Hormone Changes Are Natural. Suffering Doesn’t Have to Be: What You Need to Know About HRT!
For some women, the transition through perimenopause and menopause is relatively smooth. For others, symptoms can significantly affect sleep, work, relationships, and quality of life.
If you're considering hormone replacement therapy (HRT), also called menopausal hormone therapy (HT), you probably have questions.
Is it safe? Will it help? Am I a good candidate?
Those are important questions, and the answers aren't the same for every woman.
What Is Hormone Therapy?
Menopausal hormone therapy uses hormones, most commonly estrogen, with or without a progestogen depending on uterine status, to treat symptoms associated with menopause.
According to The Menopause Society, hormone therapy remains the most effective treatment for bothersome hot flashes and night sweats and can also help with genitourinary symptoms of menopause.
The goal isn't to reverse aging. It's to appropriately treat symptoms and improve quality of life when the benefits of treatment outweigh the risks.
Perimenopause vs. Menopause
Perimenopause is the transition leading up to menopause. During this time, ovarian hormone production fluctuates, and symptoms can begin even while you're still having periods.
You may experience:
Irregular or changing periods
Hot flashes or night sweats
Sleep problems
Mood changes
Brain fog
Vaginal or urinary changes
Changes in sexual desire
Menopause is reached after 12 consecutive months without a menstrual period when there is no other medical explanation.
Symptoms don't necessarily stop when your periods do. Hot flashes and night sweats can persist for years in some women, while vaginal and urinary symptoms may continue or progress without treatment.
How Can Hormone Therapy Help?
Hormone therapy is particularly effective for vasomotor symptoms, the medical term for hot flashes and night sweats.
Depending on the type of therapy and the individual, treatment may help with:
Hot flashes and night sweats
Sleep disrupted by vasomotor symptoms
Vaginal dryness and discomfort
Painful intercourse
Some urinary symptoms associated with menopause
Prevention of menopause-related bone loss
The FDA's menopause resource provides additional information about the benefits and risks of menopausal hormone therapy.
Estrogen Alone or Estrogen + Progesterone?
The appropriate treatment depends partly on whether you have a uterus.
Estrogen Therapy
Women who have had a hysterectomy can generally use systemic estrogen without a progestogen.
Estrogen + Progestogen
If you still have your uterus and use systemic estrogen, a progestogen is generally added to protect the uterine lining.
Estrogen stimulates the endometrium. Using systemic estrogen without adequate endometrial protection can increase the risk of endometrial hyperplasia and cancer.
Progesterone is one type of progestogen; synthetic progestins are another.
There are exceptions and different treatment strategies, which is why therapy should be individualized rather than a one-size-fits-all approach.
What Does “Bioidentical” Hormone Therapy Mean?
This term causes a lot of confusion.
Bioidentical hormones have the same chemical and molecular structure as hormones produced by the human body.
And importantly, bioidentical does not automatically mean compounded.
There are FDA-approved forms of estradiol and micronized progesterone that are considered bioidentical and are available through regular pharmacies.
Custom-compounded hormones may sometimes be appropriate when a patient's needs cannot be met by an FDA-approved product. However, compounded products are not FDA-approved, and they have not undergone the same evaluation for safety, effectiveness, quality, and consistency.
The FDA explains the difference between FDA-approved and compounded bioidentical hormone therapy for patients who want to learn more.
Is Hormone Therapy Safe?
For many healthy women experiencing bothersome menopausal symptoms, hormone therapy can be an appropriate treatment option.
But HRT isn't right for everyone.
The benefits and risks depend on several factors, including:
Your age
How long it has been since menopause
Your personal and family medical history
The type and severity of your symptoms
The hormone being used
Dose and route of administration
Whether you have a uterus
Other individual risk factors
The Menopause Society notes that for many healthy women who begin hormone therapy before age 60 or within 10 years of menopause onset, the benefit-risk profile is generally favorable for treating bothersome menopausal symptoms.
Certain medical histories—including some cancers, unexplained vaginal bleeding, blood clots, cardiovascular disease, and liver disease—may affect whether systemic hormone therapy is appropriate.
This is why HRT should be a shared, individualized decision between you and a knowledgeable healthcare professional, rather than something automatically prescribed—or automatically avoided.
Does the Type of HRT Matter?
Yes.
Hormone therapy isn't a single medication.
Estrogen, for example, may be delivered through:
Patches
Gels or sprays
Pills
Vaginal creams, tablets, inserts, or rings
The route matters.
For example, oral estrogen is associated with an increased risk of blood clots. Evidence suggests that this risk may be lower with transdermal estrogen, such as patches, gels, or sprays.
Low-dose vaginal estrogen is different from systemic hormone therapy because systemic absorption is minimal and it is used primarily for vaginal and urinary symptoms.
The right formulation depends on your symptoms, medical history, preferences, and individual risk factors.
HRT Isn't About Chasing Youth
Menopause is natural.
That doesn't mean you have to ignore symptoms that are interfering with your life.
Hormone therapy isn't an anti-aging treatment, and it isn't appropriate for every symptom associated with getting older.
But for appropriately selected women, it can be a highly effective treatment for specific symptoms of menopause.
At Tennessee Valley Health & Hormones, we take an individualized approach to hormone therapy. We consider your symptoms, health history, risk factors, goals, and treatment preferences when determining whether hormone therapy—and which type—may be appropriate for you.
Because the question isn't simply:
“Should women take hormones?”
It's:
“What are the potential benefits and risks for you?”
Medical Disclaimer
This article is intended for educational and informational purposes only and should not be considered medical advice. Never disregard professional medical advice or delay seeking treatment because of something you have read on this website.
