Menopausal hormone therapy (MHT) is approved for the prevention of osteoporosis in postmenopausal women. MHT reduces bone loss, increases bone density in both the spine and hip, and reduces the risk of hip, spine and other fractures in postmenopausal women. MHT also relieves menopausal symptoms.
MHT is commonly available as a tablet or skin (transdermal) patch and in other forms and in a wide variety of doses.
When estrogen is taken alone, it can increase a woman’s risk of developing cancer of the uterine lining (endometrial cancer). To reduce this risk, physicians prescribe the hormone progesterone in combination with estrogen (hormone therapy or HT) for those women who have a uterus. Estrogen therapy (ET) is prescribed for women who have had hysterectomies. Side effects may include vaginal bleeding in women with a uterus on HT, breast tenderness and gallbladder disease.
The Woman’s Health Initiative (WHI) study confirmed that one type of HT, Prempro® (given to women who on average were more than ten years past menopause), reduced the risk of hip and other fractures, as well as colon cancer. However, it was associated with a slight increase in the risk of breast cancer, strokes, heart attacks, venous blood clots and cognitive (mental) decline. Although ET was associated with a similar increase in the risk of strokes, venous blood clots and cognitive decline, it did not increase the risk of breast cancer or heart attacks.
Women who have early menopause or their ovaries removed in their 30s or early 40s may benefit from low dose MHT. The results of the WHI study do not apply to women in this age group. Women who have had breast cancer or have a high risk for breast cancer should not consider MHT.
According to the FDA, postmenopausal women should consider other osteoporosis medicines before taking MHT to prevent osteoporosis. Because estrogen use has risks, women should discuss with their healthcare providers whether the benefits outweigh the risks. Women who decide to take MHT should take the lowest possible dose for the shortest period of time to control menopausal symptoms and achieve desired goals. When MHT treatment is stopped, bone loss can be rapid and other medicines should be considered to maintain the increase in bone density.