Aug 3, 20248 min read

MHT, HRT, and BHRT: Your Guide to Safely Taking Hormone Therapy During Menopause

Updated: Oct 31, 2024

This article has been recently updated since its original publication.

Key Takeaways:

Perimenopause can start as early as age 35, and is when many women choose to start hormone therapy.
Hormone Replacement Therapy (HRT) can alleviate menopausal symptoms and reduce health risks like osteoporosis, heart disease, and cognitive decline.
Estrogen, progesterone, and testosterone each play unique roles in women’s health.
Vaginal estrogen may be the safest option and is even considered safe for breast cancer patients.
While some women may seek bioidentical hormones or dietary phytoestrogens, conventional HRT may be more effective.

Introduction

Menopause is a complex physiological transition marked by a woman's final menstrual period. However, women can start to experience menopausal symptoms 7-10 years before they stop menstruating, as early as age 35. [1]

As our hormone levels fluctuate, women may experience vasomotor symptoms (e.g., hot flashes, night sweats), urogenital atrophy (e.g. vaginal dryness, urinary incontinence), and psychological changes (e.g. muscle loss, bone loss, cognitive decline).

Research has found that certain forms of hormone therapy not only alleviate menopausal symptoms but can also reduce associated health risks. [2]

Understanding Menopausal Hormone Therapy (MHT)

Hormones do not require medical replacement in menopausal women; hence, the Menopause Society has transitioned language from Hormone Replacement Therapy (HRT) to MHT or Hormone Therapy (HT).

This treatment is designed to alleviate symptoms associated with menopause by supplementing hormones that decrease during this transition.

It can also be given to women with premature ovarian failure, premature menopause, or surgically induced menopause.

Estrogen

This hormone is crucial for regulating the female reproductive system. Its decline during menopause is responsible for many symptoms, including fatigue, brain fog, hot flashes, and vaginal dryness.

Estrogen can be administered alone when taken vaginally or in women who've had a hysterectomy.

Progesterone

Essential for regulating the menstrual cycle and preparing the uterus for pregnancy, progesterone levels also drop during menopause. It is particularly important for women with a uterus as it helps prevent endometrial cancer when estrogen is taken. [3]

"The most important hormone in HRT is progesterone, since it supports all the hormone glands." Dr. Sangeeta Pati, MD, FACOG, ABOIM

Testosterone

Though primarily known as a male hormone, testosterone also plays a significant role in women’s health. While testosterone drops don't necessarily occur during menopause, many women use it to assist with sexual desire, orgasm, energy levels, and mood. [4]

The Benefits of Menopausal Hormone Therapy

The menopause typically lasts between 2-8 years. HRT is widely recommended for alleviating common symptoms of menopause, such as:

Hot flashes: Experienced by approximately 75% of women during menopause, HRT can significantly reduce the frequency and severity. [5]
Reduced libido: Up to 50% of women observe a significant reduction in sex drive and ability to climax during perimenopause. [6]
Brain fog: 60-73% of women have brain fog during this transition. [7]
Vaginal discomfort: Up to 50% of postmenopausal women experience vaginal dryness, which can be effectively treated with vaginal estrogen. [8]
Heart palpitations: A recent research review found that up-to 54% of women experience palpitations in menopause. [9]

Using MHT to Reduce Health Risks

MHT can help reduce the following health risks associated with menopause:

Osteoporosis: This degenerative disease is highly prevalent in post-menopausal women. Estrogen therapy is highly effective in preventing bone loss and fractures.
Cardiovascular disease: Menopause can elevate heart disease risk by 40% due to decreased estrogen levels. Many forms of estrogen therapy can counter this. [10]
Prolapse: 50% of women will experience at least one form of pelvic organ prolapse when one or more pelvic organs drop from their position. Some suggest that HRT can help prevent this. [11]
Cognitive decline: MHT may reduce the risk of Alzheimer's and other forms of dementia by up to 30%. [12]
Type 2 diabetes: Estrogen is linked to insulin sensitivity; HRT is linked to reduced risk of metabolic disease in women with or without prediabetes. [13]
Depression: Hormonal fluctuations can trigger mood disorders, and HRT has shown promise in alleviating depressive symptoms. [14]

HRT is also associated with reductions in all-cause mortality and overall quality of life improvements.

One Drug for Multiple Issues

One of the significant advantages of MHT is its ability to address various menopausal symptoms and health risks with a single therapy, may reduce the need for multiple medications. This holistic approach can enhance patient adherence and overall satisfaction with treatment.

Administration Methods for Hormone Therapies

When it comes to minimizing health risks, how you take HRT matters.

The administration method for MHT can significantly impact both its effectiveness and side effects.

It is critical to consult a physician before starting on any of these medications.

1. Oral Medications

Oral medications are convenient and a widely used form of MHT, providing effective systemic relief for menopausal symptoms. Estrogen and progesterone are typically given together for women with a uterus.

"If a woman develops breast tenderness or uncontrolled vaginal bleeding, her estradiol dose may need to be adjusted. Daytime drowsiness might mean backing off on progesterone." Steve Goldring, RPh

There is an increased risk of blood clots, particularly with oral estrogen. Women with breast cancer may also be advised against this method. [15]

2. Transdermal Patches

Patches provide a steady, slow-release delivery of hormones and have a higher safety profile than oral estrogen. Research also finds that HRT patches do not cause blood clots or endometrial cancer but may lead to skin irritation. [16]

There can be variability in hormone absorption depending on the patch site; typically patches are placed on the lower stomach or upper buttocks region.

3. Gels and Creams

These formulations offer rapid absorption and can be adjusted easily for individual dosing. Similar to transdermal patches, research finds that gels and creams do not increase your risk of blood clots or endometrial cancer. [16]

4. Vaginal Estrogen

This method provides targeted relief for vaginal dryness and urinary symptoms, with lower systemic exposure and risks compared to oral forms.

Studies show that vaginal estrogen does not increase the risk of blood clots or endometrial cancer. Research shows that vaginal estrogen is even considered safe for breast cancer patients. [17]

Many leading menopause specialists, including Dr. Mary Claire Haver, are campaigning to remove the "outdated warning label" on local vaginal estrogen products.

Which Administration Method of HRT is Best?

Every woman is different and carries a different medical history, so it's critical to consult your physician, who specializes in menopause, before starting any treatment.

Currently, here are some of the benefits and risks found in research.

Method	Benefits	Risks
Oral Medications	Convenient	Increased risk of blood clots; contraindicated if there's a history of breast cancer
Transdermal Patches	Steady delivery; no increased blood clot risk	Skin irritation; inconsistent absorption
Gels and Creams	Customizable; no increased blood clot risk	Skin reactions; transfer risk
Vaginal Estrogen	No increased blood clot risk; safe for breast cancer patients	Possible irritation

Bioidentical Hormone Replacement Therapy (BHRT)

BHRT uses hormones identical at the molecular level to those naturally produced in the body. These hormones are typically derived from plant sources and are designed to mimic natural hormone structures.

Common hormones in BHRT include:

Estradiol (an estrogen)
Progesterone
Testosterone

Benefits of BHRT

Many women choose BHRT, believing it offers a more natural and individualized approach to hormone therapy.

Proponents argue that because these hormones are bioidentical, they may result in fewer side effects and higher absorption levels than synthetic alternatives.

Risks and Concerns

Despite its popularity, there are concerns regarding the regulation and standardization of BHRT. Since it is less regulated than conventional HRT, the safety and efficacy of BHRT preparations may vary significantly.

More research is needed to fully understand the long-term effects of these treatments.

When Can You Start HRT?

Once you start experiencing menopausal symptoms, you can consider MHT. Many women start MHT during perimenopause once they begin to identify symptoms like irregular periods, mood swings, weight gain, etc. Read more about HRT vs Ozempic for menopause weight gain.

Starting HRT sooner may reduce the magnitude of degenerative effects on the musculoskeletal system. [18]

How Long Can You Take HRT?

Research indicates there is no predetermined age at which women must stop HRT. Studies suggest that even women over 65 can benefit from continued hormone therapy.

"Women aged older than 65 years can continue using hormone therapy with appropriate counselling and risk assessment." The Menopause Society

The most common reason women discontinue HRT is vaginal bleeding, which may indicate the need for dosage adjustment or further evaluation. [19] Women experiencing this should consult with their healthcare provider for personalized recommendations.

Dosage with HRT

Some practitioners recommend that women begin HRT at the lowest effective dose to minimize potential risks while effectively alleviating symptoms. This individualized approach ensures optimal benefit-risk ratios.

Dosages may need to be consistently adjusted as you progress through perimenopause as your hormone levels continue to drop. Regular monitoring by a healthcare provider is essential to ensure that the therapy remains effective and safe.

Is Dietary Estrogen Enough?

While certain foods contain phytoestrogens—plant-derived compounds that can mimic estrogen in the body—relying solely on dietary sources to achieve adequate estrogen levels during menopause is not very feasible for the following reasons.

Limited Absorption of Dietary Estrogen

Phytoestrogens, found in foods like soy products, flaxseeds, and whole grains, must undergo metabolic/gut conversion to exert estrogen-like effects. This process varies significantly among individuals and is influenced by factors such as gut microbiota composition and overall health.

Research indicates that only 30-50% of women can produce equol, an estrogenic compound, from dietary sources. [20] As a result, the amount of phytoestrogens that can effectively mimic estrogen in the body is often inadequate to compensate for the significant hormonal decline experienced during menopause.

Insufficient Quantity of Phytoestrogens in Diet

One would need to consume large quantities of soy to achieve even a fraction of the estrogen levels typically provided by HRT.

A comprehensive review of 15 high-quality randomized controlled trials (RCTs) showed that the intake of phytoestrogens did not have a significant effect on relieving hot flashes. [21] This suggests that while some women may experience mild benefits from dietary phytoestrogens, they are generally insufficient to address the more severe symptoms associated with menopause.

Consulting with Healthcare Professionals

Women considering hormone therapy should consult with their healthcare providers to discuss individual health profiles and preferences. Key questions to address during consultations include:

- What are the potential benefits and risks of starting HRT?

- What administration method is best for my lifestyle and health status?

- How often should I have follow-up appointments to monitor my therapy?

Regular communication with healthcare providers is crucial to tailoring hormone therapy and ensuring optimal outcomes..

Unsure of Your Menopausal Status?

Navigating menopause can be challenging, but you don't have to do it alone.

With the MenoTime at-home test kit, the first-ever time-to-menopause predicting algorithm by Timeless Biotech, you can gain insights and community for your hormone journey.

Our innovative platform not only helps you understand when to expect menopause but also connects you with a supportive community of women experiencing similar challenges.

Receive personalized predictions about your time to menopause.
Get certainty on whether you're in perimenopause.
Access educational resources tailored to your specific needs.
Engage with a network of women sharing experiences, tips, and support.

This article is for informational purposes only and not a substitute for professional medical advice. Always consult a qualified healthcare provider with any questions regarding medical conditions.

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