history would require further investigation to establish if MHT is safe
  • Thrombophilia (a group of conditions that lead to an increased risk of thrombosis)…”.13

Do Not Take

Which women should not take HT?

In Menopause: Medicines To Help You the (United States) Food and Drug Administration elaborate on:

“Do not take hormone therapy if you:

  • Have problems with vaginal bleeding
  • Have or have had certain cancers such as breast cancer or uterine cancer
  • Have or have had a blood clot, stroke or heart attack
  • Have a bleeding disorder
  • Have liver disease
  • Have allergic reactions to hormone medicine”.14

Health Care Provider

If I choose to take HT, how may I find out what my risks are?

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

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:

Hormone Therapy Risks

  • “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”.15

What is VTE?

VTE can be an abbreviation for Venous Thromboembolism.

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”.16

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

  • “Jean Hailes recommends each woman discusses her decision about taking MHT with her doctor regularly and whenever there are any concerns”.17

In Menopause: Diagnosis & Treatment – Treatment: Hormone Therapy the (United States) 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”.18

Health Topics A-Z

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

In Health Topics A-Z may find:

Health Topics A-Z

Links

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Links

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  1. 20 Years of Data Lead To Changes In Perceptions, Usage of Menopausal HT
  2. Askearlymenopause.org [Ask EM] [+ Video: What Is Early Menopause?]
  3. BMS & WHC’s 2020 Recommendations on Hormone Replacement Therapy In Menopausal Women
  4. BMS, IMS, EMAS, RCOG and AMS Joint Statement on Menopausal Hormone Therapy and Breast Cancer Risk In Response To EMA Pharmacovigilance Risk Assessment Committee Recommendations In May 2020
  5. Bioidentical Hormones Explained – A British Menopause Society Video
  6. Bioidentical Hormones: Are They Safer?
  7. Combined Menopausal Hormone Therapy (MHT)
  8. Complementary and Alternative Therapies Explained – A British Menopause Society Video
  9. Compounded Bioidentical Hormone Therapy [Video]
  10. Consumer Health: Menopause, Hormone Replacement Therapy and Heart Health
  11. Deciding About Hormone Therapy
  12. Deciding About Hormone Therapy Use
  13. EMAS Menopause Essentials
  14. EMAS Replay
  15. EMAS Replay: Risk Assessment for MHT – When, To Whom, Which, and How Long? [Multiply Languages]
  16. EMAS Replay: Role of Progestogens In MHT [Multiply Languages]
  17. EMAS Replay: The Relevance of Estrogen and Progestogen Choice for Breast Safety During MHT [Multiply Languages]
  18. Early Menopause: Experiences and Perspectives of Women and Health Practitioners – Women’s Profiles
  19. Estrogen & Hormones
  20. Estrogen & Hormones: Postmenopausal Hormone Replacement Therapy
  21. Family History
  22. Fast Facts: HRT and Breast Cancer Risk
  23. Find A Menopause Practitioner [United States and Other]
  24. Find An AMS Doctor [Australasian Menopause Society i.e. Australia and New Zealand]
  25. Find Your Nearest BMS Menopause Specialist [British Menopause Society]
  26. HRT
  27. HRT and Breast Cancer: Overall Risks and Benefits Explained – A British Menopause Society Video
  28. HRT and the Risk of Breast Cancer Explained – A British Menopause Society Video
  29. HRT: Benefits and Risks
  30. HRT: Summary
  31. HRT: The History
  32. HRT: Types, Doses and Regimens
  33. Hormone Replacement Therapy
  34. Hormone Replacement Therapy (HRT)
  35. Hormone Replacement Therapy (HRT) Explained – A British Menopause Society Video
  36. Hormone Replacement Therapy (HRT): Benefits and Risks
  37. Hormone Replacement Therapy (HRT): Overview – Risks and Side Effects of HRT
  38. Hormone Replacement Therapy Safe, Despite Rare Blood Clot Risks From Tablets
  39. Hormone Therapy for Menopause
  40. Hormone Therapy: Is It Right for You?
  41. Index To Drug-Specific Information [United States]
  42. Later Years (Around 50 Years and Over): Menopause and Post Menopause Health – Hormone Replacement Therapy (HRT) [+ Video: Is HRT Bad for You?]
  43. Later Years (Around 50 Years and Over): Menopause and Post Menopause Health – Signs and Symptoms [+ Video: Talking Menopause With Your GP]
  44. Learning To Cope With Hot Flashes
  45. MHT and Breast Cancer Risk
  46. Making Choices At Menopause
  47. Making Sense of Menopausal Hormone Therapy Means Understanding the Benefits As Well As the Risks
  48. Mayo Clinic Minute: Help With Hot Flashes Due To Menopause [+ Video]
  49. Menopausal Hormone Therapy
  50. Menopausal Hormone Therapy and Breast Cancer Risk
  51. Menopausal Hormone Therapy and Venous Thromboembolism
  52. Menopausal Hormone Therapy and Women’s Health: An Umbrella Review
  53. Menopausal Hormone Therapy, Heart Disease and Stroke
  54. Menopause
  55. Menopause
  56. Menopause
  57. Menopause
  58. Menopause FAQs: Hormone Therapy for Menopause Symptoms
  59. Menopause Hormone Therapy and Your Heart
  60. Menopause Hormone Therapy and Your Heart: How To Limit the Risks
  61. Menopause Hormone Therapy: Does It Cause Vaginal Bleeding?
  62. Menopause Hormone Therapy: Follow-Up Appointments?
  63. Menopause Hormone Therapy: Who Shouldn’t Take It?
  64. Menopause Management: Menopausal Hormone Therapy (MHT) – Benefits & Risks of HRT
  65. Menopause Management: Menopausal Hormone Therapy (MHT) – What Are the Risks of HRT?
  66. Menopause Map: Downloadable Resources – My Personal Path Print Tools: Questions for Your Health Care Provider
  67. Menopause Symptoms and Relief
  68. Menopause Treatment
  69. Menopause – Is Menopausal Hormone Therapy (HRT) Safe? [Multiply Languages] [Video]
  70. Menopause: Diagnosis & Treatment
  71. Menopause: Diagnosis and Management – Information for the Public: Benefits and Risks of HRT [NICE Guideline]
  72. Menopause: Diagnosis and Management – Information for the Public: Questions To Ask About Menopause [NICE Guideline]
  73. Menopause: Medicines To Help You
  74. Menopause: Menopause – Hormone Treatments
  75. NAMS 2017 Position Statement Updates Guidelines for Hormone Therapy Use
  76. National Center for Complementary and Integrative Health: How Safe Is This Product or Practice?
  77. National Center for Complementary and Integrative Health: Know the Science: How Medications and Supplements Can Interact
  78. National Center for Complementary and Integrative Health: Menopausal Symptoms In Depth
  79. Oestrogen Only Menopausal Hormone Therapy
  80. Revised Global Consensus Statement on Menopausal Hormone Therapy
  81. Risks and Benefits of MHT
  82. Study IDs Non-Hormonal Options for Menopause Symptoms
  83. The North American Menopause Society Statement on Continuing Use of Systemic Hormone Therapy After Age 65
  84. Topical Estrogens and Non-Hormonal Preparations for Postmenopausal Vulvovaginal Atrophy: An EMAS Clinical Guide
  85. Types of Hormone Therapy
  86. Venous Thrombosis/Thromboembolism Risk and Menopausal Treatments
  87. Video Series-2020: What You Need To Know About Bioidentical Hormone Therapy
  88. Video Series-2021: Treatment Options for Vaginal Dryness and Urinary Issues
  89. Video Series-2021: What Women Need to Know About Hormone Therapies
  90. Video Series-2022: Hormone Therapy: Understanding the Risks and Benefits
  91. Video Series-2022: Perimenopause, Signs, Symptoms, and Solutions
  92. Videos and Podcasts: Interviews and Podcasts – Interviews: Prevention of Chronic Diseases In Women: Where Does MHT Fit In
  93. Videos and Podcasts: Interviews and Podcasts – Interviews: The Women’s Health Initiative – What Can We Believe
  94. Webinars: Previous – 2021 Vision: Practical Steps to Optimize Your Benefit-Risk. Discussions for A New Decade
  95. Webinars: Previous – Breast Cancer
  96. Webinars: Previous – Primary Prevention of Cardiovascular Disease With MHT: Where Are We Now?
  97. Webinars: Previous – Progestogen, Progestin, Progesterone: Why All the Confusion?
  98. Webinars: Previous – The Early Menopausal Patient
  99. What Are the Benefits and Risks of HRT?
  100. What Is Menopausal Hormone Therapy (MHT) and Is It Safe?

Sources

Where may I find the Sources quoted?

You may find the Sources quoted at:

Sources

  1. 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: 31 May 2022
  2. HRT: Types, Doses and Regimes. Published: September 2021. British Menopause Society https://www.womens-health-concern.org/help-and-advice/factsheets/hrt-types-doses-and-regimens/ Accessed: 31 May 2022
  3. 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: 31 May 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: 31 May 2022
  5. Risks and Benefits of MHT: Supporting Women Making A Decision. Content Updated January 2021. Australasian Menopause Society https://www.menopause.org.au/hp/information-sheets/risks-and-benefits-of-mht-hrt Accessed: 31 May 2022
  6. Menopause: Diagnosis and Management – Information for the Public: Benefits and Risks of HRT. 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/Benefits-and-risks-of-HRT Accessed: 31 May 2022
  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/wp-content/uploads/2020/08/global-consensus-hrt-2016-06.pdf Accessed: 31 May 2022
  8. Glossary: V – Vasomotor Symptoms. North American Menopause Society http://www.menopause.org/for-women/menopause-glossary#V Accessed: 31 May 2022
  9. 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: 31 May 2022
  10. Deciding About Hormone Therapy Use: Potential Risks. 2017:1. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/menonote-deciding-about-ht-2017.pdf Accessed: 31 May 2022
  11. 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: 31 May 2022
  12. Deciding About Hormone Therapy Use: Potential Risks. 2017:1. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/menonote-deciding-about-ht-2017.pdf Accessed: 31 May 2022
  13. Menopause Management: Menopausal Hormone Therapy (MHT): Contraindications To Taking 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: 31 May 2022
  14. Menopause: Medicines To Help You. Content Current As of: 22 August 2019. Food and Drug Administration https://www.fda.gov/ForConsumers/ByAudience/ForWomen/ucm118627.htm Accessed: 31 May 2022
  15. 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: 31 May 2022
  16. 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: 31 May 2022
  17. 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: 31 May 2022
  18. Menopause: Diagnosis & Treatment – Treatment: Hormone Therapy. 14 October 2020. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/menopause/diagnosis-treatment/drc-20353401 Accessed: 31 May 2022

Topic Last Updated: 31 May 2022 – Topic Last Reviewed: 31 May 2022
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