During perimenopause, estrogen levels drop and progesterone fluctuates, causing the hallmark symptoms women know so well — but hormone therapy can help replace those hormones in carefully measured doses.
“Hormone therapy replaces the hormones that our bodies start making less of,” says Christine McCrae, PA-C, MSCP, physician assistant and Menopause Society Certified Practitioner at Methodist Family Health Center – Murphy. “It closes the gap and makes us feel better.”
Treatment can take several forms:
- Estrogen patches or gels can be applied to the skin.
- An estradiol vaginal ring can remain in place for 90 days or tablets can be applied vaginally.
- Progesterone capsules are often taken at night to improve sleep, and estrogen pills can help resolve other symptoms
- Testosterone may be prescribed when a lack of sex drive is the concern, although this is not FDA-approved.
Estrogen applied to the skin has been shown to be safer than oral estrogen. That’s because pills must be processed by the liver first, potentially raising a risk of blood clots and even gallstones.
Hormone therapy can be administered in many ways, including orally or through the skin in lotions or patches.
DIFFERENT FROM BIRTH CONTROL
Hormone therapy is not the same as taking birth control pills, says Heather Havener, MD, MSCP, OB-GYN and Menopause Society Certified Practitioner on the medical staff at Methodist Mansfield Medical Center. Both contain estrogen and progesterone, but the dose and purpose are different.
“Birth control is a very high dose, and it’s a synthetic form of estrogen and progesterone,” Dr. Havener explains. “It suppresses your ovaries.”
In contrast, menopausal hormone therapy is a low-dose, bioidentical form of the hormones designed to mimic the hormones your ovaries once made.
This means younger women in their 30s and early 40s may stay on birth control, which supplies more than enough hormones. But as women reach their mid-40s, some women may benefit from switching to hormone therapy.
“We always want someone on the lowest effective dose,” McCrae adds.
Aside from symptom relief, hormone therapy may reduce the risk of cardiovascular diseases.
BENEFITS BEYOND SYMPTOM RELIEF
Most women seek hormone therapy for relief from hot flashes, mood swings, or poor sleep. But the therapy also offers longer-term health benefits.
“Hormone therapy may reduce the risk of dementia and cardiovascular disease, even diabetes, especially in younger women,” McCrae says. “It keeps us healthier down there, which can improve our sex lives.”
She and Dr. Havener both agree that the benefits can help women maintain vitality and wellness for years to come.
But there’s a flip side to that coin. For some women, hormone therapy can raise some risks.
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UNDERSTANDING THE RISKS
The risks that come with hormone therapy include blood clots, heart attack, and stroke. Those risks grow if therapy begins more than 10 years after menopause but are considered minimal for women in the earlier stages.
“If you are younger than 60 years old, and you have gone through menopause within the last 10 years, hormone therapy is unlikely to increase the risk of heart attack or stroke in most healthy women,” Dr. Havener says.
Cancer presents another risk for some patients. If a woman still has her uterus, progesterone must be given with estrogen to protect against uterine cancer.
When it comes to breast cancer, the picture is more nuanced.
“Most studies show that estrogen and progesterone increase the number of breast cancers that are diagnosed. The Women’s Health Initiative, which is one of the largest studies done on hormone therapy, showed an increase by about 10 additional cases per 10,000 person-years,” Dr. Havener explains. “It’s statistically significant but not a big number.”
The risks may be low for most women, but McRae and Dr. Havener don’t want to minimize them, either. Educating patients is always the first step.
“Any time we take a medication for quality of life,” Dr. Havener says, “we have to weigh risks versus benefits.”
Transdermal hormone therapy is considered safer than taking estrogen in pills or capsules.
WHO IS A GOOD CANDIDATE?
According to both Dr. Havener and McCrae, most women are good candidates for hormone therapy, with some notable exceptions.
Those exceptions include women with a personal history of heart disease, clotting disorders, or prior stroke. Other women who may not be good candidates are those with a personal history of breast cancer, a high risk of developing breast cancer, or those with ongoing liver disease. In these cases, a doctor can help patients make the best decision for them.
For others, the decision depends on family history, current health, and the severity of symptoms — as well as a frank discussion and guidance from their physician.
“Think about the symptoms that are bothering you, how much they affect your quality of life, and what benefit you hope to get,” Dr. Havener says. “Then weigh the possible risks to decide if it’s the right choice for you.”
Menopause may be unavoidable, but suffering through it is not. With modern hormone therapy, women have safe and effective options to manage symptoms and support long-term health.
“Most women are good candidates for hormone therapy,” McCrae reassures. “Please don’t be afraid to bring this up to your provider. We want to get you feeling better. And we know that you want to start feeling better.”
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