What hormone therapy is
Hormone therapy, also called menopausal hormone therapy or HRT, is prescription medicine that contains estrogen, often with a second hormone called a progestogen. It is mainly used to treat symptoms caused by falling estrogen levels around menopause. It is different from hormonal contraception and from hormones used in fertility treatment.
Hormone therapy is a medical treatment with real benefits and real risks. It should be started only after a doctor has reviewed your health, and it should never be bought and taken without a prescription.
Who may be offered it
A gynecologist may discuss hormone therapy if you have:
- Hot flushes and night sweats that disturb sleep, work or daily life
- Vaginal dryness, soreness or painful sex that has not improved with lubricants
- Premature ovarian insufficiency, meaning the ovaries stop working before 40
- Early menopause, natural or after surgery to remove both ovaries
- A high risk of fracture when other bone medicines are not suitable
It is not prescribed just to prevent heart disease, memory loss or ageing. Decisions about symptom care usually sit within wider menopause management, which includes lifestyle steps and non-hormonal options.
Types and forms
Estrogen alone or combined
If you still have your uterus, estrogen is given together with a progestogen. Estrogen taken alone can thicken the womb lining and raise the risk of cancer there, and the progestogen protects against this. If you have had a hysterectomy, estrogen alone is usually enough. Your doctor decides which combination fits your case.
How it is given
| Form | How it is used | Good to know |
|---|---|---|
| Tablets | Swallowed daily | Widely available |
| Skin patch | Stuck on the skin and changed regularly | May carry a lower clot risk than tablets |
| Gel or spray | Rubbed or sprayed on the skin daily | Dose is easy to adjust |
| Vaginal estrogen | Cream, tablet or ring placed in the vagina | Acts locally for dryness, very little reaches the blood |
| Hormonal IUD | Fitted in the womb | Can supply the progestogen part |
Availability of each form differs between cities and pharmacies. Costs also vary by brand, form and hospital.
Benefits and risks
Possible benefits
Hormone therapy is the most effective treatment known for hot flushes and night sweats. It often improves sleep and vaginal comfort, and it helps to slow bone loss while you are taking it. Many women report better quality of life once troublesome symptoms settle.
Possible risks
Risks depend on your age, your health, the type of hormone, the form and how long you use it. Combined therapy is linked with a small rise in breast cancer risk that grows with longer use. Estrogen tablets slightly raise the risk of blood clots in the legs or lungs and of stroke. For most healthy women who start before 60, or within about ten years of menopause, experts consider the benefits to outweigh the risks. Starting much later carries more risk. Vaginal estrogen in low doses has far fewer of these concerns.
Common side effects
Breast tenderness, bloating, nausea, headaches and light bleeding can occur in the first few months and often settle. Tell your doctor if they continue, as a change of dose or form may help.
Who is usually advised against it
Doctors generally avoid hormone therapy taken by mouth or through the skin, or use it with great caution, in women who have:
- Current or past breast cancer, or another hormone-sensitive cancer
- Vaginal bleeding that has not been investigated
- A past blood clot in the leg or lung, or a known clotting disorder
- A previous heart attack or stroke
- Active liver disease
- A pregnancy or possible pregnancy
Conditions such as high blood pressure, diabetes, migraine, gallstones and obesity do not always rule it out, but they affect the choice of form. Share your full medical and family history so the doctor can judge this properly.
Starting and reviewing treatment
- Your doctor records your symptoms, medical history, family history and current medicines.
- Blood pressure, weight and breasts are checked. A pelvic examination, mammogram, blood tests or an ultrasound scan may be requested, depending on your age and history.
- You discuss the options and agree on the type and form. The aim is the lowest dose that controls your symptoms.
- A first review takes place after about three months to see how you feel and to manage any side effects.
- After that, you are reviewed at least once a year. The doctor reassesses whether you still need treatment and whether the risks have changed.
- When it is time to stop, your doctor may reduce the dose gradually. Symptoms can return for a while.
There is no fixed time limit that applies to everyone. Women with premature ovarian insufficiency are usually advised to continue until around the natural age of menopause.
When to see a gynecologist urgently
While on hormone therapy, get medical help straight away if you notice:
- Pain, swelling or redness in one calf
- Sudden chest pain or shortness of breath
- A sudden severe headache, trouble speaking, loss of vision or weakness in the face, arm or leg
- A new lump in the breast
- Vaginal bleeding that is heavy, or any unexpected bleeding after the first few months of treatment
- Yellowing of the skin or eyes
This page is general information, not a prescription or personal advice. Only a doctor who knows your history can say whether hormone therapy is right for you.
This page is general information for readers in India. It is not medical advice. Speak to a qualified gynecologist about your own health.