Astrid Hancock
reviewed by Dr Michael Yapko
Friday, December 18, 2020
Astrid Hancock
Friday, December 18, 2020

Hormone Replacement Therapy for Menopause: Benefits, Risks, & Natural Alternatives


Hormone Replacement Therapy (HRT) is a common treatment for difficult menopause symptoms. If you’re suffering from some of the more uncomfortable side effects of menopause, like hot flashes, night sweats, and insomnia, you may wish to select from a range of natural treatment options to keep symptoms at bay. However, if your symptoms are severely impacting your daily life, you may want to speak to your doctor about the benefits and risks of HRT or look into another alternative treatment, like menopause hypnotherapy. Estrogen and progesterone deficiency during menopause causes various changes in the body. Let’s discuss what you can expect when entering menopause and whether it might be time to bring up HRT with your doctor.

What is menopause?

Menopause is a natural part of a menstruating woman’s life cycle. Although 1.5 million women globally are currently experiencing menopause, it can be difficult to navigate. Changes occur in the body that can be confusing, uncomfortable, and even down-right annoying.

Menopause refers to the last menstrual period a woman experiences and usually occurs at around the age of 50. As the female body ages, there is a reduction of estrogen and progesterone released from the hypothalamus, resulting in fewer eggs being released for fertilization. Over time, the release of eggs stops completely, and you no longer have a monthly period.

Symptoms of menopause

Menopause is confirmed by 12 consecutive months of no menstrual period. The years leading up to menopause is called ‘perimenopause’, which is the beginning of the body transitioning into the end of the reproductive cycle. Missed and irregular periods can be expected during this time.

Every woman experiences menopause differently, but the most common symptoms associated with menopause include:

The reduction of estrogen in the body can also lead to additional changes. While most side effects from the reduction of estrogen levels are normal, it is important to have regular checks with your doctor to make sure you are not experiencing more serious side effects like cardiovascular disease or osteoporosis.

Through modern medicine, there are some ways to get your symptoms under control. A common suggestion from your doctor may be HRT, which ultimately adds the lacking estrogen and progesterone back into the body.

What is HRT and what types are available?

Hormone replacement therapy (HRT), also known as menopausal hormone therapy (MHT) is proven to balance women's hormones through the addition of lacking estrogen and sex hormones, using either pills, patches, creams, or gels. Depending on your symptoms, your doctor will recommend or prescribe the right fit for you.

A highly popular form of HRT is the estrogen patch, which is a transdermal form of HRT. The patch is a great alternative to oral HRT as it requires very little maintenance. These patches are stuck to the abdomen, or buttocks, and can last for up to one week. Although there are limited studies on HRT patches available, some research has shown transdermal HRT to be a safer alternative to oral HRT, as it may reduce your chance of developing cancers and blood clots.

It is important to note, that for a woman with an intact uterus, the addition of progestogen in their therapy, alongside estrogen is necessary to protect the lining of the uterus and prevent the possibility of endometrial hyperplasia and uterine cancers. Women with a history of breast cancer are often encouraged to avoid HRT due to the risk of cancer recurrence.

Questions to ask your doctor before starting HRT

Do I need a prescription to get HRT?

It is important to consult with your doctor before deciding whether to start HRT. Your doctor will be able to recommend the best type of HRT for your symptoms and will advise you on how it can be administered.

There are several different options of prescription HRT available:

  • Oral estrogen and progesterone: This is the most common form of hormonal therapy, and is taken in the form of a daily pill/s.
  • Patches: Transdermal HRT patches are available for those who would prefer not to take oral medication daily. The patches can last up to a week and can be worn while bathing.
  • Creams/gels: Similar to patches, these are a convenient way to manage symptoms and are applied by rubbing into the skin. There are also creams, pessaries (prosthetic devices), and rings that can be inserted vaginally to assist in vaginal dryness and reduction of pain during intercourse.
  • Implants: These small, pill-like, implants can be inserted under the skin and are a less common form of HRT.

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Over-the-Counter ‘Estrogen’ and alternative HRT products

Many women will look to relieve their menopausal symptoms, such as hot flashes and night sweats, with over-the-counter estrogen alternatives and ‘natural HRT’ products. However, many ‘natural hormone replacement’ products you find at your local pharmacy do not replace progesterone or estrogen levels in your system.

Some popular OTC hormone support products, such as Estroven™ and Estrogen for Women™ by Life Extension, may seem to be natural HRT, but products like these are generally herbal supplements—not synthetic versions of naturally occurring hormones.

The key ingredients of over-the-counter ‘natural HRT’ alternatives typically include traditional herbs and plants as an active ingredient. Most often, they will include one or more of the following:

  • Black cohosh (Cimicifuga racemosa): a North American plant historically used as an indigenous treatment for menopausal symptoms.
  • Wild yam (Dioscorea): a tuber used in traditional Chinese medicine to treat the symptoms of menopause.
  • Dong Quai (Angelica Sinensis): a traditional Chinese herb used to treat female reproductive issues.
  • Maca: a native South American plant used as a treatment for infertility and female hormone balance.
  • Pollen extract: flower pollen which is sold under brands like Serelys, Femal, Femalen, and Relizen.
  • Evening primrose oil (EPO): oil derived from the seeds of the evening primrose plant.
  • Phytoestrogens: nonsteroidal plant-derived compounds from soy, red clover, flaxseed, and hops.
  • Siberian rhubarb (Rheum rhaponticum): A dry extract from the roots of rhapontic rhubarb.

Natural alternatives to HRT can be a good option for women with specific risk factors, such as estrogen/progesterone-dependent tumors, including breast cancer. Around 40% of women in the UK are currently said to use complementary and alternative treatments to help ease menopausal symptoms.

Natural HRT alternatives can usually be found at your local pharmacy or health food stores. Even non-prescription remedies may come with adverse effects and risks, so it’s best to consult with your doctor before purchasing.

As an entry-point into menopause management, natural remedies have been shown to provide some relief. However, the effects and safety of herbal menopause remedies are difficult to prove scientifically due to large variations in the studies that have been conducted and because of the lack of regulation in the supplement industry.

Why you should avoid buying over-the-counter estrogen online

Occasionally, some people try to reduce their menopausal symptoms by buying HRT products online without a prescription. This is risky at best and at worst it’s potentially life-threatening.

Many online pharmacies claim to sell prescription medicines, such as HRT and estrogen patches at discounted prices without requiring a valid prescription. If you’re not being asked for a prescription, it probably means you’re buying from an untrustworthy source, even if the website looks legitimate.

The U.S. Food and Drug Administration specifically warns people against buying medications online: “Internet-based pharmacies often sell unapproved or counterfeit medicines outside the safeguards followed by licensed pharmacies.”

“These rogue sites often prominently display a Canadian flag, but may actually be operated by criminals from the other side of the globe with no connection to Canada. Medicines bought from these websites can be dangerous and may put your health at risk”.

Online medications obtained from legitimate sources can also be dangerous. They may:

  • Contain the wrong amount of the active ingredient needed to treat your condition
  • Contain the wrong active ingredient
  • Contain harmful ingredients

Remember: Even small changes in the hormone levels in the blood can have a huge impact on your wellbeing. So, before undertaking any course of HRT, you must speak to your doctor first and get a valid prescription.

What are the side effects of HRT?

Like all medication, HRT comes with the risks of side effects. There is a range of potential symptoms, scaling from more common to less common. More often than not, less severe symptoms will clear up on their own after a few weeks, but it’s important to be monitored by your doctor when starting HRT or changing your medication.

Common side effects from HRT include:

  • Breast tenderness
  • Headaches
  • Mood swings
  • Nausea
  • Hair loss
  • Vaginal bleeding
  • Fluid retention

Less common side effects include:

  • Blood clots
  • Cancer

Oral HRT has been more regularly linked to the increased risk of developing blood clots and cancers, compared to transdermal HRT. These are topics that your doctor will discuss with you during your consultation.

Current advice is that there are more benefits compared to risks if you begin HRT during the therapeutic window, but this may differ between individuals. Smaller doses of HRT early in your menopause journey may be more beneficial than larger doses later on, but your doctor can advise you on what is appropriate for your body.

Alternatives to HRT in menopause

Depending on the severity of your symptoms and your medical history, HRT doesn’t have to be your only option. Through adequate nutrition, exercise, quitting smoking, and trigger avoidance (like cutting out spicy food and hot drinks), you may find that your symptoms improve without the need for medical interference. Some alternatives include:

1. Trying hypnotherapy for menopause

Looking to avoid hormones and the potential side effects of HRT? The most effective, drug-free natural management tool for hot flashes, is hypnotherapy.

According to a recent study published in the journal Menopause, clinical hypnosis can significantly reduce hot flashes. Through the suggestions of coolness, relaxation, and deeper sleep, participants saw around an 80% mean reduction in their hot flashes. The same study also found that sleep quality improved, which is good news for anyone suffering from menopause-induced insomnia.

While finding a licensed hypnotist may seem harder than applying an HRT patch, it is possible to practice hypnotherapy in the comfort of your home through an app such as Evia, developed with world leading hypnotherapy clinicians.

2. Avoiding triggers

While a hot cup of coffee or a bowl of spicy curry may sound enticing, they can increase the likelihood and severity of hot flashes.

During menopause, try switching to cooler beverages and cut back on overly spicy meals. If you’re experiencing frequent symptoms, it can also be helpful to dress in layers that can be easily shedded. Additionally, too many thick layers of clothing can trigger a hot flash.

3. Diet and exercise

It is important to eat a nutrient-rich diet during menopause. Hormonal fluctuations during menopause can also cause weight gain, so it’s a good idea to keep an extra careful eye on your diet to support your health.

While there is not sufficient evidence to suggest that exercise can reduce incidences of hot flashes, a recent study in the Journal of Midlife Health showed that exercise may decrease your risk of developing osteoporosis and improve your overall well-being during menopause. To further reduce your risk of osteoporosis, your doctor may encourage the addition of supplements to your diet, including vitamin D and calcium to keep your bone density from dropping.

Where to find more menopause information

If you are interested in learning more about HRT and finding out whether it’s the right fit for you, there are many useful resources available.

Trustworthy places to get information include:

  • Your general practitioner
  • Your gynecologist
  • Trusted online resources, like government-supported health websites

As always, it’s best to get help from a healthcare professional who is aware of your medical history and can discuss available options and preferences with you.

The Wrap Up

Menopause can be a daunting experience, especially when considering starting medication in the form of HRT. Modern medicine and research have been able to provide menopausal women with increased support and treatment options, such as HRT and hypnotherapy. Through open and honest communication with your healthcare provider, finding ways to manage your menopausal symptoms can be a positive experience. From a daily pill to a weekly patch, HRT is constantly evolving and may be a useful tool for you and your future.

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Our Sources

Mindset Health only uses high-quality sources, including peer-reviewed research, to support our articles. We work with experts to ensure our content is helpful, accurate and trustworthy.

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