Menopause is a natural part of the female life cycle, but even still, it has many associated challenges that come along with it. To help ease its symptoms, women often look to hormone replacement therapy (HRT), also known as menopausal hormone therapy (MHT). If you’re going through this life stage, learn more about the process and health risks associated with HRT and how consuming alcohol may affect treatment.
What is Hormone Replacement Therapy?
As a normal part of the aging process, women go through menopause, a time in which their ovaries stop producing estrogen and progestogen.1 Usually occurring after age 45, a female’s hormone levels can go up and down in the years before and during menopause.1 Because of this, they can experience symptoms such as night sweats, pain during intercourse, hot flashes, and vaginal dryness.1 For some women, these symptoms go away on their own and are pretty mild.
For others with more severe symptoms, hormone replacement therapy (HRT) may be recommended to relieve symptoms and address long-term biological changes (i.e., protection from osteoporosis).2,3 HRT usually involves treatment with estrogen (only) or estrogen plus progestin (synthetic progesterone)—the latter is typically prescribed to women who have not had a hysterectomy since estrogen alone is associated with an increased risk of endometrial cancer.3
What Are the Health Risks?
Much of our understanding of the potential health effects of HRT comes from two randomized clinical trials that were conducted as part of the National Institute of Health-sponsored Women’s Health Initiative (WHI) study.3,12
These and other studies have linked HRT to increased risk of certain forms of cancer, including breast and ovarian cancer in women taking combined HRT, and endometrial and ovarian cancer in women taking estrogen only HRT.3,4,5 Women taking combined HRT were also at risk of being diagnosed with larger and more advanced stage (e.g., with lymph node involvement or distant site metastases) breast cancers.3,4
Depending on the type of treatment, medical history and lifestyle, other HRT-associated modifications to certain health risks include:
- Blood clots (increased risk).2,6
- Gallbladder disease (increased risk).2
- Heart attack (increased risk).2,6
- Stroke (increased risk).2,6
- Hip and vertebral fractures (decreased risk).3
- Vaginal bleeding (increased risk).3
- Dementia (increased risk).3
Taking the lowest dose of HRT that works for you, and for the shortest period of time necessary, can help reduce the risk of complications. Your doctor should reassess your need for HRT every 3-6 months.
How Are They Taken?
Hormone replacement can be administered in different ways, including:7,8,9
- Orally – Pills are one of the most-common methods of taking HRT, whether estrogen only or in combined forms. However, oral tablets may confer a slightly increased risk of blood clots compared with other forms of HRT.
- Topically – This involves applying an estrogen gel to the skin once daily. As with other forms of estrogen monotherapy, if you still have a uterus, you’d need a separate form of progestin to minimize your risk of endometrial cancer. Vaginal creams are available to help with dryness and pain that is associated with intercourse.
- Transdermal – This type of treatment utilizes a patch that is applied to skin once every few days. This can be a more convenient option for those who think they may skip daily pills. HRT patches can also help you avoid certain side effects such as indigestion and the added risk of clotting associated with oral therapy.
- Implant – This is a small, pellet-type implant inserted under the skin that slowly releases estrogen over several months. This may be a more convenient option for women who don’t want to have to take a daily pill or worry about creams or patches; although, if you still have a uterus, you’d still need to take progestin.
- Vaginally – HRT is also available in the form of a cream, pessary or ring that is placed inside your vagina and includes estrogen. This method can used without taking progestogen and, with relatively low doses and less systemic absorption, doesn’t carry the same risk profile as some other methods of HRT. While this method helps to relieve vaginal dryness, it won't help with other symptoms, such as hot flashes.
What Are the Side Effects of HRT?
Hormone replacement can have some side effects; though not everyone will experience them. Side effects can include:3,9,10
- Breast soreness.
- Changes in appetite or weight.
- Changes in libido.
- Discoloration or breakouts on skin.
- Mood swings.
- Stomach cramps.
- Urinary incontinence.
- Water retention.
- Vaginal bleeding.
How does Alcohol Use Affect HRT?
Alcohol is potentially associated with increased estrogen levels, resulting in a buildup, which may contribute to a higher risk of cancer than that of just alcohol or HRT alone.12 Alcohol is recognized as a carcinogen, meaning that its use increases the risk of developing certain cancers; this risk increases with the amount of alcohol a person drinks regularly over time.12 An estimated 3.5% of cancer deaths in the United States (about 19,500 deaths) were alcohol-related, according to a 2009 study.13
Studies have estimated that women who are taking HRT and have 1-2 drinks daily are 3 times more likely to develop breast cancer, while women who have more than 2 drinks a day and are taking HRT are at 5 times greater risk of developing breast cancer.14 Heavy drinking can also cause blood clots, which increases your chances of heart attack or even stroke.15 Because blood clots are also a side effect of HRT, the combination of the two can increase those risks even more.
Along with the more severe health effects such as cancer and blood clots, consuming alcohol can amplify some of the side effects associated HRT such as headaches, nausea, diarrhea, or anxiety. There are known associations between anxiety disorders and alcohol use disorders. Should a self-medication mechanism (i.e., consuming alcohol) be involved with this association, in a situation of HRT-related anxiety, it’s possible that any resulting increase in drinking behavior might further reinforce maladaptive patterns of drinking—potentially worsening the severity of an AUD.16
If you feel you may be at risk of an AUD or need to talk with someone about your drinking habits, our admissions navigators are available 24/7 to discuss treatment options.
. MedlinePlus. (2019). Menopause.
. MedlinePlus. (2019). Hormone Replacement Therapy.
. National Cancer Institute. (2018). Menopausal Hormone Therapy And Cancer.
. American Cancer Society. (2019). Menopausal Hormone Therapy And Cancer Risk.
. Gapstur, S.M., Morrow, M., Sellers, T.A. (1999). Hormone replacement therapy and risk of breast cancer with a favorable histology: Results of the Iowa women's health study. Journal of the American Medical Association, 281(22), 2091-2097.
. Health Canada. (2006). Benefits and risks of hormone replacement therapy (estrogen with or without Progestin).
. National Health Service. (2016). Hormone Replacement Therapy.
. Wiley Online Library. (2015). Latest Evidence on Using Hormone Replacement Therapy in the Menopause. The Obstetrician & Gynecologist; 17, 20-28.
. U.S. National Library of Medicine. (2019). Types of Hormone Therapy.
. U.S. National Library of Medicine. (2019). Estrogen and Progestin (hormone replacement therapy).
. Register, T.C., Cline, J.M., & Shively, C.A. (2003). Health Issues in Postmenopausal Women Who Drink.
. National Cancer Institute. (2018). Alcohol and Cancer Risk.
. U.S. National Library of Medicine. (2013). Alcohol-Attributable Cancer Deaths and Years of Potential Life Lost in the United States.
. Edelman, J.S. (2010). Menopause Matters: Your Guide to a Long and Healthy Life. The Johns Hopkins University Press.
. National Institute on Alcohol Abuse and Alcoholism. (1997). The Hematological Complications of Alcoholism. Alcohol Health & Research World; 21(1), 42-52.
. U.S. National Library of Medicine. (2012). Anxiety and Alcohol Use Disorders. Alcohol Res. 2012; 34(4): 414–431.
. University of Oxford. (2017). The Million Women Study.