7 signs you could benefit from hormone therapy

Chances are that women in their 40s or 50s know someone who can’t say enough good things about menopause hormone therapy (MHT), commonly known as hormone replacement therapy (HRT). Maybe they credit it with helping them sleep better, improving their mood, or just making them feel more like themselves again. Let’s learn to spot the signs indicating that a woman may benefit from MHT and should speak with a provider about treatment.

Hot flashes are those sudden, intense waves of heat that can leave a woman soaked in sweat, even in air-conditioned rooms. When they hit at night, they become night sweats, which can create a cascade of issues including sleep deprivation, fatigue, and cognitive difficulties. If getting a good night’s sleep has become elusive — perhaps a woman is regularly changing pajamas due to night sweats — or if hot flashes are interrupting her work or social life, this may be a sign that HRT could benefit her, and she should talk to her doctor.

Poor sleep quality can create a domino effect, leading to daytime fatigue, difficulty concentrating, and a worse mood. Hormone therapy isn’t right for all sleep issues, but if a woman has tried sleep hygiene improvements, meditation, and other non-hormonal solutions without success, and her sleep issues may be linked to other menopausal symptoms (like hot flashes) MHT might be an option.

Find out more about sleep during menopause

The dramatic ups and downs of hormones can cause menopausal women to feel depressed, anxious, angry, or irritable more often. These emotional changes can strain relationships and make daily tasks more challenging. While MHT isn't FDA-approved specifically for mood changes, it can be worth discussing with one’s doctor — especially if some of the mood problems are being brought on by sleeplessness from night sweats.

As estrogen levels drop, vaginal tissue becomes thinner, drier, and less elastic, which can lead to discomfort during sex, increased susceptibility to urinary tract infections, and general vaginal irritation. While systemic hormone therapy may be of some help, there are also other options available, such as localized treatment delivered with a cream, tablet, or ring. "Low-dose vaginal estrogen therapy can be extremely helpful for minimizing those symptoms," says Dr. Monica Christmas, M.D., the associate medical director at The Menopause Society, and director of the Menopause Program and Center for Women’s Integrated Health at the University of Chicago.

A decline in libido may be due to both physical factors, like pain during intercourse from vaginal dryness, fatigue, and lower testosterone impacting arousal, as well as psychological factors like stress, anxiety, and body image concerns. Local estrogen therapy applied to the vaginal area can help with the dryness and irritation while MHT with testosterone may help with low desire.

Learn more about libido and menopause

As estrogen levels drop significantly during menopause, the urethral and vaginal tissues may become thinner, and could lead to increased frequency or urgency to pee, leaking when coughing or sneezing, and more UTIs. While hormone therapy is not a first-line treatment for urinary problems, if a woman’s doctor determines her bladder symptoms are primarily related to issues with her vulva, vagina, and bladder, local estrogen treatments — such as vaginal creams or rings — can help offer relief.

If a menopausal woman’s hair is becoming thinner, brittle, or falling out more than usual, alongside other menopausal symptoms, this could be another sign pointing toward hormone imbalance (estrogen can affect hair growth cycles). Though MHT may not be the first recommended treatment, there’s some evidence that hormonal therapy (or oral contraceptive pills) may be able to help with hair loss.