Hormone Replacement Therapy 101
With contributions from Afra discussing alternative hormone replacement therapy options.
Hormone replacement therapy (HRT) is a useful treatment for menopause symptoms. However, it is also associated with an increased risk for breast cancer. In fact, the use of certain types of HRT can increase the risk of breast cancer by up to 75 percent.
HRT is a treatment option for some women but should not be considered for others. Below, we’ll talk about HRT in detail.
What Is Hormone Replacement Therapy?
HRT is a treatment used for menopausal women.
During menopause, estrogen levels plummet. Due to this drop in estrogen levels, symptoms occur, such as vaginal dryness and hot flashes. HRT is an effective treatment for these symptoms – it is essentially replacing the hormone that is “lost” in the body.
HRT can truly be a “magic” pill for some menopausal women. However, it also carries an increased risk for certain conditions, so it should be used judiciously.
Menopause and Hormones
As we just discussed, menopause occurs when estrogen levels decrease in the body. When we utilize HRT, we are essentially supplementing these hormones.
But what exactly are these hormones? Why are they so important?
Estrogen and progesterone are the two “key players” of the reproductive system. They help to control our menstrual cycles, as well as our fertility. Estrogen thickens the lining of the uterus – this allows for implantation of a fertilized egg. When an egg isn’t implanted, menstruation occurs. Estrogen also “influences how the body uses calcium, an important mineral in the building of bones. In addition, estrogen helps maintain healthy levels of cholesterol in the blood. Estrogen is necessary in keeping the vagina healthy.”
Once this loss of estrogen occurs, symptoms of menopause begin to occur.
And why is progesterone taken, along with estrogen? As we’ll learn below, progesterone is only prescribed to women who still have their uterus – it helps to keep the lining of the uterus thin. When taken this way, it reduces a woman’s risk of developing endometrial cancer.
Types of Hormone Replacement Therapy for Menopause
There are several different types of HRT available.
Systemic Hormone Therapy
Systemic hormone therapy is undoubtedly the most effective type of HRT. Typically an estrogen preparation or estrogen and progestin preparation, systemic HRT is available as a pill, a patch, a gel, a cream, or a spray. It is highly effective in treating hot flashes associated with menopause, as well as night sweats, vaginal dryness, itching, burning, and discomfort with intercourse.
Women who have had to undergo a hysterectomy are often recommended an estrogen supplement. Most women will take this medication as a pill or a patch.
Women who still have their uterus typically will take an estrogen and progestin supplement. Progestin is the synthetic form of the hormone progesterone. This supplement is meant only for women who still have their uterus, and is generally used as birth control.
Low-Dose Vaginal Products
Low-dose vaginal products contain estrogen and are available in a cream, a tablet, or a ring. They typically treat the vaginal symptoms associated with menopause, such as vaginal dryness, as well as urinary symptoms.
In addition, the absorption of hormones is thought to be less when administered vaginally. When given vaginally, HRT does not help with symptoms such as hot flashes and night sweats.
How Does Hormone Replacement Therapy Help Menopause?
Research indicates that certain systemic preparations are protective of the body.
For example, combined estrogen and progestin appears to reduce the risk of colon cancer. It may also reduce cancer of the endometrium.
Estrogen alone may stave off heart disease – but only in the early postmenopausal years. It may also protect against osteoporosis, but bisphosphonates should still be used as the primary treatment for this condition.
Hormone Replacement Therapy Side Effects
All supplements and medications carry the risk of side effects.
When taking estrogen, the following side effects may be noticed:
- Breast tenderness and swelling
- Leg cramps
- Swelling in other areas of the body
- Vaginal bleeding
Typically, the side effects will pass in a few weeks. Self-care measures to reduce the side effects may include taking the estrogen with food to reduce nausea and estrogen, regular exercise and stretching to reduce leg cramps, and/or consuming a low-fat, high-carbohydrate diet to reduce breast tenderness.
When taking progestin, the following side effects may be noticed:
- Breast tenderness
- Headaches or migraines
- Mood swings
- Vaginal bleeding
- Abdominal pain
Typically, these side effects pass in a few weeks. If side effects of progestin do not pass, a different medication can be prescribed.
Many women believe that weight gain is associated with HRT. There has been no substantiated evidence to this belief; however, many women gain weight during menopause, regardless of whether HRT is prescribed.
Hormone Replacement Therapy Risks
Although HRT seems to be highly effective in treating the symptoms associated with menopause – and is basically supplementing the hormones that are “missing” from the body – there are definite risks associated with these medications.
In a very large clinical trial, combination estrogen-progestin was found to increase the risk of several health conditions which may include heart disease, breast cancer, stroke, and blood clots.
Subsequent studies have found that these risks vary. According to Mayo Clinic, “women who begin hormone therapy more than 10 or 20 years from the onset of menopause or at age 60 or older are at greater risk of the above conditions. But if hormone therapy is started before the age of 60 or within 10 years of menopause, the benefits appear to outweigh the risks.”
Mayo Clinic goes on to say, “the risks of hormone therapy may also vary depending on whether estrogen is given alone or with progestin, the dose and type of estrogen, and other health factors such as your risks of heart and blood vessel (cardiovascular) disease, cancer risks, and family medical history.”
Given these risks, who should consider HRT? HRT is still considered the most effective treatment for symptoms of menopause, so if symptoms are debilitating, the benefits may outweigh the risks, especially if you’re a healthy woman and you…
- Stopped periods before age 40, which is considered premature menopause, or lost normal function of your ovaries before age 40, which is considered premature ovarian insufficiency.
- Have lost bone mass and are not tolerating other treatments.
- Have moderate to severe hot flashes and/or other menopause symptoms.
There are women who should avoid HRT completely. For example, due to the heightened risk of breast cancer, women who have already had breast cancer, as well as endometrial and ovarian cancer, should avoid HRT. Women who have had or who have blood clots in their extremities, who have had a stroke, a liver disease, and any unexplained vaginal bleeding should generally avoid HRT as well.
What if You Can’t Take Hormone Replacement Therapy?
As we’ve discussed, not every person is able to take HRT – and some women choose not to take HRT to manage their menopausal symptoms, and that's perfectly okay!
Did you know there are many alternative, homeopathic and natural ways to combat symptoms? There are numerous in fact!
Exploring Hormone Replacement Therapy Alternatives
Looking to manage your menopause symptoms without the use of traditional HRT? Keep on reading to discover some alternative HRT options.
Hot flashes, for instance, can be uncomfortable and inconvenient but dressing in layers can be a simple solution. I always kept a gel bead filled neck scarf in my bag, which after a morning soak in cold water stayed cool all day. When the flush hit I simply wrapped it around the back of my neck or pressed it against my forehead. You can buy hats with built-in cooling headbands too.
Smoking is thought to increase the likelihood of hot flashes, and sufferers might consider avoiding hot and/or spicy food and any drinks containing caffeine, which is also believed to make symptoms worse.
Many studies have noted that many menopausal women found acupuncture very effective in dealing with hot flashes and general wellbeing. And the great news, if you are not keen on the idea of even very fine needles, is that acupressure and cupping work well for lots of women too.
Anxiety and Mental Illness
Is anxiety your issue? Your doctor might be able to help with antidepressants or hormone replacement therapy but regular exercise could help boost your mood and improve your general health too. Doing four or five sessions of weight-bearing exercises a week like walking or jogging will produce endorphins (the feel-good hormones) in your brain.
You might also lose any extra pounds, strengthen your bones (great news as menopausal women are prone to osteoporosis) and improve your heart health.
Include some relaxing exercise into your routine too like Yoga, Pilates, Tai Chi or meditation and you will hopefully soon feel much happier and able to cope with the physical symptoms this time brings.
St John's Wort is a well known herbal remedy for menopause to help combat depression but it can interfere with other medications, including those prescribed by your doctor so you should always talk to them before taking it.
Bone Density and Osteoporosis
Coming back to bone density and osteoporosis -one of the benefits of HRT is that it can help protect against diminishing bone density. However, there are lots of alternatives - as well as making sure you have lots of vitamin D (the sunshine vitamin) in your diet through oily fish, eggs and dairy you could also consider supplements of fish oil or evening primrose oil.
Many menopausal women are deficient in magnesium so if you are considering supplements for strong bones make sure you include this. Or you could just choose one of the many multi-vitamin supplements compiled especially for use during the Peri-menopause and Menopause. You might find they help combat mood swings and your flagging libido too.
Whilst we are in the bedroom metaphorically, solving vaginal dryness might help you feel more confident and solve any relationship issues cause by a partner who might be feeling confused and upset by your apparent lack of interest in them.
Don't be embarrassed to ask your pharmacist for vaginal moisturizers or lubricants (or pick up a tube in bigger grocery stores) or head to your local natural or alternative health store and ask about phytoestrogens – natural estrogens found in plants.
Ginseng and Dong Quai both contain phytoestrogens as do many soy products, linseed, tofu, and mung beans. Soy products have been shown to lower blood cholesterol too – a useful bonus. You could switch to soy milk, buy soy yogurts or look for soy and linseed bread. Be aware though, if you have been told you cannot take estrogen for medical reasons you might not be able to use phytoestrogens either.
It's an interesting fact by the way that Japanese women (who eat more soy and tofu products than other ethnicities) and Asian women report fewer hot flashes and other menopausal symptoms than many other ethnic groups. Mayan women in Mexico report almost no hot flashes while African American women report a higher incidence of hot flashes and vaginal dryness than Caucasian women. Fascinating!
Whatever your ethnic background, if you really don't want to take any form of medication or supplement, even those based in nature, you could try that reliable standby - a balanced diet.
Making sure you eat a good mix of foods, ensuring that not all of your protein comes from meat or dairy and keeping a watchful eye on your portion sizes could just mean the difference between suffering and sailing through the menopause.
The Bottom Line...
In general, HRT is a safe and viable treatment option for menopausal symptoms. HRT is used to treat menopausal symptoms for many women each year. The possible side effects, as well as the risks associated with HRT, should be discussed prior to prescribing with your physician.
HRT is not for every woman. Is it for you? Maybe – and maybe not! If you’re wondering about how to treat your menopausal symptoms, it is time to contact your physician.