Once (and after) menopause, women are at increased risk of certain health conditions including weight gain, heart disease, and osteoporosis due to bone loss or weakening. Incontinence may occur with involuntary urine loss and a higher risk of vaginal and urinary infection; vaginal dryness may bring pain, bleeding and reduced libido.
A study led by the Women’s Health Initiative (WHI) since the early 1990s that included 27,347 women in the US ages 50-79 on HRT and subsequent no treatment with follow-up of 13 years, was published in 2002 showing increased risk for breast and uterine cancer, as well as heart attack, blood clots and stroke. This study however drew its conclusions from mainly older women (average age 64) who received HRT long after menopause, whereas the recommendation is to start earlier, right after menopause. Subsequent studies and analyses found that when HRT started earlier it did not cause an increased cancer or stroke risk, and it may even protect from heart disease. In 2012-2013 several medical and OB/GYN organizations in the US stated that HRT is an option for menopausal symptoms treatment.
Nowadays there is a variety of different HRT formulations to choose from that come in different forms and dosages, including creams, gels or sprays to be topically applied on the arm or leg or as vaginal suppositories, rings or creams for women that experience uncomfortable vaginal dryness and intercourse; combination of estrogen and progestin as skin patches hidden from sunlight usually used below the waistline on the lower stomach; or tablets (pills) taken daily. When both progestin and estrogen are used (for women with a uterus), called “combined HRT” the regimen can be monthly or every 3 months in a cyclical manner (estrogen daily, progestin only for 14 days) for women still having periods, which will then come monthly or every 3 months respectively, or continuously (both hormones taken daily) for women who are post-menopausal and no longer have periods.
The Endocrine Society, through its hormone health network, has made a very comprehensive Menopause Map - My Personal Path available in English or Spanish, where you can find information (that you can read or listen to) about perimenopause, menopause and early menopause, why hormone depletion matters and options to treat symptoms including lifestyle changes (diet, sleep, exercise, vitamins) and HRT, as well as numerous additional resources such as calculators of risks or vitamin D intake, and several additional informational booklets and videos on a variety of menopause-related topics.