This article is part of WHA’s new perimenopause and menopause series.
We’re finally at a point of time where not only are there effective options for managing the symptoms of perimenopause and menopause, but awareness among both patients and providers has increased to the point where initiating treatment to reduce suffering has become far more common.
Menopause hormone therapy (MHT – sometimes also called hormone replacement therapy) is an effective treatment that replenishes hormones to alleviate symptoms of perimenopause and menopause. MHT may be estrogen-only or a combination of estrogen and progesterone. For many, hormone therapy for menopause symptoms can be life-changing by reducing the severity of symptoms, and even providing long-term wellness benefits.
Unfortunately, there remains some confusion around the recommended duration of menopause hormone therapy, prompting a closer look at the evolving guidelines.
How long can someone safely stay on menopause hormone therapy?
For years, the standard advice around hormone replacement therapy for perimenopause and menopause was to use the lowest possible dose for the shortest amount of time. However, more recent research has shifted that perspective.
Long-term data from studies like the Women’s Health Initiative and other prospective research show no evidence of harm in long-term use of the most commonly used estrogen and progesterone formulations when prescribed appropriately. In fact, the evidence points to a decreased risk of osteoporosis, cardiovascular disease and premature death when MHT is started within 10 years of menopause.
The American College of Obstetricians and Gynecologists (ACOG) and The Menopause Society now agree that there is no maximum duration for MHT use.
Decisions about how long to continue MHT are now driven by individual health factors, symptoms and personal goals. Simply put, you can stay on menopause hormone therapy for as long as it works for you.
Long-term effects of menopause hormone therapy
Risks and side effects of menopause hormone therapy
MHT is considered safe for most people. It’s important to note, though, that certain health conditions may preclude initiation of, or prompt discontinuation of treatment. These conditions include:
- Breast cancer
- Heart attack
- Stroke
- Blood clot
MHT doesn’t cause these conditions, but they are considered contraindications—meaning people with these health issues should not start or continue MHT due to increased risks.
Persistent side effects of MHT are rare and can often be reduced through dose adjustment if they don’t go away on their own. Some of the more common, usually temporary side effects include breast tenderness, irregular bleeding and bloating.
Benefits of hormone therapy for perimenopause/menopause
The benefits of long-term menopause hormone therapy can be significant.
Research from the Women’s Health Initiative and other studies showed a substantial reduction in mortality in those who started MHT in their 50s. Studies have also shown up to a 50% reduction in cardiovascular disease for women who start MHT within 10 years of menopause. Additionally, MHT is FDA-approved for the prevention of osteoporosis, offering an important option for maintaining bone health. Some studies showed that the beneficial effects on heart disease risk persisted even after stopping treatment, while the benefits for bone density were lost after treatment ended. So depending on a person’s long-term wellness goals and risk factors, it may be preferable to continue MHT indefinitely.
There is emerging evidence that menopause hormone therapy may have additional preventive benefits such as lowering the risk of dementia and diabetes but there are not yet enough data to recommend treatment specifically for these indications.
How MHT dosage needs change over time
Menopause hormone therapy dosage needs often change as a person progresses through the menopause transition. During perimenopause, when estrogen levels fluctuate more dramatically, higher doses of estrogen may be required to manage symptoms effectively. Post menopause–or following 12 months without menstrual bleeding–these fluctuations tend to stabilize, and many find they can manage symptoms with lower doses. Regular monitoring is key to ensuring that the dosage remains appropriate as the body’s needs change.
Adjustments aren’t just about dosage, though. Sometimes, changing the type of hormone or regimen is necessary. In situations where MHT side effects persist or symptoms aren’t well-managed, your provider may explore alternative hormone options or even non-hormonal medications.
This is why frequent check-ins are essential during the early stages of menopause hormone therapy, usually every two to three months after starting treatment or following any dose changes. Once the treatment is stable and working well, annual follow-ups are typically enough to ensure everything stays on track.
Why MHT may not be right for you
Deciding if menopause hormone therapy is right for you depends on your personal health history and family risk factors. In terms of who should not take menopause hormone therapy, there is an associated risk in those with a personal history of breast cancer, heart disease, stroke or blood clot. In these cases, providers will often recommend non-hormonal treatments to help manage the symptoms of perimenopause/menopause.
Each person’s health profile is unique, so it’s essential to have a thorough discussion with your provider.
When menopause hormone therapy should be discontinued
MHT should be discontinued for two primary reasons:
- If a person develops certain health conditions, such as breast cancer, heart attack, stroke or blood clot. MHT does not cause these conditions, but hormones may increase risks for those with a predisposition to these conditions. In these situations, your provider will explore alternative ways to help manage any peri/menopause symptoms.
- If you experience side effects from menopause hormone therapy that cannot be resolved through dose adjustments. While this is uncommon, if side effects persist and remain intolerable despite changes in treatment, discontinuing MHT may be necessary.
Empowering your menopause journey
The menopause transition is a natural phase of life, and most people have symptoms to one degree or another. Thankfully, we now have effective ways to manage those symptoms.
Menopause hormone therapy can provide significant relief for symptoms that can frankly make us feel awful, with added long-term wellness benefits, too. Regular conversations with your provider will ensure that your treatment plan remains tailored to your unique needs, allowing you to navigate this transition with confidence—and, hopefully, feeling a lot more like yourself!
For those who can’t or don’t wish to use MHT, there are effective non-hormonal treatments available, making it possible for every person to find a solution that works for them. Find a WHA menopause care provider to discuss your options.
For further reading, visit The Menopause Society.
