Menopausal Hormone Therapy (MHT) is a common treatment option for women looking to alleviate the symptoms related to menopause. Perimenopause and menopause are a transitional time for women marked by hormonal changes and menstrual irregularity that can cause an array of symptoms for women that may impact daily life and prevent many from feeling their best. Some wonder if the treatment option MHT is right for them. In honor of Menopause Awareness Month in October, Progyny hosted a discussion to dive into this topic and address top questions and misconceptions.
This webinar featured:
- Janet Choi, MD, MSCP, Chief Medical Officer at Progyny
- Rebecca Dunsmoor-Su, MD, MSCE, MSCP, FACOG, Chief Medical Officer at Gennev
- Claudia Zimmerman, RNC-OB, Sr. Director, Network Management at Progyny (Moderator)
What is Menopausal Hormone Therapy (MHT) and how does it work?
Menopausal Hormone Therapy (MHT) is a treatment option for menopause symptoms that replaces the hormones in the body the ovaries no longer produce during this phase, including the transition periods known as perimenopause and post-menopause. These hormones, most commonly estradiol and progesterone, mimic what the body naturally produced before menopause to help manage symptoms like hot flashes, sleep disturbances, brain fog, and more.
MHT is FDA approved to treat hot flashes and as a prevention treatment for osteoporosis. However, your provider may prescribe MHT to help relieve other common symptoms of menopause, such as mood swings, brain fog, and vaginal health.
MHT is available in various forms, such as patches, gels, pills, sprays, and vaginal rings. There are many other various combinations of MHT patients can be prescribed in addition to estradiol and progesterone, and you can work with your provider to discuss which option may be the best for you.
Who is MHT recommended for?
There aren’t certain tests someone has to pass to determine if MHT is right for them. Instead, deciding if MHT is beneficial to a patient is a decision that varies from patient to patient and is decided along with your trusted healthcare provider. Your provider will consider a range of factors to help weigh the potential benefits against any risks, such as your medical history, current health conditions, family health risks, and the severity of your symptoms. Your provider will review your menstrual history and symptoms, and may recommend routine screenings like mammograms, pap smears, and possibly bone density scans before starting therapy.
After MHT is taken, hot flashes or night sweats can improve within 1-2 weeks. More subtle symptoms such as sleep and brain fog may take anywhere from weeks to months to see improvement. You may experience light side effects such as breast tenderness, bloating, or light spotting. Some side effects may come from certain MHT routes, such as getting a skin irritant from the patch or experiencing mood changes from progesterone (which affect a very small percent of women who experience mood swings during their menstrual cycle).
Deciding to take MHT is not a lifetime decision, although some patients may choose to be on MHT through post-menopause. Every case is individual, and the choice is always discussed with your doctor to determine what is best for you. If you choose to stop taking MHT, you may experience some hot flashes or other common symptoms which will typically disappear quickly after stopping.
What are the myths and common misconceptions of MHT?
Does MHT cause breast cancer?
Early studies from the WHI (World Health Initiative) caused a lot of fear among the public surrounding MHT. However, more recent research shows the risk is much smaller than believed two decades ago when the study first came out. MHT does not cause breast cancer, and risk factors of MHT are dependent on the type you take, duration of use, and your medical history and personal risk factors. If you start MHT, you will typically be prescribed a combination of estrogen and progesterone. This is because progesterone counteracts the stimulatory effects of estrogen on the uterine lining, which may reduce the risk of uterine cancer. You may not be prescribed the full systemic menopausal therapy if you are a survivor of breast cancer, have an active hormone-related cancer, liver disease, blood clots, or a cardiovascular disease. Deciding to take MHT is an individual decision made with the help of your menopause provider, who will help you weigh the benefits and risks to decide if MHT may be right for you.
Is MHT only used for hot flashes?
No, MHT is not only used for hot flashes. Although MHT is approved by the FDA to treat hot flashes and prevent osteoporosis, MHT can be used for other symptoms decided by your doctor.
What are the side effects of MHT?
Side effects of MHT are usually mild and manageable, and may include breast tenderness, bloating, or mood changes, especially with progesterone. More serious side effects, such as blood clots or cardiovascular issues, are extremely rare but should be discussed with your provider, especially if you have a personal or family history of these conditions.
Are “natural” alternatives safer than MHT?
MHT treatments are FDA approved and prescribed by menopause trained specialists. The most commonly prescribed forms are bioidentical, meaning they are molecularly identical to the hormones your body naturally produced pre-menopause. While it is always an individual’s decision whether they want to be on MHT or not, taking MHT can be a very beneficial and safe treatment option for women having trouble managing symptoms.
What are non-hormonal treatment options for menopause symptoms?
There are other available options that can treat menopause symptoms if a patient is uncomfortable or not the right fit for MHT. Prescription medications such as SSRIs are seen to improve hot flashes and night sweats. Newer FDA-approved treatments, such as fezolinetant, work at the control center of your brain to help regulate and minimize your vasomotor symptoms (hot flashes and night sweats).
Lifestyle changes can also help alleviate perimenopause and menopause symptoms for those who don’t want to take MHT or those in a higher risk category, such as breast cancer survivors. Treating sleep disruptions can be helped psychologically with cognitive behavioral therapy, or physically, such as keeping your room cool or having a cold pad in your bed. Many women also experience weight changes, which can be helped by adjusting the amount of protein and fiber in your diet and exercising to build muscle.
MHT is not the only available option for menopausal women wanting to manage their symptoms. If you ever have questions around symptoms you’re experiencing and want to discuss treatment options, always consult your healthcare provider to understand the best next steps for you.
If you are a Progyny member, know that Progyny is always here to support you across life’s milestones, and you can access additional resources at progyny.com/education.
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