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HEALTH & WELLNESS
All About Hormone Replacement Therapy By Lisa Sousou
W
hile menopause - the complete cessation of menstrual periods - can be a welcome milestone in a way for many women, the years leading up to menopause, or peri-menopause, can be less welcomed. During these years, estrogen levels decline, leading to irregular menstrual periods. Also during this time, some women will begin to experience symptoms such as hot flashes, night sweats, sleep disruptions, mood changes or depression, and/or vaginal dryness, while others will experience few problematic symptoms at all. These symptoms can be short-lived, or can last for several years to a decade, even after menopause occurs, and into postmenopause (the time after menopause occurs). For some women, these symptoms are mild and tolerable. For others, they can be severe. For women who have life-disrupting symptoms, sometimes medication can help. One of the most helpful therapies is often hormone replacement therapy, or HRT. Hormone replacement therapy is used to boost the declining estrogen levels enough to help relieve distressing symptoms. Women who have a uterus and who take estrogen must take a second hormone, called progestin, along with it. This reduces the risk of cancer of the uterus, which can occur if estrogen is taken alone. Women who have had their uterus removed (a hysterectomy) can take estrogen alone.
What are the options for forms of hormone replacement therapy, and what are their benefits? HRT can be taken as a pill, a patch, a vaginal ring, or even a gel or a spray to use on the skin. All of these forms are absorbed into
the bloodstream and boost the estrogen levels throughout the body. These medications can help reduce symptoms like hot flashes, insomnia, and mood changes, as well as vaginal dryness and pain with intercourse. Some contain both estrogen and progestin; others only contain estrogen, in which case women with a uterus may need to take a separate progestin medication. Although HRT is not prescribed for this specifically, it also helps lower the risk of bone fractures from osteoporosis (low bone density). Estrogen alone can also be used in the form of vaginal creams, vaginal inserts, or a different, lower-estrogen vaginal ring. These forms only boost estrogen levels in the vagina, helping to relieve vaginal symptoms. They only provide a small dose of estrogen, and do not help with other perimenopausal symptoms. Their benefit is that they avoid systemic (whole-body) hormone dosing, which can have some associated risks.
What are the risks of hormone replacement therapy?
Many women may have concern about risks associated with HRT based on the Women’s Health Initiative (WHI) study, which initially released news in the early 2000s. This study did find an increase over time in breast cancer, heart attacks, strokes, and blood clots in postmenopausal women who took HRT containing estrogen and progestin. The risk of heart attacks increased more in women 60 and older. Oral medications may have more associated risk of clots than non-oral medications. In women who took estrogen only, the risk of blood clots and stroke were also increased, but the risk of blood clots was not as high as with estrogen-progestin HRT. No increase in breast cancer
August 2020
Recovery Edition
