If you’re navigating the transition to menopause, you’re in good company. Every year, approximately 1.5 million women in the U.S. enter perimenopause, the phase leading up to menopause. This phase can start as early as your 30s, driven by the gradual decline of hormone levels, or it can happen suddenly if you undergo surgery to remove your uterus and ovaries, propelling you into menopause almost overnight.
Symptoms like brain fog, mood swings, hot flashes, and insomnia can leave you searching for relief. Today, choosing hormone replacement therapy (HRT) is a highly personalized decision, tailored to a woman’s unique needs and potential risk factors.
What is Hormone Replacement Therapy?
HRT aims to replenish your body’s hormone levels, thereby reducing menopausal symptoms and offering protection against conditions such as osteoporosis.
The therapy involves taking estrogen and, if you have a uterus, another hormone called progestin (progesterone). Estrogen can be administered through pills, skin patches, or gels. Progesterone, when prescribed, may be combined with estrogen in a single pill or patch, but is often given separately to avoid breakthrough bleeding.
How Hormones Help
Estrogen and progesterone are vital for various bodily functions. Progesterone mainly supports pregnancy and uterine health. However, estrogen also helps protect bones, lowers cholesterol, fuels the brain through glucose metabolism, and maintains the vaginal lining.
Benefits and Risks of HRT
- Bone Health: One of the primary benefits of HRT is the alleviation of menopausal symptoms. Research suggests it also helps protect bones. A study of over 25,000 postmenopausal women aged 50-79 found that hormone therapy reduced fracture risk, which is particularly crucial for women who undergo surgical menopause before age 45 and face a higher risk of bone loss and osteoporosis.
- Brain Health: HRT may protect the brain by safeguarding nerve cells. Menopause-induced estrogen decline hampers the brain’s ability to utilize glucose, its main fuel source, prompting it to switch to fats (lipids) for energy. This adaptation involves converting brain fats into ketones for fuel. When initiated during the perimenopausal transition, HRT can mitigate this metabolic shift, potentially halving the risk of Alzheimer’s disease. However, once menopause is reached, HRT’s brain-protecting benefits seem to diminish.
- Stroke and Cancer: HRT carries risks, including stroke, blood clots, and cancer. Your individual risk depends on your age, medical history, hormone type, and delivery method. Transdermal estrogen patches, for instance, have a lower risk of stroke and blood clots compared to oral estrogen. Women with a uterus require combined therapy (estrogen and progesterone) to prevent uterine cancer, but this combination may increase breast cancer risk according to the American Cancer Society.
Your doctor can help weigh these risks and benefits to determine if HRT is suitable for you.
Alternatives to HRT
If HRT isn’t the best option for you, there are alternatives. Antidepressants and gabapentin, an anti-seizure medication, can reduce hot flashes and improve sleep quality.
Non-prescription alternatives like soy supplements and red clover extract might also help alleviate menopause symptoms, although studies on their effectiveness are inconclusive.
Length of Therapy
The duration of HRT depends on individual risk factors and symptoms. Symptoms are usually worst during the first 5 years after menopause until eventually, the body gets used to the much lower estrogen levels. However, every person is different, and a tailored approach is vital.
When to See your OB/GYN
If you’re under 40 and experiencing menopausal symptoms or have reached menopause (defined as 12 months without a period) and your symptoms are impacting your quality of life, it is time to talk to your OB/GYN. Together, you and your doctor can decide whether HRT or an alternative treatment is the best path to relief. https://www.ovationobgyn.com/contact-us/
Further Reading:
Cedars Sinai: https://www.cedars-sinai.org/blog/hormone-replacement-therapy-risks-benefits.html