How Hormone Replacement Therapy (HRT) Help Can Ease Menopause Symptoms
Menopause is a natural phase in a woman's life, typically occurring around the age of 51, with perimenopause lasting on average 4 years before this. Menopause can be a welcome change from the hassle of menstrual cycles, PMS symptoms, and pregnancy prevention — but the transition often comes with a range of uncomfortable symptoms that can feel just as bad, if not worse than PMS.
“Hot flashes, night sweats, mood swings, insomnia, and more are all signs of your body transitioning to fewer hormones,” says Trisha Tomkins, MD, Obstetrics & Gynecology, Munson Healthcare Charlevoix Women's Health.
Thankfully, proven interventions can help ease these symptoms and improve how you feel. Hormone Replacement Therapy (HRT) offers relief from many of the most common symptoms of menopause.
Understanding Hormone Replacement Therapy (HRT)
Hormone Replacement Therapy involves providing your body with hormones it no longer produces as much (perimenopause) or at all (menopause), including estrogen and progesterone. There are several different types of HRT:
Synthetic Hormones: Chemically created hormones that the body converts into a usable form.
Bioidentical Hormones: These hormones are also made in a lab but come from natural sources like plants. Bioidentical hormones are considered to be chemically identical to those the body produces.
Compounded Bioidentical Hormones: These are custom-made mixtures not monitored by the FDA, which means their doses can vary and they may have contamination risks.
Both synthetic and bioidentical hormones are regulated by the FDA, so there is less risk of contamination and the dose is known.
Types of Hormones Used in HRT
Estrogen: Estrogen is available in multiple forms, including whole-body (a.k.a. systemic) forms absorbed through the bloodstream (think oral pills, transdermal patches, and vaginal rings) as well as more localized forms such as vaginal creams and tablets that specifically treat the area they’re applied to. For example, an estrogen cream applied to the vaginal skin may address vaginal dryness.
Bazedoxifene/Conjugated Estrogens (SERMs): This type of estrogen (typically taken in pill or tablet form) is absorbed through the bloodstream but acts locally by mimicking estrogen in specific tissues to treat menopausal symptoms or prevent diseases like osteoporosis (weak bones susceptible to fractures and breaks).
Progesterone: Available as oral pills or patches (typically in combination with estrogen) and intrauterine devices (IUDs), which are small T-shaped devices that release progestin (a man-made progesterone) directly into the uterus.
Testosterone: This hormone is not currently approved by the FDA for treatment in women.
The 5 Top Benefits of HRT
HRT is the most effective treatment for alleviating menopausal symptoms. When initiated within 10 years of menopause or before the age of 60, it offers several benefits:
- Reduction of menopause symptoms, such as night sweats, hot flashes, and vaginal dryness
- Decreased risk of cardiovascular diseases when started within 10 years from the onset of menopause, or less than 65 years old
- Prevention of bone loss and risk of fractures
- Increased metabolic function, including improved glycemic control and decreased risk of type 2 diabetes
- Improved cognition and mood, particularly if started early
Is HRT Necessary During Menopause?
HRT is currently recommended to treat symptoms of menopause that are not relieved with other lifestyle modifications. HRT is often prescribed when menopause symptoms are interfering with a woman’s quality of life.
“There is no specific timeframe on how long to continue treatment, and approximately 50% of women will have recurrence of their symptoms when they discontinue HRT,” explains Dr. Tomkins. “The decision on how long to continue treatment is individualized based on symptoms and risk factors.”
Does HRT Have Risks?
While HRT has many benefits, it does come with certain health risks, including:
- a slightly increased risk of breast cancer (if receiving both estrogen and progesterone for 5 or more years)
- a higher risk of gallbladder disease (especially with oral estrogen)
- an increased risk of venous thromboembolism and stroke (also particularly with oral estrogen)
Before starting HRT, it's essential to review risk factors (such as hypertension, diabetes, and cholesterol) with your OB/GYN and assess your 10-year risk of cardiovascular disease to determine which form of estrogen is best for you.
“Depending on your risk level, we may recommend specific forms of estrogen, and it’s important to start with the lowest effective dose and adjust as needed,” says Dr. Tomkins “And unless you’ve had a hysterectomy, progesterone is necessary to protect against endometrial cancer.”
Non-Hormonal Menopause Management Therapies
If HRT isn’t right for you, your OB/GYN can prescribe FDA-approved, non-hormonal options like Paroxetine (Paxil) and Fezolinetant (Veozah) as well as other SSRIs, SNRIs.
Currently, no over-the-counter supplements have been proven to be effective at treating menopausal symptoms.
Next Steps
HRT can help tremendously during the transition through menopause by alleviating symptoms and even providing various health benefits like reduced risk of osteoporosis, heart disease, and certain cancers. It’s essential to discuss HRT, and possibly alternative therapies, with your OB/GYN to weigh the benefits and risks and determine the best treatment plan based on your individual health needs.
Do you need an OB/GYN or are you looking for a new women’s health provider who can help with HRT? Find a Munson Healthcare OB/GYN near you.