What you’ll learn:
- Hormone replacement therapy can help alleviate menopause symptoms like hot flashes, but it may also cause side effects.
- Monitor your symptoms and communicate openly with your healthcare provider to tailor your treatment plan effectively.
- Alongside HRT, various lifestyle modifications and alternative treatments can help manage menopause symptoms effectively.
Menopause is defined as the day 12 months after your last menstrual period, but signs that it’s coming can show up several years before. Perimenopause, that period before the end of your period, can come with unexpected symptoms like hot flashes, mood swings, and weight gain as estrogen levels fluctuate.
Hormone replacement therapy (HRT—also sometimes called menopause hormone therapy (MHT) or hormone therapy (HT)—can help ease some of these symptoms, making you feel more like you again. HRT might also prevent changes in your body that can lead to long-term health issues like osteoporosis and heart disease, and it might offer protection against diabetes, cognitive decline, and even colon cancer.
While it’s often very effective, HRT can cause side effects and has some warnings associated with it. When you start using it and for how long will depend on your unique health history and stage of menopause. You’ll need to weigh the pluses and minus with your doctor to decide which types and time frame is right for you.
At Noom, we’re all about helping you take charge of your health decisions. We blend health insights with personalized coaching so you have the tools and support to explore HRT (or any treatment) on your terms. Let’s unpack HRT, discuss side effects, and see what it can offer so you can decide what’s best for you.
How does HRT work?
HRT is designed to alleviate the symptoms of menopause by replenishing the hormones that the body no longer produces in sufficient quantities. As estrogen and progesterone levels decline, people experience various symptoms, including hot flashes, mood swings, sleep disturbances, and more. HRT can help restore hormonal balance, potentially easing these symptoms and improving overall quality of life.
Different Types of HRT
When considering hormone replacement therapy, it’s essential to understand the different options available. HRT typically falls into two categories:
- Estrogen-only HRT: This is recommended for people who have had a hysterectomy (surgical removal of the uterus). It involves taking estradiol alone, which can be delivered orally, through a patch, a vaginal ring, or topically as a cream, spray, or gel.
- Combined HRT: For people with a uterus, a combination of estrogen and progestogen is used. The addition of progestogen helps protect against the risk of endometrial cancer associated with using estrogen alone.
Common side effects of hormone replacement therapy
As your system adapts to the new hormone levels, you may experience a few temporary side effects. HRT side effects might also overlap with menopause symptoms because hormonal fluctuations influence both. For instance, nausea, headaches, mood swings, and breast tenderness can result from changes in estrogen and progesterone levels, mimicking the body’s natural responses during menopause. Additionally, some side effects, like bloating, may temporarily occur as the body adjusts to new hormone levels. Here’s a look at what you might experience by the form:
Oral tablets: Pills are one of the most common forms of HRT. They are convenient and widely available, but since the hormones are processed through the digestive system, they are more likely to cause systemic side effects, like nausea. Symptoms often appear during the first few weeks of use as the body adjusts and typically subside within a few months. Common side effects include:
- Nausea: A frequent side effect due to hormone processing in the digestive system. Usually temporary and subsides within a few weeks.
- Headaches: Triggered by hormonal fluctuations, especially during dose adjustments. Often temporary and improve as hormone levels stabilize.
- Breast tenderness: Common during the initial weeks of therapy and typically resolves after 1 to 2 months as the body adjusts.
- Mood changes: Includes mood swings or depressive symptoms. These may vary by individual but often lessen as the body adapts.
- Weight changes: Slight weight gain or bloating is possible, often due to fluid retention. This usually stabilizes after a few months.
Skin patches: Transdermal patches deliver hormones directly into the bloodstream through the skin, bypassing the digestive system and reducing the likelihood of nausea and other systemic effects. Most side effects are temporary and linked to the adjustment period, typically resolving within a few weeks. You may experience:
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- Skin irritation: There may be localized redness or itching at the application site, but it usually resolves quickly or improves over time. Switching patch locations can help.
- Headaches: May occur during the adjustment phase, especially with dosage changes. Generally temporary.
- Breast Tenderness: Similar to oral forms, this tenderness is common early on but typically subsides after the first month.
Topical applications: Creams, gels, and sprays are applied directly to the skin and absorbed gradually into the bloodstream. They are a good alternative for individuals seeking to avoid oral or patch-based therapies. Side effects are often mild and temporary and include:
- Skin reactions: Mild irritation or rash at the application site usually resolves within a few weeks of use.
- Breast tenderness: Common during the initial phase of therapy and typically subsides after 1 to 2 months.
Vaginal applications (creams, rings, tablets): Vaginal applications are primarily used to address localized symptoms such as vaginal dryness, irritation, or discomfort. These forms deliver hormones directly to the vaginal area, with minimal systemic absorption, so side effects are usually limited to the application site, like:
- Vaginal irritation: Itching or mild discomfort, often temporary, and resolves within the first few weeks.
- Discharge: Increased vaginal discharge is common early on and usually subsides as the body adjusts.
- Abdominal cramps: Mild cramping may occur initially but typically resolves within a few weeks.
Since these side effects can overlap with menopause-like symptoms, keeping a detailed symptom diary can help you and your healthcare provider track any changes and fine-tune your treatment if needed.
When to seek medical advice
It’s always best to check in with your healthcare provider if anything feels different or unexpected. Here are a few signs of more serious issues to watch for:
- Severe abdominal pain or ongoing nausea or vomiting: If you’re dealing with intense stomach pain or nausea, get immediate medical attention.
- Unexpected vaginal bleeding or spotting: A little bleeding when starting HRT can be normal and usually settles within 3 to 6 months, but if it persists, give your doctor a call. If you experience any extremely heavy or abnormal bleeding, you should get immediate medical attention.
- Severe headaches: While mild headaches can happen as your body adjusts, it’s important to discuss recurring or intense headaches with your clinician. They can help determine whether these headaches might be migraines or need more attention. Additionally, any sudden, extremely painful headache requires immediate medication attention.
- Sudden mood swings or feeling down: If you notice a big change in your mood or feel unusually low, it’s time to talk to your provider.
- Signs of a blood clot: Swelling, redness, pain in your legs, or sudden shortness of breath, as well as chest pain, pressure, nausea, arm or jaw pain (possible heart attack), sudden numbness, confusion, or difficulty speaking (possible stroke), all require immediate medical attention.
What do we know about HRT and long-term health risks and concerns?
You might have heard that hormone replacement therapy (HRT) can cause breast cancer or blood clots. One study in particular, the Women’s Health Initiative (WHI), led to a scare that linked HRT with these conditions. While the WHI suggested that combined HRT (estrogen and progestin) was linked to slight increases in certain health risks, it’s essential to consider the broader context. What we know about HRT has significantly evolved since this study came out in the early 2000s.
The WHI study showed that people using combined HRT saw a slight increase in the rate of breast cancer, strokes, and blood clots. When the study was reevaluated, these absolute risk increases were found to be relatively small.
The WHI was also conducted on postmenopausal women with an average age of about 63. This group doesn’t accurately represent the experiences of women in perimenopause or those in early menopause who start HRT at a younger age. This emphasizes the importance of personalized decision-making regarding HRT, as the timing of initiation can significantly influence its safety and efficacy.
Ultimately, the decision to use HRT should be individualized. Factors such as age, the duration of therapy, and overall health play critical roles in determining its safety. It’s crucial to have open discussions with your healthcare provider about your specific health profile and concerns.
Can HRT impact your emotional health?
We often talk about hormone replacement therapy (HRT) in terms of physical symptoms like hot flashes and night sweats, but what about its effects on mood? Recent studies show HRT can have a complex influence on mental health, ranging from mood stabilization to increased risk of depression, depending on factors like age, delivery method, and personal health history.
The emotional effects of HRT vary widely. Some women feel more balanced, while others may experience irritability or mood swings. A 2024 study found that HRT enhanced emotional well-being and sleep quality, especially in women taking it for mood-related symptoms like anxiety.
But some people also experienced the opposite. A 2022 Danish study found that women who started HRT before age 50 had a higher risk of developing depression, especially within the first year of treatment. The study reported that using pills or patches significantly increased depression risk in younger women. People who used localized HRT (like vaginal creams or rings) had a much lower risk.
Because the effects of HRT on mood can vary, it’s important to discuss your personal health history and goals with your doctor before starting treatment. They can help determine whether HRT is the right option for you and guide you toward the best approach.
When should I start hormone replacement therapy?
Most people begin to consider HRT when menopause-related symptoms become difficult to manage during perimenopause, typically in their late 40s or early 50s.
Signs that it may be time to start HRT include:
- persistent painful or uncomfortable symptoms
- significant mood changes
- other issues that affect your quality of life
If you notice changes in weight distribution or difficulty managing your weight during menopause, HRT stabilizing effects might help.
Discuss your symptoms, health history, and personal preferences thoroughly with your clinician. They can help you determine if HRT is the right option for you and suggest the most appropriate time to begin treatment to alleviate your symptoms and improve your overall well-being.
Is after menopause too late to start HRT?
It’s not necessarily too late to start hormone replacement therapy (HRT) after menopause, but the timing and potential benefits can vary. While many women begin HRT during perimenopause or shortly after menopause to manage symptoms, some may find relief even years later.
Starting HRT after menopause can still help alleviate symptoms like hot flashes, mood swings, and vaginal dryness. It can also play a role in preventing osteoporosis and reducing the risk of diabetes. It’s important to consider individual health factors, including personal risk factors for conditions such as heart disease, breast cancer, and stroke, as the risks of these conditions may increase with HRT, especially if initiated later in life.
It is also important to note that different types of HRT may carry different risks. For example, oral estradiol can increase the risk of heart issues, while a transdermal patch shows lower risk. Local treatments, like creams, suppositories, and rings, also carry fewer risks since they only target the areas they are applied to and don’t increase estrogen levels throughout the whole body. Your doctor will evaluate the benefits and risks based on your unique health profile and determine the most appropriate course of action.
Other treatments to consider for menopause symptoms
For many women, hormone replacement therapy (HRT) has been a traditional go-to for managing menopausal symptoms like hot flashes, night sweats, and vaginal dryness. But HRT isn’t for everyone—especially if there are health concerns. So, what else is out there?
Let’s look at some alternatives that might help you feel more like yourself:
Lifestyle and behavioral changes
Changes to your daily routine can make a big impact. Although lifestyle changes alone might not completely eliminate severe symptoms, they can help ease the intensity and frequency of things like hot flashes or mood swings. Here are a few common strategies:
- Losing weight, if needed: This can help menopause symptoms like hot flashes while also reducing the risk of some of the more serious long-term effects of menopause, like cardiovascular issues or bone fractures.
- Exercise: Regular physical activity has been linked to improved mood, better sleep, and reduced hot flash frequency. Noom Move has a library of thousands of exercises for all fitness levels to help you get your daily movement in.
- Relaxation techniques: Practices like yoga, meditation, and deep breathing exercises might help manage stress and reduce the severity of hot flashes. The Noom app has many different guided meditations and breathing exercises that you can incorporate into your routine.
- Getting better sleep: Getting plenty of quality sleep is crucial for managing menopause symptoms. It will ensure you have the energy you need, reduce cortisol levels, and even reduce cravings. Check out the Noom app for tips on how to get quality, restorative sleep that will maximize your health.
- Avoiding triggers: Things like spicy foods, caffeine, alcohol, and smoking can make hot flashes worse. Learning to identify and limit these triggers might provide some relief.
While research on these techniques is still developing, some women find them helpful as part of a broader strategy for managing symptoms.
Non-hormonal medications
Certain medications can provide relief from menopausal symptoms. These include:
- Weight loss medications: GLP-1 medications can help you lose weight, which may improve some symptoms. To qualify, you must have a BMI of 30 or more or 27 or more with a health-related medical condition (like high blood pressure). These can be prescribed by your doctor or a Noom Med clinician if you qualify. These include:
- Ozempic® and Wegovy® (semaglutide): Wegovy® is approved for weight management, and Ozempic® can be prescribed off-label.
- Zepbound® and Mounjaro® (tirzepatide): Zepbound® is approved for weight loss, and Mounjaro® can be prescribed off-label.
- If cost is a factor, you can ask your Noom Med clinician (if you qualify) about Noom’s compounded semaglutide*. This treatment contains the same active ingredient as Ozempic® and Wegovy® but can be more affordable for some people. It starts at just $149 per month and includes home-delivered medication if prescribed. You’ll also get access to a clinician, a personalized treatment plan, and all of Noom’s trackers and tools.
- Antidepressants (SSRIs and SNRIs): Venlafaxine (Effexor) and paroxetine (Paxil) can be prescribed to help reduce hot flashes. Low-dose paroxetine (Brisdelle) is FDA-approved for treating them. A study found that venlafaxine reduced hot flash frequency by 61%, compared to just 20% with placebo. Side effects like nausea and sexual dysfunction can be a concern with these types of medications.
- Clonidine: Originally used to treat high blood pressure, clonidine can sometimes help with hot flashes, though side effects like dry mouth and dizziness are common.
- Gabapentin: Typically prescribed for nerve pain or seizures, gabapentin has shown some promise in reducing hot flashes, particularly for women who experience nighttime symptoms.
- NK3 receptor antagonists: This newer class of medication targets the brain’s thermoregulatory center and effectively reduces hot flashes and other vasomotor symptoms.
While these medications don’t provide the same benefits as estrogen for bone health or vaginal dryness, they can be a safer option for women who want or need to avoid hormones.
Making informed decisions about HRT
Navigating HRT during menopause can feel a bit overwhelming. That’s why partnering closely with your healthcare provider is key to figuring out what works best for you. And Noom is here to support you every step of the way!
Connect with others who are going through the same issues through Noom Communities. It’s not just about getting through menopause—it’s about thriving through it and beyond! If you want extra guidance, add Noom’s Healthy Aging and Metabolism Course Enhancement to your plan. It breaks down the science of how your body shifts over time and gives you tools to keep feeling strong, confident, and in control.
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With Noom’s support, you’ll have a personalized roadmap to navigate menopause and beyond—so you can feel your best, no matter your stage. Want to know more? Tell us what you want to accomplish to see how Noom can support your health goals!
*Compounded semaglutide available on the Noom platform is produced in an FDA-registered facility but not reviewed by the FDA for safety, efficacy, or quality.
Note: Ozempic® and Mounjaro® are not FDA-approved to treat obesity or for weight loss.