Hormone Therapy for Menopause: Myths vs. Facts

Hot flashes. Night sweats. Restless nights. If you’re going through menopause, you may wonder if hormone therapy may help. Maybe you’ve heard it’s risky. Or maybe you’ve seen social media posts that say it’s life-changing. 

“We’ve come full circle,” says Shauna Pagel, APRN-CNP, a nurse practitioner in MetroHealth’s Menopause Clinic. “Everyone used to be afraid of it and didn’t want to be on it. Now everyone wants to be on it.”

Here are four common myths and the facts behind each one.

Myth 1: Menopause Hormone Therapy Causes Breast Cancer

Reality: For most people, the added risk is small. Many fears come from a large study that was done more than 20 years ago. Here’s what we know now:

• Taking estrogen with a progestin raises the risk a little. Pagel says that’s about 4 cases for every 1,000 people over 5 years. 
• In the study from 20 years ago, people who took estrogen alone had a lower risk for breast cancer.
• Smoking, being overweight and even one daily glass of wine raises the risk of breast cancer more than hormone therapy.

Myth 2: Hormone Replacement Therapy Will Fix Every Symptom

Reality: It works best for certain symptoms. Research shows hormone therapy can help:

• Reduce hot flashes and night sweats
• Relieve vaginal dryness and painful sex
• Prevent bone loss (osteoporosis) in people with low bone mass
• Ease symptoms in people who reach menopause early, before about age 45

It may or may not help with brain fog, mood, sleep or thinning hair. These can also take months to improve.

“It may fix all your menopause symptoms, or it may not,” Pagel says. “We need to have realistic expectations.”

Myth 3: Hormone Therapy Isn’t Safe for Most People

Reality: Many healthy people are candidates. You may be a good fit if you:

• Had your last period within the past 5 to 10 years
• Have diabetes or high blood pressure under control
• Have a low risk of heart disease
• Have no personal history of breast cancer

If you still have a uterus, you will also need to take progestin to help protect the lining of the uterus.

Estrogen comes as a pill, patch, gel, or spray. Options that go through the skin, such as patches and gels, may have a lower risk of blood clots than pills. The overall risk of blood clots with hormone therapy is low.

Myth 4: If You Can’t Take Hormones, You Don’t Have Any Options

Reality: Some people who can’t take hormones feel stuck. Pagel tells them they still have choices. Other ways to ease hot flashes include:

• Medicines made just for hot flashes
• Cognitive behavioral therapy (CBT), a type of talk therapy
• A Mediterranean-style diet
• Cutting back on alcohol, sugar and nicotine, which can trigger hot flashes

What about supplements? The Menopause Society says research hasn’t shown that dietary supplements, including those with soy, relieve hot flashes and night sweats any better than a placebo (a pill with no active ingredients).

How to Prepare for Your Menopause Visit

The more your provider knows, the more they can help. Before your visit, you might want to:

• Write down your symptoms and when they happen
• Track your periods and the date of your last one
• Choose your top three goals for the visit

Be honest about what bothers you most and what matters to you most.

Menopause Care That Puts You First

At MetroHealth, menopause care starts with listening. Our Menopause Clinic team includes providers in family medicine, gynecology, behavioral health and nutrition. Together, they build a care plan around your symptoms and goals. 

“It’s about listening to patients about their issues, concerns and symptoms,” says Pagel. “We may adjust or tweak the dosing based on symptoms. If something isn’t working for you, let’s figure something else out.”

Your Questions Answered

Q. How long does hormone therapy take to work?

A. Many people notice fewer hot flashes within a few weeks. Your provider may check in about every 3 months. 

Q. Do I need progestin if I’ve had a hysterectomy?

A. Usually not. Progestin protects the lining of the uterus. Without a uterus, you can often take estrogen alone. 

Q. Can I take hormone therapy if my mother had breast cancer?

A. A family history doesn’t rule you out, but your provider will want to look at your health history. They will help you weigh the pros and cons.