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How Long Should a Woman Be On Hormone Replacement Therapy?

A woman’s body undergoes various changes throughout their life. This is mainly due to the presence of hormones that fluctuate as they age, causing certain irregularities that mark the end of their prime years. A good example is the menopause stage which affects a woman’s menstrual cycles and reproductive abilities. 

So how long should a woman be on hormone replacement therapy? Most signs of menopause start showing when women reach their early 50s. These menopausal symptoms typically include irregular periods, hot flashes, vaginal dryness, weight gain, night sweats, and mood changes among others. In the instance that these symptoms become severe and affect a woman’s quality of life, hormone replacement therapy may be recommended for up to five years.

When Can Women Start Taking Hormone Therapy? 

It’s not uncommon for women to experience the telling signs of menopause as their bodies stop ovulating and begin a decrease in ovarian estrogen production. These menopausal symptoms ease up when women reach their postmenopause years.

However, there are circumstances where these signs of discomfort become too serious and more difficult to bear. Such is the case for young women who enter early menopause after receiving surgeries such as oophorectomy (ovary removal).

When that happens, your physician may recommend treatment with hormone replacement therapies (HRT). For extreme situations, patients may be suggested to be on HRT for up to five years when they feel their symptoms stabilize.

On the other hand, those who are close to the menopausal age (50 to 59 years old) may begin hormone therapy at the lowest dose to manage symptoms and avoid possible health risks. Patients would continue HRT treatment for two to three years until menopause symptoms subside.

Meanwhile, those who entered surgical menopause usually take it earlier than women who encounter natural menopause. Most individuals in this group would begin HRT after their surgeries to balance the hormones until they reach the age where they would expect to enter menopause naturally (usually at 52 years old).

For postmenopausal women who are seeking HRT treatment, the American College of Obstetricians and Gynecologists, the North American Menopause Society, and the Endocrine Society have published guidelines to determine the right approach for each patient: 

  • Is younger than 60 years old 
  • Has not been menopausal for more than 10 years
  • Experiences serious symptoms such as painful intercourse due to dry vagina, sweating during hot flashes, or loss of sleep because of nighttime flashes
  • Has no history of breast cancer, blood clots, or heart disease 

Benefits of Hormone Therapy

Patients can be assured that HRT benefits outweigh the risks. Most hormone therapy drugs contain the two most important female hormones (estrogen and progesterone or progestin) to replace what’s lost after menopause. It takes a few weeks for HRT to start kicking in and for estrogen levels to begin to rise to help alleviate the symptoms. Some of its benefits are: 

Relieves hot flashes 

Hot flashes are characterized as sudden heat waves that run up in the face and spread in the upper body. One of the many roles of estrogen is controlling the part of the brain that regulates body temperature. Women usually experience hot flashes due to low levels of estrogen. HRT is effective in managing the occasional hot flashes that may be experienced during and after menopause.

Reduces mood swings 

Most menopausal women experience frequent emotional changes and may suffer from low mood and lack of energy. Estrogen therapy is one treatment to relieve these mood swings. It’s long been known that estrogen receptors play a role in influencing the recognition of emotion via different neuropsychological factors. Likewise, estrogen can increase the production of serotonin (also known as the happy hormone) and put women in a good mood. 

Alleviates vaginal dryness

Itchiness in the vaginal area, pain during sex, and frequent urinary tract infections are warning signs of vaginal dryness. When estrogen levels drop, the walls of the vagina lose their natural lubrication and the lining becomes thin and less elastic. Hormone therapy can help restore normal estrogen levels, thicken vaginal walls, and increase blood flow. 

Improves bladder problems 

Low estrogen levels during menopause can also damage the healthy lining of the bladder and cause the loss of some of the tissues in the pelvic floor. This results in poor bladder control, triggering the need to urinate more times than usual. HRT can be a treatment to assuage overactive bladder issues by helping the pelvic floor remain strong for more control over bladder problems. 

Prevents osteoporosis

During menopause, women are at high risk for osteoporosis, which is a condition where the bones are too brittle due to loss of mass and tissue. Estrogen makes it less possible for osteoclasts (cells that break down bone tissue) to break down and encourages the formation of osteoblasts (cells that build bones). 

Hormone therapy can prevent bone density loss and reduce the risk of fractures by supplementing estrogen that’s needed to continuously replace old bones with new bones. It helps maintain the body’s normal bone cycle. It also regulates the health of connective tissues to prevent potential aches and pain in the muscle joints. 

Reduces diabetes 

Women who take hormone therapy during the menopause period may be at less risk of developing diabetes. It’s been reported that estrogen hormones are also capable of handling glucose levels. While it doesn’t affect low estrogen levels, it has direct effects on the pancreas and intestines by secreting glucagon to elevate blood glucose. HRT is mostly considered as a treatment for Type 2 diabetes in women.

Risks of Long-Term Hormone Therapy 

As a rule of thumb, hormone replacement therapy should not be done any longer than five years. As compared to short-term treatment, there are higher chances for complications when patients stay on hormone therapy longer than what’s intended. Some of the serious health problems that may occur on long-term HRT are:

1. Breast Cancer

The risk of breast cancer depends on the type of HRT administered to the patient and how long they stayed on the treatment. Usually, women who use combination HRT (taking estrogen and progesterone) increase their risk of the disease by about 75% even when used for a short time. Meanwhile, those who use estrogen-only HRT increase the risk only when they use it beyond 10 years. 

Hormone treatment normally increases a woman’s estrogen levels to relieve menopausal symptoms. A study shows that some cancer cells may be estrogen receptor-positive which means they are driven by estrogen and can help the tumor to develop and grow. 

Patients may subscribe to lower-dose combination HRT to lessen the risk of breast cancer. Once they decide to stop taking the hormone therapy, there are chances that the breast cancer risk will decline. 

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

2. Pulmonary Embolism 

Pulmonary embolism, also known as venous thromboembolism, is a condition where there’s a blockage in one of the lungs. It happens when a blood clot forms in the veins inside the body and travels through the bloodstream until it reaches the arteries in the lungs. The medical term for this blood clotting is “deep vein thrombosis.”

Some of the symptoms of pulmonary embolism include difficulty breathing, leg swelling, discoloration on the skin of the leg, and visible veins. In cases of HRT treatment, women under 50 years old are at risk of this condition especially if they take oral hormone medications. There’s an estimated 65% increase in the risk of pulmonary embolism and deep vein thrombosis for those who take oral estrogen. 

Meanwhile, the risk for users of HRT patches is 10% lower than the average. Patients can err on the side of caution and opt for estrogen patches, gels, or creams, which are more easily absorbed by the body.

3. Cardiovascular Disease

Estrogen plays a role in almost all organs and tissues in the body including the heart and blood vessels. Some of the known effects of estrogen on the cardiovascular system include increased HDL cholesterol, decreased LDL cholesterol, blood clots, smooth blood flow, and free radicals that can damage the arteries and other tissues. 

The National Institutes of Health (NIH) and National Heart, Lung, and Blood Institute conducted a study in 2002 to determine the side effects of taking estrogen and progestin among women. According to their observation, HRT significantly elevated the risk of breast cancer, coronary heart disease, heart attack, and stroke. To be safe, patients should avoid long-term use of HRT and should take it under the guidance of a doctor. 

It should also be considered that women who have a family history of heart disease are not good candidates for HRT. The treatment is generally safe with no increased risk for heart diseases for women under the age of 60. However, postmenopausal women have a small increased risk for cardiovascular problems or stroke, especially when taking combined HRT orally.

4. Endometrial Cancer and Ovarian Cancer 

The endometrium is the lining of the uterus. Estrogen is responsible for thickening the lining and preparing the uterus for pregnancy. But once the endometrium thickens too much, it can lead to endometrial hyperplasia or even cancer of the uterus. It can also cause abnormal vaginal bleeding which can be a source of discomfort, especially for menopausal women.

Most estrogen-only treatments increase the risk of endometrial cancer since it elevates the level of estrogen in the body. On the other hand, the possibility of this condition is low for patients who have had their uterus removed through hysterectomy.

The risk is also high for women who took long-term hormone therapy. Specifically, combined estrogen and progesterone after menopause can expose patients to this type of cancer. However, the possibility of getting diagnosed with this condition decreases gradually when the HRT is stopped.

Learn more: Which Side Effects Are Most Common among Women Taking Hormone Replacement Therapy for Menopause?

What to Do When Quitting HRT

While HRT shows promising effects that improve a woman’s condition, there are still instances where they want to stop the therapy due to either personal or medical reasons. Individuals should consult their doctor to get assistance on stopping the treatments because quitting suddenly may trigger menopausal symptoms to return.

Taking patients off HRT treatments is a gradual procedure. Most physicians recommend lowering down the estrogen and progestin dosage over time. Others may decrease the number of times a week they take the HRT. Those who take oral medications may be advised to switch to patches and creams. Usually, it takes about 3 to 6 months until patients can completely let go of hormone therapy.

Most of the side effects of stopping hormone therapy are manageable as compared to before the treatment. However, taking off from HRT may affect bone health and lead to brittle bones since there will be a decrease in estrogen levels again. A good way to prevent potential bone loss or fracture is by incorporating calcium-rich and zinc-rich meals into one’s diet.

Once the body starts recovering from the therapy, it will need support so hormone levels will return to normal more quickly and naturally. Ideally, women coming off HRT should get rich nutrition, follow a healthy lifestyle, exercise, and have strong metabolism to mitigate the risks that come with quitting the treatment.

The Science Behind Hormonal Imbalance in Women 

Naturally, an imbalance in hormones is caused by aging and is a telling sign that the body has started menopause. The primary hormones involved in menopause are estrogen, progesterone, and testosterone. It can be accompanied by special control hormones such as follicle-stimulating hormone (FSH) and luteinising hormone (LH), which are both secreted by cells at the pituitary glands for regulating the body’s reproductive functions.

When women start perimenopause, the amount of estrogen and progesterone produced in the ovaries becomes less as they age. While the period of time and severity of the symptoms vary per person, most women may experience this for an average of 4 to 5 years. Natural menopause typically has three stages and the hormones change gradually per phase: 

  • Perimenopause — This is the first stage of menopause wherein the ovaries moderately produce less estrogen, marking the last menstrual cycle and end of one’s reproductive years. Normally, the levels of estrogen and progesterone are kept in balance.

But as women approach their early 40s to 50s, progesterone begins to decrease and hormone levels fluctuate at an accelerating rate which becomes the cause for common symptoms such as mood swings, night sweats, and irregular periods. This stage can go on for 2 to 10 years and only begins its transition to menopause when the ovaries stop releasing eggs.

  • Menopause — This is typically diagnosed as the point where a woman has not bled for one whole year. The symptoms of this stage overlap with those commonly experienced during the perimenopause stage. With the drop of hormones and the complete stop in producing eggs, a menopausal woman can no longer become pregnant. The sharp decline in progesterone during this phase can also lead to vaginal dryness.
  • Postmenopause — This stage is characterized as the period where menopause symptoms finally end. Due to the significant drop in female hormones, postmenopausal women are at risk for possible health conditions such as osteoporosis and heart disease. The natural aging process and lifestyle may also play a role in the severity of postmenopause symptoms that women may encounter.

How HRT Treats Hormone Imbalance 

Hormone replacement therapy (or menopausal hormone therapy) is one of the accepted treatments for the changes that women experience during their menopause years. It’s a generally safe and minimally invasive procedure that helps regulate hormone deficiency by supplying estrogen and progesterone to the body. 

Today, bioidentical hormone replacement therapy (BHRT) is very common among women. As compared to synthetic hormones (manufactured in the lab), bioidentical hormones are derived from plant materials such as yam and soy which make them a more natural and safer alternative. They are also identified as a more compatible chemical match because they produce hormones that are similar to the ones that are already produced by the body. 

For women who still have a uterus, pure estrogen therapy is usually taken. Meanwhile, for those who have had hysterectomies, a combination therapy containing both doses of estrogen and progesterone is recommended. Both types can be taken orally via tablets or pills, topically via patches, gels, or creams, and through hormone pellets or implants which usually require a subcutaneous injection done by a doctor.

The effectiveness of HRT depends on the dosage of the treatment as well as the patient’s lifestyle and current health condition. Usually, relief from symptoms is seen within days or weeks after the treatment. While results from the therapy may last for months up to a year, regular visits to the doctor may be done to maintain the natural hormone balance. 

Start Your Hormone Replacement Therapy With Revitalize You MD

Changes in a woman’s hormone levels can cause great discomfort and impact their quality of life. It can worsen once they enter the menopause stage where symptoms such as hot flushes, night sweats, and irregular periods become frequent and may pose severe symptoms if unmanaged. Bioidentical hormone therapy can help alleviate these side effects and restore balance so the body can function normally again and avoid serious health problems. 

Revitalize You MD is just a call or message away for a consultation about your HRT needs. As Roswell’s top med spa clinic, we have licensed and professional staff who can guide you in your first hormone replacement treatment. We take careful measures to know about your health and lifestyle so we can customize your hormone dosage. We also offer other medical and aesthetic treatments to help improve your quality of living. Contact us now or schedule an appointment online.


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