HORMONE THERAPY

Hormone therapy is either estrogen or a combination of estrogen and a uterine-protectant (usually a progesterone). Unless you have already had a hysterectomy, for some other reason, you would also need to take medication to protect your uterus from the estrogen. You don't need to check an estrogen level as the level (blood or salivary test) doesn't correlate with symptoms. Some women with lower levels of estrogen have no symptoms while women with higher levels of estrogen can have severe symptoms. In general, we start by using the lowest dose of estrogen and reassessing symptoms after a few weeks.

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Estrogen is available in oral (pills) and transdermal (patch, gel, cream, spray, vaginal ring) formulations. Transdermal estrogen has a lower risk of causing blood clots and is generally preferred over oral medications. 

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If you take estrogen and have a uterus, you must also take a medication to prevent uterine cancer. This can be a progesterone or a SERM (selective estrogen receptor modulator) called bazedoxifene. Progesterones are also available in various formulations (oral, patch, intra-uterine device). 

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Some forms of hormone therapy are available as combinations of estrogen and a progesterone (patches, pills) or combinations of estrogen and bazedoxifene (pill). 

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Other benefits of HT include improvement in quality of sleep and mood, reduction in vaginal dryness, urinary urgency and frequency as well as preserving bone density. Some studies show HT might be good for your heart health if you start before age 60 or within 10 years of your last period. If you don't have hot flashes or night sweats and your only symptoms are vaginal and bladder symptoms, you might consider a vaginal estrogen/DHEA medication rather than HT. 

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HT also has potential risks. HT might increase your risk of strokes or blood clots. Starting HT in women over age 65 may increase the risk of dementia. There may be an increase risk of breast cancer for women who use combination HT (estrogen and progesterone) over age 60 and for more than 5 years, particularly if starting HT more than ten years from their last period. For women using estrogen-only HT, studies have shown no increased risk of breast cancer at 7 years but there may be risk with longer use.

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