Menopausal Hormone Therapy

Important Points

Menopausal hormone therapy (MHT) is generally used to treat women in menopause, after their final menstrual period

We were surprised to learn that the doses of hormones used in menopausal hormone therapy are generally much lower than the doses used in birth control pills.

The most common hormone used in menopausal hormone therapy is estrogen. And for women who have not had a hysterectomy (that is, they still have a uterus), a progestogen (a progesterone-like product) must be used to protect the uterus from endometrial cancer. For this reason, many women in menopause are prescribed both estrogen and a progestin — the same two ingredients that are in birth control pills.

Many healthcare providers prescribe birth control pills for symptomatic perimenopausal women

Why? First, perimenopausal women are still making hormones. As a result, their hormone levels are fluctuating within a cycle and between cycles. The pill works by overriding and shutting down your own hormone production. This is viewed as preferable to hormone therapy, which adds lower doses of hormones, but on top of what is already being produced by your body. However, menopausal hormone therapy, because a lower dose is used, doesn’t shut down hormonal production and a woman can end up with levels that are too high, making symptoms worse.

Second, the other benefit of using a birth control pill to manage symptoms is that it takes care of pregnancy prevention for those that want that since you can still get pregnant in perimenopause.

Here are a few other factors to consider

There are many options for birth control pills and women tolerate them differently

The pill works great for some and others experience side effects like mood changes and bloating. Take the time to read reviews, understand how different products differ and work with your provider to find the right one for you. For user reviews, follow this link and type in the product you are considering. Then scroll down to find “reviews”. Here is a recent opinion in the New York Times.

The latest research is drawing attention to the side effects of the pill, namely depression. We urge you to do your research before and after talking to your provider.

Many people in perimenopause may not need birth control (for example, those without a partner, those with a same-sex partner or a partner who has had a vasectomy). For these people, providers may recommend estrogen and progesterone separately.

Compounded Hormone Therapy

Not All Hormone Therapy is the Same is our three-part series about compounded hormone therapy products. Please note: We created this series with the sole purpose of clarifying the difference between FDA-approved products and compounded products. This does not cover whether or not to use menopausal hormone therapy (MHT).

Terms to understand

MENOPAUSAL HORMONE THERAPY (MHT) is the use of hormones to mitigate symptoms associated with hormonal fluctuations during perimenopause and menopause. This treatment is often called Hormone Therapy (HT) and was formerly called hormone replacement therapy, (HRT) but the word “replacement” was removed to more accurately convey the idea that fluctuating and lower hormone levels during the menopause transition are normal and don’t need to be replaced.
Menopausal hormone therapy which is estrogen — and a progestogen in women with a uterus — has only been approved for two indications (i.e. symptoms) related to the menopause transition: (1) night sweats and hot flashes (vasomotor symptoms) and (2) symptoms associated with vaginal changes: dryness, pain with sex.
No other claims about MHT for symptoms have been proven in a scientific study.

The term COMBINED HORMONAL THERAPY also referred to as combined hormonal contraception, refers to what we typically call the birth control pill.

BIOIDENTICAL PRODUCTS are products with the same molecular structure as those produced by our own bodies. They are still synthesized (or manufactured) in a lab. It makes sense that a chemical that is molecularly identical to those already in our bodies will have fewer side effects than one that is manufactured to work similarly but has a different molecular structure, but this has not been proven in scientific research.

SYNTHETIC PRODUCTS are those in which the product is manufactured in a lab and is usually optimized for potency (strength). For example, synthetic estrogen (ethinylestradiol, or EE) is four to 10 times more potent than 17β-estradiol (the bioidentical one).

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