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Facts About Hormone Replacement Therapy (HRT) for Menopause Symptoms

If you’re a middle-aged woman, you may start to notice some of the tell-tale signs of menopause—many women start having hot flashes, night sweats, mood changes, vaginal dryness, trouble sleeping and weight gain in their mid-40s.

Menopause is the time when women no longer have menstrual periods. You’re considered in menopause when you haven’t had a period for 12 months. During the menopausal transition, or perimenopause, your hormones fluctuate and decline—that’s what causes your symptoms. 

Some women have mild symptoms. But for others, they can become a problem. For example, hot flashes can strike at any time—it can be tough to power through a work presentation if your face is flushed and you’re sweating all over. Vaginal dryness can take a toll on your sex life. And sleep disturbances can make it seem like you’re a zombie going through your day, trying to push through the fatigue.

“For most women, hot flashes are the first thing to show up,” said Sarah Schutte, MD, an OB/GYN with Banner Health. “After that, they may notice weight changes and, a little later in the game, vaginal dryness.”

Could hormone replacement therapy (HRT) help?

Hormone replacement therapy is a medical treatment where you supplement or replace the hormones that decline during menopause. Increasing the levels of these hormones can help keep your symptoms under control so you’re better able to do the things you need and want to do. With HRT, you may find you don’t have as many hot flashes or night sweats, your mood is better, sex is more enjoyable and your quality of life improves.

And HRT can help in other ways, too. It may reduce your risk of heart disease and stroke, high cholesterol, Alzheimer’s disease, insulin resistance, osteoporosis and depression.

There are different types of hormone therapy you can try. The two hormones that decline during menopause are estrogen and progesterone. Women who have had a hysterectomy (removing the uterus surgically) can use estrogen-only therapy (ET). Women who have a uterus can use combined estrogen-progestin therapy (EPT).

There are lots of different ways you can take HRT. It comes in:

  • Pills or tablets you take by mouth, such as Premarin, estradiol (Estrace) and Estratab.
  • Nasal sprays (Nafarelin).
  • Gels (Estroge and Divigel), creams (Estrasorb) and sprays (Evamist) you apply to your skin.
  • Transdermal patches, which deliver the medication through the skin on your belly or thigh, such as Alora, Climara, Estraderm, Vivelle-Dot, Climara Pro and Combipatch.
  • Transvaginal creams, tablets, suppositories and rings, such as Imvexxy, Vagifem, Estrace, Estradiol, Estring and Femring, which you place inside your vagina.

Some doctors are beginning to prescribe intrauterine devices (IUDs) to replace progesterone. “That’s a newer thing, and it’s not completely vetted in terms of the risk, but IUDs are well-used for contraception,” Dr. Schutte said. 

For most of the side effects of menopause, you’ll probably need treatment for four to seven years. “After that, most of the symptoms will typically pass,” Dr. Schutte said. 

Vaginal dryness is the exception. That takes longer to develop, but it never goes away. You can treat it with vaginal estrogen, which can sometimes be used in people who are at risk of side effects from HRT because it’s not affecting your whole body. Hyaluronic acid, which is a non-hormonal treatment that plumps the vaginal walls, is another option. 

What are the risks of HRT?

If you’re considering HRT, discussing the pros and cons with your health care provider is important. HRT is a good option for many women, but there are some risks. It may increase your risk of breast cancer, blood clots, uterine cancer or stroke. 

Other risk factors for blood clots include high blood pressure and obesity. And blood clots can increase your risk of stroke. You can be at higher risk for breast cancer if you have had it or a close family member has had it. So, if you’re at higher risk for those conditions, you’ll want to weigh the pros and cons of HRT carefully. 

Your risk of uterine cancer increases if you take estrogen-only HRT. “If you have a uterus and you take hormone replacement therapy, you’ll have to balance estrogen with progesterone to prevent that increased risk of uterine cancer,” Dr. Schutte said. There’s a therapy that places pellets under your skin that some people try. “But we’ve found out you can only get the estrogen that way. You can’t get progesterone. So, there’s a bigger risk of getting an imbalance of estrogen to progesterone,” she said.

There are also some side effects you might notice with HRT. It could negatively change your mood and cause weight gain, breast tenderness and headaches. “You can see side effects similar to what you see with birth control pills,” Dr. Schutte said. 

If you decide to try HRT, your doctor will tailor your treatment based on your age, medical history and personal preference. You’ll want to stay in communication with your doctor while taking HRT to ensure it’s working properly for you. You’ll need to stay on track with follow-up appointments to make sure HRT is effective and to watch for any possible side effects. Be sure to share any concerns or changes in your symptoms.

What other treatment options can you try?

If HRT isn’t a good choice for you medically or it’s not something you want to take, there are other ways you can try to alleviate your symptoms. 

Selective serotonin reuptake inhibitors (SSRIs) such as paroxetine (Paxil) are typically used to treat depression, but they are also approved by the U.S. Food and Drug Administration (FDA) to treat hot flashes. Doctors used to prescribe a blood pressure medication called clonidine (Catapres), but it’s not used as often now because the SSRIs don’t have as many side effects. 

Some people try over-the-counter (OTC) non-hormonal or phytoestrogen supplements. “Some have more data to support them, and some have less,” Dr. Schutte said. “Phytoestrogens such as soybeans, lentils and tofu have some data to say they’re helpful.” And Relizen, an extract of pollen from a Swedish flower, may help improve hot flashes. 

Black cohosh is one of the supplements people try most often. Dr. Schutte said its benefits might come from a placebo effect. But that’s not necessarily a bad thing. “The placebo effect in treating menopause is 20% to 50%, so there is a lot of help.”

Lifestyle modifications and dietary changes might also make a difference. “Wearing layers, using fans and losing weight can help since people who are heavier tend to have more hot flashes. But that’s for more mild symptoms,” Dr. Schutte said. 

Even if you’re not taking HRT, it’s important to talk to your health care provider about what you’re trying to manage your menopause symptoms and how well it’s working for you.

The bottom line

Hormone replacement therapy can be an effective way to keep your menopause symptoms under control and improve your quality of life. To connect with a health care provider who can help you choose the best option for managing your menopause symptoms, reach out to Banner Health. 

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