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What You Should Know About Hormone Therapy and Menopause

When menstruation stops, menopause begins. During this transition and life stage, certain hormone levels decrease, setting off a plethora of possible symptoms. Most women—about 85%—have at least one symptom that negatively impacts daily functioning. For some, menopause wreaks endless havoc, disrupting every facet of life, work, relationships, and health.    

“You do not need to suffer. Your symptoms are real. There are safe treatment options, and your treatment can be guided to address what symptoms are most significant for you at the time,” says Hoosna Haque, MD, assistant professor of obstetrics & gynecology at Columbia University Vagelos College of Physicians and Surgeons. 

Haque, who is certified in integrative medicine, has worked with many women to alleviate their menopausal symptoms. There’s a variety of options, she says, from lifestyle modifications to hormone replacement therapy. And one that’s right for your specific needs. 

We asked Haque about the proven benefits and risks of hormone replacement therapy. 

What is hormone therapy? 

Hormone replacement therapy (HRT) is a treatment to relieve symptoms of menopause. It’s also known as menopausal hormone therapy and estrogen replacement therapy. 

Like the name says, hormone replacement therapy replaces hormones that are at a lower level when menopause begins: estrogen, progesterone, or both. Because hormones control anxiety, appetite, body temperature, brain function, heart rate, metabolism, mood, sleep cycles, sexual function, stress, urination, and really everything, imbalances (too low or too high) can lead to uncomfortable (at best) and disruptive symptoms. 

To restore balance, there are different combinations of hormones and different ways to take them: creams, patches, pills, and more.  

Talk to your doctor about what is right for you. There is no need to suffer.  

Columbia gynecologist Dr. Hoosna Haque speaking with a patient

Columbia University gynecologist Hoosna Haque: "If your quality of life is disrupted by symptoms of menopause, hormone replacement therapy may be appropriate for you." Photo by John Abbott.

What are the signs that you need hormone replacement therapy?      

If your quality of life is disrupted by symptoms of menopause, hormone replacement therapy may be appropriate for you.  

You may not recognize your symptoms as being part of menopause; when you’re going through it, it can be hard to have perspective. Know there are treatment options and you can be helped.  

Get evaluated by a doctor if you are:

  • Not sleeping well or at all 
  • Having hot flashes and/or night sweats 
  • Having joint, muscle, and/or body aches 
  • Hearing from friends and family that you’re acting or reacting unusually  
  • Feeling low in energy, or feeling like you can't be as active as normal 
  • Feeling like you’re not as productive as normal 
  • Getting upset by things that would not normally upset you 
  • Feeling like you’re not in control of your body or emotions  
  • Having problems with memory, thinking, speaking, working  
  • Having discomfort with sexual activity 
  • Having any discomfort that is persistent and not resolving 
  • Wondering ‘why is this happening to me?’ 

These symptoms and more are common. But you do not need to tolerate them. A doctor can validate your experience, evaluate your symptoms, and work with you to find a treatment that’s best for you.  

Does hormone replacement therapy work? 

People can respond really well, especially for management of vasomotor symptoms, like hot flashes, night sweats, trouble sleeping, memory concerns, and generalized joint aches, which tend to occur earlier in menopause, sometimes with severe intensity.  

Later on, genital urinary symptoms may arise: vaginal dryness, pain with sex, urinary frequency, urinary urgency, more frequent UTIs. About half of women experience these symptoms. 

In addition to alleviating symptoms, hormone replacement therapy can reduce risk of diabetes, heart disease, and osteoporosis. 

Is hormone replacement therapy safe? 

Yes. Most women can safely use hormone replacement therapy.

In fact, for decades it was the most prescribed menopause treatment because it relieves the widest range of symptoms and has the best results. But in 2002 use in the United States dropped after a study was published on women who started the treatment 10 or more years after menopause began. The study noted an increase in health risks in certain women. Before careful review, the study was widely publicized, overestimating risks. In the United States, many women stopped hormone replacement therapy. And millions never started.  

Women in other countries continued to get hormone replacement therapy and the relief they needed. Plus the added long term benefits: decreased risk of heart disease, osteoporosis, diabetes, and more. 

Research shows that for most women, the benefits of hormone replacement therapy outweigh the risks. If someone has a history of a blood clot, deep vein thrombosis, pulmonary embolism, liver disease, or hormonally driven cancer, such as breast cancer, there are other treatment options. A patch, for example, has lower risks for blood clotting than other delivery methods, and it may provide better protection against osteoporosis than taking pills.   

Further, many of hormone replacement therapy’s risks are the same—or even less significant—than other behaviors, such as drinking alcohol, which can increase estrogen levels in the body.  

Like all medications and treatments, hormone replacement therapy may cause side effects in some women, including breast tenderness, headaches, and stomach aches. If you are concerned about the risks, talk to your doctor and find out what is best for you.  

Why should someone treat menopause symptoms? 

If symptoms are interfering with your quality of life, stopping you from doing things you would otherwise do, interfering with your productivity, or what you hope to accomplish that day, you do not have to live that way. And you should not. Especially if your sleep is impacted. When you can't sleep it's hard to feel good, concentrate, or function at your peak.. 

Women should have their concerns validated, evaluated, and be offered treatment options so they can feel and be their best. 

Are enough women treated for menopause symptoms?  

No. Barriers such as lack of awareness, embarrassment, confusion, and/or limited access prevent women from getting evaluation or treatment. Also, some health care practitioners have not had the training to feel comfortable discussing symptoms or treatment options. Look for a North American Menopause Society (NAMS) certified practitioner for expertise on the topic.

What else should women know about menopause?  

If you had a smooth, easy transition to menopause, there's no need to apologize. You may not need any treatment, but menopause is still a good time to reflect on where you are in your life and how to stay healthy going forward. 

Be mindful of how you will maintain your lean muscle mass and keep your bones healthy. Look out for bleeding: See your doctor if you have any spotting and it's been more than a year since your last period.  

Be aware of possible symptoms and treatments so you can feel more empowered to be proactive. There are safe and effective options to help. 


Hoosna Haque, MD, is a gynecologist and assistant professor of obstetrics & gynecology at Columbia University Vagelos College of Physicians and Surgeons.