If you’ve heard about hormone replacement therapy, you might have a negative view of this treatment for menopause symptoms.
Hormone replacement use fell off a cliff in the first decade of the 2000s, after a long-term study by the National Institutes of Health linked the treatment to increased risk of breast cancer, heart disease, stroke and blood clots.
Use dropped from 22 percent in 2000 to less than 5 percent by 2010.
But the annoying — and even quality of life-impairing — symptoms of falling reproductive hormones have prompted many women to rethink the strategy, especially as delivery methods have changed, lessening at least one of the risks.
What Is Hormone Replacement Therapy and Why Is It Used?
Women can experience a variety of symptoms as they approach menopause, sometimes bad enough to prompt a discussion with their doctor. These changes may include hot flashes, brain fog, sleeplessness, vaginal dryness and a slowing metabolism. Hormone therapy supplements and balances the declining levels of estrogen and progestin produced by the body, softening the physical effects.
“Women are often not prepared for what I call the ‘ovarian retirement plan,’” says Rebecca Booth, MD, a gynecologist on the medical staff at Baptist Health Louisville. “Many women are concerned about functionality at work, their relationship and love life, their overall comfort and their waistline.”
The U.S. Preventive Services Task Force recommends against the use of hormone replacement therapy for menopause symptoms, but Dr. Booth believes a less-biased look is needed, such as that promoted by the North American Menopause Society, which says benefits outweigh the risks for some women.
Lifestyle Changes for Menopause Symptoms
Doctors often start by advising low-risk ways to tackle complaints, such as:
- The supplement melatonin may help with sleep disruption.
- Avoiding sugar might help reduce night sweats.
- A diet high in plant proteins, such as nuts and nut butters, could help balance mood shifts
- Cutting carbs can help with weight maintenance.
- Meditation calms the adrenal glands, which cause night sweats, hot flashes and even heart palpitations.
“But when lifestyle changes don’t meet all a woman’s needs, she might consider whether she is a good candidate for hormone replacement therapy,” Dr. Booth says.
What’s New in Hormone Replacement Therapy
“The biggest risk with hormone replacement therapy isn’t cancer, as many think, but blood clots,” Dr. Booth says. “That’s a natural adaptation because Mother Nature designed estrogen to help mammals, particularly humans, clot.”
The desire to prevent clotting has driven one of the biggest changes in hormone replacement therapy: the shift away from oral hormone replacement medications.
“It turns out that oral estrogen and to some degree testosterone — this is not true of progesterone or progestin — result in more of a spike of clotting factors,” which increase the risk of stroke, Dr. Booth says.
But those same hormones delivered in other ways don’t carry the same clotting risk. That has given rise to a number of dose delivery options, including a transdermal patch, the size of a postage stamp, worn below the panty line.
“There are (vaginal) suppositories. There are creams. There is a ring that in inserted in the vagina. There are mists to be sprayed on the skin and gels. The list goes on and on,” Dr. Booth says.
Pro’s and Con’s of Hormone Replacement Therapy
For a patient considering hormone replacement, Dr. Booth spends time explaining the risks, which go beyond blood clots. Dual (estrogen and progesterone or a progestin) hormone replacement can increase the risk of breast cancer after about four years. Estrogen also can raise the risk of gallbladder disease.
The gynecologist helps weigh all those factors with the patient, helping come to a very personal decision based on a woman’s goals and acceptance of risk. It’s not recommended for women with a history of a hormone-sensitive cancer or a blood-clotting disorder. Smokers and women who have migraines with auras should also steer clear.
“Hormone replacement is the most individualized care plan that I know of in medicine,” Dr. Booth says. “First of all, it’s not disease treatment. Second of all, it’s controversial and there are risks. Third of all, many women have goals and values that are differing, and different fears and individual situations.”
Those opting for hormone replacement usually stay on it for about five years, Dr. Booth says. But there is no automatic cut-off time; the decision to pursue hormone replacement is one that needs to be reassessed yearly, if not more often.
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