Hormone replacement therapy (HRT) involves taking estrogen, progesterone or testosterone to treat symptoms like hot flashes, night sweats, vaginal dryness, decreased sex drive and mood changes from menopause or andropause. While HRT can provide relief, there are potential downsides to consider:
Risks
- Increased risk of breast cancer and cancer recurrence - Taking estrogen plus progestin HRT for over 5 years slightly increases breast cancer risk. There's also evidence showing increased breast cancer mortality in those taking estrogen plus progestin.
- Increased risk of endometrial cancer - Unopposed estrogen HRT without progesterone significantly increases endometrial cancer risk if used long term. Adding progesterone helps lower this risk.
- Increased risk of ovarian cancer - Long-term estrogen HRT use may increase ovarian cancer risk, but data is inconsistent.
- Increased risk of heart disease and stroke - Oral HRT with conjugated equine estrogens plus medroxyprogesterone acetate likely increases heart attack, stroke and blood clot risk in postmenopausal women. Transdermal estrogen may carry less vascular and thrombotic risk.
- Gallbladder disease risk - Estrogen therapy can increase gallbladder disease risk requiring surgery.
- Potential increased dementia risk - Some studies link estrogen plus progestin HRT to slightly increased dementia risk, but results are mixed.
Side Effects
Many experience temporary, nuisance side effects starting HRT like:
- Headaches
- Breast tenderness
- Irregular vaginal bleeding and spotting
- Bloating
- Nausea
Inconvenient Aspects
- Regular doctor's visits for screening and prescription refills
- Blood testing to check hormone levels
- Remembering to take pills or apply patches daily
- Vaginal irritation from creams
Costs
- Health insurance may not cover HRT costs depending on the plan. Out-of-pocket costs can be high.
- If uninsured, cash pay prices range $20-75 per month for oral tablets or patches. Custom compounded HRT creams are often more expensive.
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The decision about whether HRT's potential benefits outweigh possible downsides depends on each person's symptoms and medical history. Discuss all treatments with your doctor. Those with a history of hormonally-influenced cancers or at high risk may be advised against HRT. For low risk women struggling with severe, quality-of-life impacting menopause symptoms not relieved by lifestyle changes, the benefits of short term HRT often outweigh risks after weighing options during an informed discussion with your provider.