Hot Flashes, Cool Choices: HRT and Menopause
For a long time, hormone replacement therapy (HRT) has been a topic of debate among healthcare professionals and women navigating perimenopause, menopause, and post-menopause. While HRT can provide significant relief from disruptive symptoms, it also carries some risks. If you’re a woman approaching, in the middle of, or even post menopause, you may be wondering if you should consider HRT. In this article, we’ll explore the benefits and risks of HRT and dive into who may benefit the most. My goal is to arm you with all of the knowledge you need to make the best choice for yourself.
The role of HRT in menopause
Estrogen and progesterone levels begin to decline slightly in your late 30’s, and then begin to drop sharply in your 40’s. When levels become low enough toward the end of your menopause journey, your ovaries will no longer be able to release eggs and your menstrual cycle will stop. On average, this happens around the age of 51.
So, what does hormone replacement therapy do? HRT supplies the body with estrogen alone or a combination of estrogen and progesterone. The purpose of giving these hormones is to help your body make up for the falling levels that occur due to menopause.
There are two main types of hormone replacement therapy:
Combined estrogen and progesterone: Combined HRT includes both estrogen and progesterone and is commonly prescribed for most women. Combined HRT is usually taken by mouth or by wearing a skin patch, and enters the blood to act throughout the body (systemically).
Estrogen-only: Estrogen-only HRT is most often prescribed to women who’ve had their uterus removed (hysterectomy). When taken by mouth or by wearing a skin patch, estrogen enters the bloodstream to act systemically. I’ll explain why previous hysterectomy is important further down.
Locally-acting estrogen-only HRT can be used even if you still have your uterus. Symptoms like vaginal dryness or discomfort can be relieved by forms of estrogen that don’t reach the blood stream and act only on your genital tissues. Your doctor can prescribe estrogen cream, gel, or vaginal suppositories to help ease these symptoms.
Benefits of hormone replacement therapy
Relief from menopausal symptoms
HRT is highly effective at easing common menopausal symptoms. Addressing these unpleasant symptoms can enhance your overall well-being, allowing you to maintain an active and fulfilling lifestyle. You may benefit from HRT if you suffer from any of the following, particularly if they are severe or impact your quality of life:
- Sleep disturbances
- Hot flashes
- Night sweats
- Vaginal dryness or discomfort
- Mood swings
- Irritability
- Low sex drive
Bone health benefits
Estrogen plays an important role in keeping your bones hard, strong, and healthy. HRT can help prevent osteoporosis, and can even reduce the risk of broken bones in postmenopausal women. If you have severe menopause symptoms and have a family history or other risk factors for osteoporosis, you may benefit from HRT.
Cardiovascular benefits
Some studies suggest that starting HRT early in menopause for women with disruptive symptoms may lower the risk of heart disease. Estrogen can help improve cholesterol levels and the function of your circulatory system. Starting menopause before the age of 40 can raise your risk of heart disease, so if this is you and you have bothersome symptoms, HRT may be helpful.
Risks of hormone replacement therapy
You may be wondering…if HRT can ease all those symptoms of menopause, and is good for heart and bone health, why don’t doctors prescribe HRT for all menopausal women? Well, because the risks often outweigh the benefits. HRT is generally not recommended if you have or have had any of the following:
- History of breast, ovarian, or uterine cancer
- Uncontrolled high blood pressure
- Blood clotting disorders
- Liver disease
Uterine cancer
In women who have not had a hysterectomy, there is a risk of uterine cancer when taking systemic estrogen therapy alone (without progesterone). Estrogen acts on the lining of the uterus to thicken it, and when there is no progesterone there to balance out estrogen, the lining can grow too thick and increase the risk of cancer. This ties in with the reason why HRT is not recommended for women with a history of breast, ovarian, or uterine cancer. Estrogen can promote the growth of estrogen-sensitive tumors in women who have already had reproductive cancer.
Breast cancer
Using combined HRT (estrogen + progesterone) for a long period of time has been associated with a slightly higher risk of developing breast cancer. This risk is highest in women over age 60 who use systemic estrogen-only HRT.
Blood clots
Oral forms of HRT, such as pills, can increase the risk of deep vein thrombosis (DVT) or pulmonary embolism. DVT is a blood clot that forms in a vein in your leg, and a pulmonary embolism is a blood clot in your lung. This risk is highest in women who use systemic estrogen-only HRT, especially if it’s for long periods of time. Additionally, the risk of having a stroke while taking HRT increases slightly, particularly in women over age 60 who start treatment late in their menopause journey or who stay on HRT for many years.
Side effects
You may experience side effects from HRT. If you do, you can talk with your doctor and decide if the benefits of therapy outweigh the side effects. The most commonly reported side effects are:
- Nausea
- Bloating
- Breast tenderness
- Headaches
Making an informed decision
The decision to start HRT is highly personal and should be made with the help of your doctor or pharmacist. These are some factors you should consider before making your decision:
- The severity of your symptoms
- Your current age
- Your age when menopause began
- Personal and family medical history
- Alternative treatments, such as lifestyle changes, non-hormonal medications, and natural remedies
Hormone replacement therapy can be life-changing if you struggle with intense menopause symptoms, but remember that it’s not a one-size-fits-all solution! You want to take the lowest dose for the shortest amount of time. Working closely with your healthcare provider can guide you toward making an informed choice that supports your health and well-being.
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