Is It The Right Treatment For You?
Hormone therapy (HT) is a medication that contains female hormones, taken to replace the estrogen your body stops making during menopause. It is most often used to treat common symptoms such as hot flashes and vaginal discomfort.
Many menopausal women experience symptoms such as these, and many other physical changes as well. For some, the symptoms are mild and do not require any treatment. For others, symptoms are moderate or severe and interfere with daily activities. Hot flashes decrease over time, but some women have dealt with bothersome ones for many years. Menopause symptoms often improve with lifestyle changes and nonprescription remedies, but prescription therapies also are available, if needed.
Hormone therapy is one of the most effective treatments available for hot flashes and night sweats. If night sweats are waking you throughout the night, HT may improve sleep and fatigue, mood, the ability to concentrate, and overall quality of life. Treatment of hot flashes and night sweats is the principal reason women use HT. This therapy also treats vaginal dryness and painful intimacy (genitourinary symptoms) associated with menopause. It also keeps your bones strong by preserving bone density, decreasing your risk of osteoporosis and fractures.
FDA-approved indications for hormone therapy are used to prevent these issues. The 2017 Hormone Therapy Position Statement of The North American Menopause Society (NAMS) updated the society’s 2012 statement, identifying its significance.
We have come a long way …
The landmark Women’s Health Initiative Study (WHI) results from 20 years ago scared many women away from using hormone therapy altogether. Some toughed out their hot flashes and night sweats with no relief until the symptoms settled down on their own. But fortunately, we’ve learned a great deal since then about the risks and benefits of HT. For most women, experts agree that it is safe to control moderate to severe menopause symptoms within 10 years of menopause and up to age 59. It is recommended, though, that women use the lowest dose for the shortest amount of time needed to keep their symptoms under control.
HORMONE THERAPY TYPES
There are two basic types of hormonal therapy. Systemic estrogen – which comes in pill, skin patch, ring, gel, cream, and spray form – typically contains a higher dose of estrogen that is absorbed throughout the body and can be used to treat any of the common symptoms of menopause. The second type is low-dose vaginal products. These come in cream, tablet, or ring form, and minimize the amount of estrogen absorbed by the body. Because of this, low-dose preparations of this therapy type are usually used to only treat the vaginal and urinary symptoms of menopause. Estrogen alone or estrogen plus progestogen is based on uterus presence. If you have a uterus, you will need to take progestogen with your estrogen. Many pills and some patches contain both hormones together. Otherwise, you will need to take two separate hormones (i.e., estrogen pill in conjunction with a progestogen pill or estrogen patch along with a progestogen pill).
HORMONE THERAPY RISKS
While hormone therapy can provide significant relief for women who suffer menopausal symptoms and discomfort, it can pose certain risks. These risks differ depending on the therapy type, dose, duration of use, route of administration, timing of initiation, and health risk factors. Treatment should be individualized to each patient, using the best available evidence to maximize benefits and minimize these risks, with periodic reevaluation by your specialist.
For healthy women younger than 60 years old with bothersome hot flashes, and are within 10 years of menopause, the benefits of HT generally outweigh the risks. This treatment might slightly increase your chance of stroke or blood clots in the legs or lungs (especially if taken in pill form). If started in women older than 65 years of age, hormone therapy (combined estrogen and progestogen) might slightly increase your risk of breast cancer if used for more than five years. Using estrogen alone (for women without a uterus) does not increase breast cancer risk at seven years of usage, but may increase risk if taken for a longer time.
Some studies suggest that it may be good for your heart if started before age 60 or within 10 years of menopause. However, if you start hormone therapy further from menopause or after age 60, it might not improve the risk of heart disease. Although there are risks associated with taking HT, they are not common, and most go away after you stop treatment.
If you’re looking for relief from menopause symptoms and decide on hormone therapy as a treatment, you will need to consult a specialist in this area of your health. Initiating hormone therapy and menopause symptom management is a very nuanced science that needs careful planning based on your individual health history and risk factors. You and your menopause specialist will work in partnership to decide what is the best, safest, evidenced-based option for you, so you can continue this phase of your health journey with an improved quality of life.
Hajira Yasmin, MD, FACOG, NCMP, AASECT-CSC, IF
The founding physician of Alray Direct Gynecology & Intimate Health Center and is a NAMS Certified Menopause Practitioner and an ISSWSH Certified Sexual Medicine Fellow.