Written by Dr. Specialist Stine Andreasen
Specialist in Gynecology and Obstetrics, PhD in Obstetrics in 2015 and more than 15 years of clinical practice in Obstetrics and Gynecology
Hormone replacement therapy (HRT), also called menopausal hormone therapy (MHT), is an effective treatment for many menopause symptoms, especially hot flashes and night sweats. HRT isn’t necessary for everyone, and whether it makes sense for you depends on your symptoms, medical history, preferences and risks.
Key takeaways
- Estrogen is the main hormone in HRT and the most effective treatment available for hot flashes and night sweats.
- For healthy women under 60, or within about 10 years of menopause, the benefits of HRT often outweigh the risks when symptoms are bothersome.
- Women who reach menopause before 45 are generally advised to consider HRT until around the usual age of natural menopause, unless there are reasons not to.
- Women with a uterus also need progesterone or a progestogen to protect the endometrium.
- HRT is not recommended solely to prevent ageing, weight gain, heart disease or dementia.
What happens to hormones during menopause?
Menopause marks the end of the reproductive years. As the ovaries gradually produce less estrogen and progesterone, these changes can affect both physical and emotional well-being. Some women have few symptoms. Others experience hot flashes, night sweats, sleep problems, vaginal dryness or mood changes that significantly affect their quality of life.
What does HRT contain?
Estrogen is the main hormone in HRT. During the reproductive years, it is produced mainly by the ovaries. It helps regulate the menstrual cycle, maintain bone strength, and keep vaginal and urinary tissues healthy. Read more → Estrogen HRT: tablets, patches, gels and vaginal estrogen
Progesterone or another gestegen is added for women with a uterus, to protect the endometrium. Read more → Progesterone in HRT
Testosterone is not part of standard HRT, but it may be considered for persistent, distressing low sexual desire after menopause. Read more → Testosterone for women in menopause
Who benefits most from HRT?
HRT is particularly suitable for women with:
Moderate to severe hot flashes or night sweats, or other symptoms linked to low estrogen
Sleep disrupted by night sweats. Treating them can improve sleep quality and daytime functioning.
Vaginal dryness, pain during sex, or certain urinary symptoms
Early menopause
Women who reach menopause before 45, and especially those with premature ovarian insufficiency before 40, are generally advised to consider HRT until around the usual age of natural menopause, unless contraindicated. In these women, treatment also helps reduce the long-term effects of early estrogen loss.
What can HRT help with?
Hot flashes and night sweats: Estrogen is the most effective treatment available for these vasomotor symptoms.
Sleep: Fewer night sweats and night-time awakenings can improve sleep quality.
Bone health: Estrogen helps prevent bone loss and reduces the risk of osteoporosis-related fractures while you’re on treatment.
Vaginal and urinary health: Estrogen improves vaginal tissue health and can reduce dryness, irritation and discomfort during sex.
Quality of life: If symptoms are disrupting your daily life, effective treatment can make a substantial difference.
What HRT won’t do
HRT is not recommended solely to prevent ageing, weight gain, cardiovascular disease or dementia. Some women report better mood, concentration or energy, but these symptoms have many possible causes, and hormone therapy is not a universal solution.
Is HRT safe? Weighing benefits and risks
For healthy women who start treatment before 60, or within about 10 years of menopause, the benefits of systemic HRT often outweigh the risks when bothersome symptoms are present.
The risks depend on your age, medical history, the type of estrogen, how it’s taken, and whether a progestogen is used.
Blood clots: The risk is higher with estrogen taken by mouth than with estrogen absorbed through the skin. → [Read more: Estrogen HRT]
Stroke and cardiovascular events: The risk varies with age, when treatment starts and individual risk factors.
[MÅ SKRIVES AV FAGPERSON:] Breast cancer: Combined menopausal hormone therapy (estrogen and progestogen) is associated with an increased risk of breast cancer, particularly with longer treatment duration. Estrogen-only therapy, used in women who have undergone hysterectomy, appears to carry a lower risk and may not increase breast cancer risk during the first several years of treatment. Some studies have even reported a reduced risk with estrogen-only therapy. The absolute risk depends on treatment duration, individual risk factors, and the type of hormone therapy used.
Who should be careful with HRT?
Systemic HRT needs careful evaluation if you have a history of breast cancer, unexplained vaginal bleeding, blood clots, certain cardiovascular conditions or significant liver disease.
This article is general information and not a substitute for medical advice. Talk to your doctor about whether hormone therapy is right for you.
FAQ – Progesterone therapy for women in menopause
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Nothing. They are two names for the same treatment. MHT (menopausal hormone therapy) is increasingly used by clinicians.
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Estrogen is the most effective treatment available for hot flashes and night sweats.
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Women who reach menopause before 45 are generally advised to consider HRT until around the usual age of natural menopause, unless contraindicated.
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For healthy women who start before 60, or within about 10 years of menopause, the benefits often outweigh the risks. Starting later requires a more individual assessment of the risks. [Siste setning må godkjennes]
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No. HRT is not recommended for preventing weight gain.
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HRT is not recommended solely to prevent cardiovascular disease or dementia.