Which Side Effects Are Most Common Among Women Taking Hormone Replacement Therapy for Menopause?

Hormone replacement therapy (HRT) is a type of medication that contains female hormones such as estrogen, in order to replace the hormones women lose when their bodies undergo menopause. Hormone therapy is often prescribed to treat menopausal symptoms like hot flashes and vaginal dryness; however, hormonal therapy may also cause a number of uncomfortable side effects and potential risks for postmenopausal women. 

So which side effects are commonly experienced by women taking menopausal hormone therapy? Many patients report having cramps, constipation, mood swings, breast tenderness, nausea, and headaches as a side effect of hormone therapy. HRT may also increase the risk of blood clots, stroke, heart disease, and breast cancer, but these can be avoided as long as the hormone replacement is tailored to the individual patient.

Menopausal Hormone Therapy: What It Does For Your Body 

Menopause is the ‘last period’ that marks the end of a woman’s reproductive years. During this time, women stop ovulating (releasing a mature egg monthly) and her ovaries stop producing estrogen, the female sex hormone. 

Many women experience uncomfortable menopause symptoms due to the loss of estrogen, which keeps essential body functions under control. Symptoms include: 

• Hot flushes
• Night sweats
• Palpitations 
• Vaginal dryness
• Vaginal atrophy (thinning of vaginal walls)
• Vaginal or bladder infections 
• Mild urinary incontinence 
• Sleep disturbance or insomnia
• Aches and pains
• Reduced sex drive
• Mood disturbance
• Memory loss or other cognitive changes 
• Hair loss or abnormal hair growth 
• Dry and itchy eyes 
• Abnormal sensations (‘prickling’ or ‘crawling’ under the skin) 

These symptoms can be managed in a number of ways, but hormone therapy is the most effective for relieving discomfort. Usually, doctors prescribe estrogen replacement therapy to manage waning estrogen levels. There are two types of estrogen therapy: 

• Systemic hormone therapy utilizes systemic oestrogen, which allows a higher dose of estrogen to get absorbed throughout the body. Systemic oestrogen comes in various forms, including pill, skin patch, ring, gel, cream, and spray foams. 
• Low-dose vaginal products are intended to treat only the vaginal or urinary symptoms of menopause. Only a minimal amount of oestrogen gets absorbed by the body through a vaginal cream, vaginal tablet, or vaginal ring. 

For menopausal patients who haven’t undergone a hysterectomy (surgery to remove the uterus), doctors would also prescribe progesterone. Progesterone or progestogen is the female sex hormone responsible for menstrual cycles. Although it’s normally used as a hormonal contraceptive for birth control, progestogen can also treat menopausal symptoms like hot flushes. 

Progestogen is important because estrogen replacement therapy alone may stimulate growths in the lining of the uterus and increase the risk of endometrial cancer. A combined hormone therapy of oestrogen and progestin (progesterone-like medication) is usually prescribed to balance the hormones and protect the endometrium. Combined menopausal replacement therapy usually comes in the form of a tablet, a pill, or a patch. 

Learn more: Should Postmenopausal Women Having Undergone Total Hysterectomy Take Hormone Replacement Therapy?

Common Side Effects of Hormone Replacement During Menopause

Menopausal hormone replacement therapy is essential for dealing with menopause symptoms and protecting bone, heart, and brain health for the long-term. However, side effects can make it difficult for patients to continue with hormone therapy and they end up stopping HRT prematurely. 

Side effects of hormonal therapy are worse when you begin treatment, but they get better over time as your body adjusts after a few weeks or months. These side effects largely depend on the dose, the type of hormone therapy, and how long the medication was taken; they could also vary from drug to drug. If there are side effects, it’s important to alert your healthcare provider because you will be taking hormone therapy for some time. Your doctor could also prescribe an alternative remedy in case the side effects interfere with your daily life. 

Taking estrogen-only therapy usually causes symptoms like headache, breast tenderness, and nausea. However, it’s usually the progesterone part of combined HRT that presents side-effects; specific types of progesterone can cause low mood, irritability, acne, fatigue, or headaches. 

• Fatigue: When undergoing hormone therapy, you’re more likely to feel severe tiredness, lack of energy, or pains and aches in the joints. Some therapies -- specifically aromatase inhibitors -- can cause bone loss in premenopausal women, which leads to osteoporosis. 
• Digestive problems: A menopausal woman is likely to experience mild nausea, cramps, vomiting, or a queasy feeling when they begin hormone replacement therapy. This usually settles down after a few days or weeks. Diarrhea and constipation may also concur, although they’re less common and can be controlled through medication or diet. 
• Hot flashes: Hot flashes are among the menopausal symptoms women experience with hormone therapy; other signs are vaginal dryness, sweating, and a lowered sex drive. Hot flashes are a sudden rush of warmth to the face, neck, upper chest, and back, which may or may not be accompanied by sweating. Some hot flashes last only for a few seconds, while others can last for over an hour. 
• Vaginal dryness: Vaginal dryness may occur alongside the thinning of vaginal walls, which can make it difficult or painful to have sex. There may also be vaginal discharge, infections, vaginal bleeding, or spotting for the first few months after beginning hormone replacement therapy. However, these signs should not last for more than five months.
• Weight gain: Although there is some debate on whether hormone therapy actually causes weight gain (as most studies don’t show a clear link), hormone therapy can cause an increase in appetite. This, combined with age and lifestyle factors, may contribute to added pounds. It is also possible that the bloating and fluid retention in the early stages of estrogen therapy are confused with weight gain. 
• Headaches: Headaches, mood swings, depression, nervousness, or anxiety may be experienced while taking hormone therapy. Cognitive problems such as poor memory may occur as well. 

Learn more: How Long Should a Woman Be on Hormone Replacement Therapy?

Potential Risks of Hormone Replacement Therapy

Aside from side effects, hormone therapy can pose a number of significant risks: blood clots, breast cancer, stroke, cardiovascular disease, and more. While the risks are very low and patients are unlikely to develop these conditions, your doctor will still take them into account during your assessment. The possibility of heightened risks depend on: 

• Age: When you undergo therapy before reaching 60 years old or within the first 10 years of menopause, the benefits most likely outweigh the risks. However, postmenopausal woemn beginning estrogen therapy over the age of 60 or more than 10 years from the first onset of menopause have a heightened risk if they opt to get hormone therapy.
• Medical history: A family history or personal medical history for cardiovascular disease, stroke, blood clots, liver disease, osteoporosis, and breast cancer risk are factors that determine whether or not hormone therapy is appropriate for a patient.  
• Type of hormone therapy: Are you taking estrogen alone or is it combined with progesterone to combat hormone imbalance? This, plus the dose and type of estrogen used (synthetic estrogen or conjugated equine estrogen) can influence how likely you are to develop a certain medical condition. 

Some conditions menopausal and postmenopausal women are more likely to develop with hormone therapy include: 

Blood clots 

Venous thromboembolism occurs when blood clots form inside the deep blood vessels of the legs and groin, which may spread to the lungs. Although it’s extremely rare for blood clots to occur in healthy women, patients with a history or genetic predisposition to blood clots should consider the risks with taking oral hormone therapy. Women who experienced early menopause also have an increased risk, so it may be better to use hormone patches, implants, or gels instead. 

Breast cancer 

Combined HRT (estrogen and progesterone) is associated with a higher incidence of breast cancer, although it’s very rare. Some types of breast cancer are affected by female sex hormones, as the breast cancer cells may have an estrogen receptor that helps the cell grow. These estrogen receptors can be managed by estrogen-only therapy; however, there is a higher risk when using combined hormone therapy over 5 years. 

Learn more: Using Hormone Replacement Therapy for Estrogen-positive Breast Cancer Patients in Need of Hysterectomy

Endometrial cancer 

The endometrium is the lining of the uterus. When menopausal hormones are managed with estrogen HRT, women who have not had their uterus removed are more likely to develop endometrial cancer. Signs of endometrial problems include abnormal vaginal discharge, vaginal bleeding, menstrual irregularities, and pain or pressure in the lower belly. Fortunately, the possibility of it metastasizing into ovarian cancer is very small with menopausal hormone therapy. 

Cardiovascular disease

Women over the age of 60 have a small, increased risk of heart disease with combined oral HRT. Although the risk is small, it should still be considered because it can occur early on in the treatment and persist with time. And even if conjugated estrogen can help by lowering bad LDL cholesterol and raising good HDL cholesterol levels, HRT cannot actually prevent heart disease. 

Managing HRT Side Effects 

Ultimately, the choice to get hormone therapy is a decision that relies on you. Some postmenopausal women would rather experience the symptoms of menopause over the unpleasant HRT side effects, while others would prefer to take a chance on HRT than suffer through menopause. What matters most is if the benefits outweigh the disadvantages. The benefits still outweigh the risks if you’re healthy and you:

• Have moderate to severe vasomotor symptoms like hot flashes and night sweats, which can be treated with systemic HRT 
• Suffer from vaginal symptoms of menopause like dryness, itching, burning, or discomfort during intercourse 
• Need to prevent bone loss or fractures caused by weakened bone density 
• Experienced early menopause or premature menopause that led to estrogen deficiency 

The side-effects of hormone therapy are often short-lived; they are only bothersome when you start HRT, switch up your HRT method, or switch to a different hormone as your body tries to get used to the hormones. And despite the risks of hormone therapy, it can also protect you from osteoporosis, diabetes, and colorectal (bowel) cancer -- so it should still be considered as a treatment option. Here are some tips on how to deal with HRT side effects: 

1) Wait at least three months before making changes to your prescription: The side effects could disappear or become less severe during that time, as your body adjusts to new hormone levels. 

2) Talk to your doctor about the side effects: It’s best to have a face-to-face consultation with your doctor to confirm any side effects. From there, they can assess if there is a need to change the medication or advise you on how to stop hormone therapy safely. 

3) Find the best product and delivery method for you: The great thing about hormone therapy is that it can be taken as an oral pill, skin patch, gel, vaginal cream, or a slow-releasing suppository. Consult with your doctor and minimize the amount of medication you take; as much as possible, use the lowest effective dose for the shortest amount of time needed to treat the symptoms. If you’re younger than 45 years old, you would probably need to take estrogen for a longer time to protect you from the long-term effects of hormone deficiency. 

4) Change up your lifestyle: Staying healthy is the best way to manage side effects and prevent risks related to hormone therapy. Eat a nutritious diet, exercise regularly, and avoid smoking or drinking to reduce symptoms. Managing stress and chronic health conditions like high cholesterol levels or high blood pressure can also ensure your long-term wellness. 

5) Get regular check-ups and screenings: Visit your doctor regularly to ensure that the benefits of hormone therapy continue to outweigh the risks. Monitor your health by going to annual screenings, pelvic exams, mammograms, and check-ups; this also allows your doctor to reevaluate the HRT and adjust it according to your needs. 

Customized Hormone Replacement Plans at RevitalizeYou MD

At Revitalize You MD, we aim to provide the best, customized care that meets you needs. You don’t have to suffer through discomfort brought on by menopause. Let our certified and licensed medical staff help improve your quality of life. Schedule an appointment with Revitalize You MD today.