What You Need to Know About Hormone Replacement Therapy
I would have liked to call this blog post a few different titles: “What you need to know about HRT in 2022 if you are over 40” or “If you are over 40 and you are not on HRT, Please read this”--regardless of the title, I am sharing information that you need to know as a woman over 40 here in the United States in 2022. Why is the year relevant? Because the information around all of this sort of thing gets updated from time to time, but the publicity and marketing or media around the studies do not get updated. As we know, headlines in the news are generally not about how wonderful life is. Instead, misfortune is what tends to sell newspapers and television news programs. Arguments and debate often fuel the public consciousness and if there is little to no drama surrounding an issue there really is no story.
Why am I interested in HRT and why listen to me?
My name is Beth Kruger–and in case you are just finding this post online, or are searching for more info about perimenopause–I want to tell you a bit more about what makes me qualified to discuss women’s health and hormones. I have been a Childbirth Educator, Lactation Counselor, Miscarriage and Infant Loss Support Group Leader, Prenatal and Postnatal Yoga Teacher and Teacher Trainer for almost two decades. I currently facilitate Wellness Retreats for Women Over 40 and coach women through the challenges of this transitional time of life. I am most passionate about helping women navigate the uniquely female aspects of life. My current focus is on The Menopause, but started my female-focused- obsession with childbirth, pregnancy, lactation, and fertility back in 2004. I do what I do quite simply, because I believe women deserve more. They deserve more education about their bodies, so they can advocate for themselves, and make informed choices about the care that they receive for all of life’s transitions like menstruation, pregnancy, childbirth, and yes–menopause.
As a childbirth educator, I used to teach couples about what to expect in their upcoming birth experience and to share with them all of the choices that they actually had regarding the labor and birth experience. I have been empowering women to listen to their bodies and advocate for themselves during their pregnancies and postpartum period for 18 years. I have been teaching women’s partners how to be good support people and help their partners to get the care that they need at a really vulnerable time of their lives. The perimenopausal time of life is actually no different than the transition to becoming a mother and having children–or the hormonal rollercoaster of the teenage years when we are growing and hormones are raging in our bodies as we develop and begin menstruation. We really need some sort of formal support or education around The Menopause because this time of life is very transformational. Women are often told that this is a “natural time” in our lives and we can just allow it to take it’s course, and once we are through the menopause, it will all be over. Nothing is actually further from the truth. Menopausal symptoms do not end once our menstrual cycle ends. Hot flashes can continue for up to 20 years after menopause is over. If you want to learn more about what perimenopause, menopause, and postmenopause is, you can click here for my post to learn more about that.
The symptoms of perimenopause are also varied and different for every single woman.
This is why each woman needs to inform herself about what menopause is, what the symptoms could be, and how she can take more control over her experience of the menopause by educating herself about what she can do to ease symptoms, and how she can advocate for her own care with her Primary Care Physician. This post is going to discuss HRT, or Hormone Replacement Therapy–and help you to learn more about it–and how it may be a viable and helpful option for you during your perimenopause, menopause, and post-menopause time of life.
What is HRT?
Hormone Replacement Therapy is either Estrogen or a combined administration of Estrogen and Progestogen. HRT can be given as a daily pill or patch, but the hormone estrogen also is available in a vaginal ring, gel, or creams, gels, or a spray. If you have your uterus, estrogen is given in combination with progestogen to keep the lining of the uterus from thickening and developing growths–and the progesterone will be given as a micro-dose tablet orally, or as an IUD.
What Are the Benefits of HRT?
Hormone Replacement Therapy:
Relieves hot flashes and night sweats
Can help you to sleep through the night–reducing night wakefulness
Helps to prevent bone loss
Prevents fractures caused by osteoporosis
Can be used as treatment for vaginal dryness and itching
Can make sex less painful
Can improve mood and sense of well being
Improves quality of life
Make some women less likely to have heart disease
Lowers your chances of dementia
Are there Risks associated with Hormone Replacement Therapy?
Risks of hormone therapy differ for women, depending on type, dose, duration of use, route of administration, timing of initiation, and whether a progestogen is needed. Current research has shown that the benefits are much greater than the risks for many women in most cases. Taking HRT should always be done with the consultation of your primary care provider. Treatment should be individualized using the best available evidence to maximize benefits and minimize risks, with periodic reevaluation. If you and your care provider take time to go through your symptoms and your history, there should be very little risk–but HRT may still raise your chances of:
Endometrial cancer, if you take estrogen without progestin and you still have your uterus
Blood clots*
Stroke*
Breast cancer*
(*all of these risks above would be the same as a woman who drinks one or more alcoholic drinks per day)
You may be less likely to have problems if you:
Start HRT within 10 years of menopause or before age 60
Take the lowest dose that works for you for the shortest possible time
Take progesterone or progestin if you still have your uterus
Ask about other forms of HRT besides pills: like patches, gels, mists, vaginal creams, vaginal suppositories, or vaginal rings
Get regular mammograms and pelvic exams–follow up is key!!
Who Shouldn’t Take Hormone Replacement Therapy?
HRT is safe and very effective for most healthy women. However, if you have any of the below conditions, you may want to avoid HRT:
History of Blood clots, or a blood clotting disorder
Cancer (such as breast, uterine, or ovarian): for women with breast cancer, a low-dose vaginal Estrogen Therapy could be prescribed in consultation with their oncologists
Heart, liver, or gallbladder disease
Heart attack
Known or suspected pregnancy (duh?)
Stroke
Unexplained vaginal bleeding
You may also want to quit smoking before taking HRT, if you are still smoking.
What Are the Side Effects of Hormone Replacement Therapy?
As with any and all drugs, of course HRT comes with side effects.
You will want to speak with your doctor if you have any of the following:
Bloating
Breast swelling or tenderness
Headaches
Mood changes
Nausea
Vaginal bleeding
How do I know if I need (or just want) HRT?
Your doctor can help you weigh the pros and cons of HRT, and suggest choices based on the severity of your symptoms and your medical history. Also, a blood test is not the best way to figure out if you are experiencing perimenopausal symptoms. Pay attention to your body, keep track of what you are eating and drinking daily. Log how much you sleep (hours), if you are waking in the night, or if you had a night sweat. Log your mood –or if it is fluctuating a lot–take note of that. If you are having hot flashes–also write those down. The gathering of information and your feelings of low mood, depression and anxiety can also be symptoms of menopause and antidepressants are not needed if you don’’t have a history of depression. You could try HRT instead.
Here are some questions to ask your Care Provider:
Based on my medical history, is there any reason I shouldn’t use HRT?
Do you think it could help my symptoms, especially hot flashes, sleep issues, and vaginal dryness?
Are there other treatments I should consider? (You will likely know this if you read any of my other posts, but natural remedies can be helpful, diet and lifestyle changes, stress reduction, not drinking alcohol can all help)
Do you think I’ll have side effects from HRT? (If you had any issues with taking birth control pills, you will want to be sure to tell your doctor)
Does my family medical history make me a good or bad candidate for HRT?
(For example: If your mom had osteoporosis, or dementia–HRT can help lower your chances of either disease. But if your mom had breast cancer or ovarian cancer, you’ll want to talk about that with your doctor.)
What type of HRT might be best for me? (there are so many different options!)
So there you have it. If you want to learn more about the research papers that I took all of this information from–see this link here . It is very informative–though very dense to read.
If you are interested in discussing your symptoms and figuring out how to track them–reach out to me and schedule a clarity call. As a perimenopause coach and guide, I would love to work with you as you bring your body into balance with the guidance of your doctor or physician.
