Hormone Therapy: Is It for You?
What is hormone therapy?
Medically Reviewed By: Kristen Harvey, MD
Hormone replacement therapy (HRT) is the medication used to replenish a woman's declining hormone levels and lessen menopausal symptoms.
The female hormones, estrogen and progesterone are significant to a woman's reproductive health. They are a crucial component in ovulation, pregnancy, and menstrual cycles. Your periods end during menopause as a result of decreased hormone levels. While menopause can occur earlier, it primarily affects women between the ages of 45 and 55.
Most menopausal symptoms are caused by estrogen deficiency when the ovaries cease producing substantial amounts of the hormone. HRT can provide relief to the following menopause symptoms:
Hot flashes
Night sweats
Sleep problems
Mild depression
Mood swings
Anxiety
Vaginal dryness
Discomfort during sex
What are the types of hormone replacement therapy?
Typically, there are two basic types of hormone therapy:
Estrogen-only therapy or estrogen replacement therapy
This therapy is for women who have undergone a hysterectomy (surgical removal of the uterus) or use a progesterone only intrauterine device (IUS) for contraception.
Combination therapy
This type of HRT involves the combination of progesterone and estrogen. Progesterone is necessary for most estrogen-using women who still retain their uterus. Combining the two hormones helps reduce the risk of endometrial cancer (cancer of the uterus).
Types of hormone therapy preparations
Your preferences and needs will determine how HRT will be given to you. You might need to test a few varieties before selecting the one that works best for you. Your doctor can help you identify the delivery method with the lowest risks.
Pills
Pills are usually taken once daily. And there are several tablet options.
Patches
Hormone Skin patches are applied once or twice weekly to any body part below the waistline. They are usually administered for short-term treatment of menopause symptoms.
Gel
The hormone gel has a clear and nongreasy consistency. You apply the gel to a clean, dry, and uninjured skin area such as the inner thigh, upper arm or shoulder.
Internal uterine device (IUD)
An IUD is a little plastic device containing progestin inserted into the womb (Uterus), usually to prevent pregnancy.
Local hormone therapy
This type treats only certain symptoms, such as vaginal dryness at the location where you apply it. They are typically low-dose estrogen formulations. Unlike other forms, it carries minimal health risks and does not relieve other symptoms. Examples include vaginal creams, tablets, or rings.
Who should get hormone therapy?
Hormone treatment may be beneficial If any of the conditions listed below apply to you:
You have severe menopausal symptoms
Many women experience menopause without any medical intervention. But for others, the transition results in severe and bothersome symptoms. Of course, hormone replacement therapy is one of the most effective treatments to relieve uncomfortable menopause symptoms like hot flushes, night sweats and sleep problems.
You have experienced a sudden change in your reproductive health
Hormone therapy may be helpful for women who recently underwent ovarian surgery or another abrupt change in their reproductive health. For instance, if you had your ovaries surgically removed (hysterectomy) before age 45 (i.e. before menopause begins). This situation also affects women who lost their ovaries' normal function before age 40 due to primary ovarian insufficiency.
If you start hormone therapy at a younger age after a hysterectomy or for early menopause, there may be more significant benefits than in older individuals.
You experience menopause at an early age
Some women experience the onset of menopause sooner than others, and hormone replacement therapy may be beneficial for them. This applies to women who had early or premature menopause, maybe in their mid-40s or even earlier.
Benefits of hormone replacement therapy
Hormone replacement therapy has many health benefits. For most healthy women, the value of the treatment exceeds the health risks.
Reduces menopause symptoms
Menopause symptoms are prevalent, including hot flashes, leg cramps, trouble sleeping, and anxiety. You may experience mild to severe symptoms that disrupt your everyday activities or affect your well-being.
When you receive hormone replacement treatment, your estrogen and progesterone levels are controlled, which ultimately eliminates many of the bothersome menopausal symptoms.
Enhances bone health
Because estrogen affects your bone health, when you reach menopause, osteoporosis or weakening of the bones becomes a serious concern. You can prevent osteoporosis by maintaining bone density with hormone replacement treatment. Long-term HRT use may also help reduce the risk of bone disease.
Boosts sex drive
Both men and women experience a considerable decline in libido or sexual desire as they age. But for women, menopause also causes vaginal dryness, which makes sex even less appealing.
You can get your reproductive hormone levels back by using hormone replacement treatment. This improves problems like vaginal dryness and increases the desire for sex.
Improves your mood
Your hormones serve many functions in the body, including regulating your mood. Depression or mood fluctuations may occur due to the estrogen and progesterone reduction that comes with aging.
You may maintain a healthy level of estrogen and progesterone in your body by using hormone replacement treatment. This might considerably raise your mood, alleviate depression, and improve your mental health.
Supports weight management
You may have significant weight changes as you approach menopause. This happens more frequently as you age, making weight reduction particularly challenging. Although hormone therapy is not a weight loss treatment, it helps with weight gain influenced by hormones.
Maintaining or losing weight becomes extremely difficult when hormones are involved. However, Hormone replacement treatment could help you lose weight and improve your general health when combined with a healthy diet and regular exercise.
Reduces mortality risk
Beginning HRT before age 60 or within 10 years of the menopausal transition lowers the incidence of early deaths in women.
What are the side effects of hormone replacement therapy?
Like most medications, hormone treatment has adverse effects. Many women discover that the side effects are frequently more severe at the beginning of the therapy. But after a few weeks, they gradually lighten up.
Although all hormone therapy has some adverse reactions in common, some side effects are peculiar to certain types of treatment. Therefore, your hormone treatment type will determine what side effects you might experience.
The most prevalent side effects are:
Irregular bleeding or spotting.
Breast tenderness
Acne or oily skin
Mood swings
Fluid retention
Leg cramps
Headaches (including migraine)
Weight gain
Skin hyperpigmentation or discoloration (brown or black spots).
Skin irritation under estrogen patch.
Most of the time, these side effects are minor and won't necessitate you to stop taking your treatment. However, if your symptoms bother you, speak with your doctor about changing the dosage or form of administration. Usually, this lessens the effects. Don't discontinue or adjust your medicine without first talking to your physician.
What are the risks of taking hormone therapy?
Though hormone therapy aids many women in getting through menopause, there are risks involved in the treatment. HRT raises the danger of developing several severe health conditions. Therefore, you and your doctor should think carefully about these health risks before determining if hormone treatment is right for you.
Endometrial cancer
If you have never had a hysterectomy and are taking estrogen replacement therapy, you have a higher chance of developing endometrial cancer. However, you can eliminate this risk by combining progestin with your treatment.
Breast Cancer
People over 50 who use a combination HRT (estrogen and progesterone given concurrently) have a higher chance of developing breast cancer. However, there is no increased danger of breast cancer if you start hormone therapy before age 50. Your chance of developing breast cancer will still be the same as the general population's.
Additionally, the longer you use HRT, the higher your risk is for breast cancer; the risk drops when you stop the treatment.
Blood Clots
When using hormone therapy, there is a greater chance of developing blood clots (deep vein thrombosis). How you take your hormone treatment may influence this risk. For example, using skin patches or gel may reduce your risk.
Other factors, such as whether you smoke, your age and weight, are also important. In addition, your chances of getting blood clots increase slightly throughout the first year of therapy.
Stroke and heart disease
Women over 60 who use HRT have a slightly higher risk of developing cardiovascular disease or having a stroke. If they used combined HRT and began treatment later in the menopause period, this was more likely to occur.
Your HRT dosage and method of administration may affect this risk. The risk decreases if you use a hormone gel or patch, reduce your dosage, or both.
What should I consider before taking hormone therapy?
Carefully consider the following with your doctor before you begin treatment.
Your age
If you begin hormone therapy before age 60 or within ten years of menopause, the benefits of taking the treatment might outweigh the dangers involved. Women starting hormone treatment at 60 years or older, or those on HRT for more than ten years after menopause, are at higher risk for health problems.
In addition, the hazards of hormone replacement therapy (HRT) may start to exceed the health benefits as you get older, especially around 60. As you age, you'll typically notice an improvement in menopausal symptoms, making it less likely that you'll require HRT to treat them.
Your family and personal medical history
Hormone treatment should generally not be used by women who have experienced hormone-driven breast cancer. Additionally, if you have a history of heart problems, blood clots, or stroke, your doctor could advise against it. On the other hand, you should consider your history of osteoporosis when deciding if hormone replacement treatment is right for you.
The severity of your menopause symptoms
If your symptoms are mild or moderate, you may consider alternatives to HRT, such as home remedies, lifestyle changes or dietary supplements. However, it is recommended you consult with your healthcare provider before attempting such options.
Final verdict
Hormone replacement therapy is not ideal for everyone. Therefore, as you are considering the treatment, weigh the benefits and risks to your health. Of course, you don't have to reach a decision on your own.
Consult your doctor about your unique symptoms and health risks to conclude if hormone therapy is an appropriate treatment choice. Your healthcare provider can help you work out a treatment plan to make your menopausal years enjoyable. Also, periodically review your options as your symptoms improve.
Sources
https://www.acog.org/womens-health/faqs/hormone-therapy-for-menopause
https://www.hsph.harvard.edu/news/hsph-in-the-news/hormonal-therapy-menopause/
https://medlineplus.gov/ency/patientinstructions/000695.htm
https://www.ncbi.nlm.nih.gov/books/NBK493191/
https://pubmed.ncbi.nlm.nih.gov/10515671/
