Who can benefit from hormone therapy?

The benefits of hormone therapy may outweigh the risks if you're healthy and you:

• Have moderate to severe hot flashes. Systemic estrogen therapy remains the most effective treatment for the relief of troublesome menopausal hot flashes and night sweats.
• Have other symptoms of menopause. Estrogen can ease vaginal symptoms of menopause, such as dryness, itching, burning and discomfort with intercourse.
• Need to prevent bone loss or fractures. Systemic estrogen helps protect against the bone-thinning disease called osteoporosis. However, doctors usually recommend medications called bisphosphonates to treat osteoporosis. But estrogen therapy may help if you either can't tolerate or aren't benefiting from other treatments.
• Experience early menopause or have estrogen deficiency. If you had your ovaries surgically removed before age 45, stopped having periods before age 45 (premature or early menopause) or lost normal function of your ovaries before age 40 (primary ovarian insufficiency), your body has been exposed to less estrogen than the bodies of women who experience typical menopause. Estrogen therapy can help decrease your risk of certain health conditions, including osteoporosis, heart disease, stroke, dementia and mood changes.

If you take hormone therapy, how can you reduce risk?

Talk to your doctor about these strategies:

• Find the best product and delivery method for you. You can take estrogen in the form of a pill, patch, gel, vaginal cream, or slow-releasing suppository or ring that you place in your vagina. If you experience only vaginal symptoms related to menopause, estrogen in a low-dose vaginal cream, tablet or ring is usually a better choice than an oral pill or a skin patch.
• Minimize the amount of medication you take. Use the lowest effective dose for the shortest amount of time needed to treat your symptoms. If you're younger than age 45, you need enough estrogen to provide protection against the long-term health effects of estrogen deficiency. If you have lasting menopausal symptoms that significantly impair your quality of life, your doctor may recommend longer term treatment.
• Seek regular follow-up care. See your doctor regularly to ensure that the benefits of hormone therapy continue to outweigh the risks, and for screenings such as mammograms and pelvic exams.
• Make healthy lifestyle choices. Include physical activity and exercise in your daily routine, eat a healthy diet, maintain a healthy weight, don't smoke, limit alcohol, manage stress, and manage chronic health conditions, such as high cholesterol or high blood pressure.

If you haven't had a hysterectomy and are using systemic estrogen therapy, you'll also need progestin. Your doctor can help you find the delivery method that offers the most benefits and convenience with the least risks and cost.