Secondary risks

Blood clots. Even though the dose of hormones in menopausal preparations is many times less strong than in birth control pills, hormone therapy can increase the risk of blood clots (deep vein thrombosis). Risk factors include having had a previous blood clot, being older (risk goes up with each decade after age 50), smoking, being obese, being sedentary, prolonged sitting or air travel, genetic risk, or active cancer. Risk maybe lower for women using preparations that are absorbed through the skin, such as gels or patches. For some women the risk is simply too high to use hormone therapy in any form.

Stroke. Hormone therapy is associated with a very small increased risk of stroke, especially in women over 60 who are on higher doses of hormones. This risk increases with age. Therapy administered by skin patch does not seem to have the same risk as oral therapy.

Migraine. Fluctuating or decreasing levels of estrogen can trigger migraine headaches and can be a particular problem during perimenopause. Hormone therapy is not given to women who experience a neurological deficit during a migraine. Women vary in their response to HT, for some it can lead to a worsening of migraine headaches.

Breast tenderness. Breast tenderness is not an uncommon side effect. It is not a sign of breast cancer risk, but it is unpleasant. Often it can be improved by reducing the dose of hormones, or by switching to a cyclic instead of continuous pattern of hormone use. Women on the conjugated estrogen bazedoxifene combination report less breast tenderness, so this may be an option.

Breast cancer. Women who are exposed to prolonged estrogen and progesterone or a progestogen are at increased risk for breast cancer. The small elevation seen is the same whether the hormones come from a woman’s own body, as with an early onset of menses, or a late menopause, from her own body fat (after the ovaries become menopausal the body fat continues to make estrogen), or from hormonal medications that she may be taking – whether bioidentical or not. The risk is small but becomes more detectable after several years of exposure to hormones; for therapy with estrogen alone, risk is detected after about ten years, for women on the combination of estrogen and progestogen, it is detected after about 5 years. For women on conjugated estrogens and bazedoxifene, it is too early to say for sure, but it appears to have less impact on the breast than the estrogen-progestogen combinations.

If a cancer was already present when hormones were started, the hormones may enable it to grow. It takes about ten years from when a cancer starts to when it is large enough to be diagnosed.

Stopping hormone therapy

When it is time to stop taking hormonal therapy there are no special procedures to follow, you can simply stop taking them. There is no advantage to tapering off, though some women do prefer to do it that way. Symptoms may return but become less troublesome over the next few months, so don’t be discouraged if they do. Try stopping during the winter months, rather than during summer’s heat.