Can Hormone Therapy Ease Your Menopause Symptoms?
There’s a lot of confusion that still exists around hormone therapy. Here’s what experts have to say about its ability to help manage perimenopause and menopause symptoms
Just like the symptoms it was designed to cure, hormone replacement therapy’s reputation has run hot and cold over the last eight decades.
Today, hormone therapy has settled into a more temperate role—as vital aid for some women who are experiencing symptoms of perimenopause and menopause.
The symptoms can be debilitating: heavy or irregular periods, brain fog, headaches and night sweats are just a few. And they hit women during one of the most productive stages of their careers.
“You don’t have to put up with symptoms, says Dr. Fiona Mattatall, an assistant professor in obstetrics and gynecology at the University of Calgary. “Hormone therapy is often the most effective treatment for symptoms related to hormonal fluctuations.”
But after decades of mixed messages about the risks and benefits of hormone therapy, there’s a lot of confusion and even stigma. Is it safe? For whom? And how do you know what will work best for you?
Here’s everything you need to know about hormone therapy and its place in managing the symptoms of perimenopause.
What is hormone therapy?
These are hormones that supplement or mimic hormones that your body is no longer making consistently. During perimenopause, as ovarian function wanes, hormone levels fluctuate. Physicians often prescribe estrogen and progestin: estrogen to help with symptoms of menopause and progestin to reduce risk of uterine cancer and osteoporosis.
Is hormone therapy harmful?
It has risks and benefits, and these vary from person to person. Hormone therapy is safe and effective for some women, but it requires careful discussions between a woman and her doctor.
In the past, many women took hormone therapy just because they were older, and not for specific symptoms. But studies have shown over time that hormone therapy is better suited for women who have symptoms of perimenopause or early menopause. Ideally, you should use the lowest dose for the shortest possible time, said Dr. Mattatall.
Why is there so much confusion?
Hormone therapy is complicated, and it’s been a long process to figure out how and where it works best.
Estrogen was initially prescribed to treat menopause—not so much the symptoms but the aging process itself, said Dr. Wendy Wolfman, director of the menopause clinic at Mount Sinai Hospital and professor of obstetrics and gynecology at the University of Toronto. “The goal was to make women feel younger and be more sexually responsive,” she said. Estrogen sales doubled and tripled in the 1960s and 1970s.
Hormone therapy fell briefly out of favour in the 1970s after research showed that taking estrogen alone increased rates of uterine cancer. But scientists soon found that adding progestin to hormone therapies mitigated that risk.
In the 1980s, a landmark study from the United States called the Nurses’ Health Study showed that women who took hormone therapy had less coronary heart disease—a major killer of women after menopause. Over the next two decades, hormone therapy use among women soared.
But in 2002, results from the Women’s Health Initiative (WHI), a US study of more than 160,000 post-menopausal women, raised the alarm about hormone therapy. An analysis showed that postmenopausal women who’d been taking hormone therapy for approximately five years had an increased risk of heart attacks, strokes, clots in the legs and breast cancer. “Women came off the therapy in droves,” says Wolfman.
We now know that the picture is more complex: younger women—those aged 59 years and younger—did not have significant increases in breast cancer and strokes, though there are lingering questions about breast cancer risk. At the same time, younger women benefited the most in terms of relief of symptoms from perimenopause and menopause.
But this history created a stigma around hormone therapy, said Dr. Wolfman.
What’s the current recommendation?
Most major women’s health organizations now recommend hormone therapy for women with symptoms of perimenopause, as well as women with menopause if they are in their 50s or less than ten years after menopause. It is not recommended for women with a history of breast cancer.
Is this the same thing as hormone replacement therapy?
Many experts now use the term hormone therapy instead of hormone replacement therapy. “The word replacement suggests that something is gone that’s supposed to be there,” said Dr. Mattatall.
But perimenopause and menopause are natural parts of aging, even if they come with difficult symptoms, she pointed out. “There was a historical misogynist view that older women are supposed to be hormonally like they were in your 20s,” she said. That’s unfair, she added. “There’s nothing wrong with you in menopause. If you have these symptoms, we have therapies that can help.”
What are your options?
You should talk to a doctor about any symptoms of perimenopause. Irregular bleeding should be investigated to rule out cancer and fibroids, both of which become more common with age.
Birth control pills or an IUD can be a good first-line hormone therapy for women in perimenopause. Plus, there’s the added benefit of contraception, and women in their 40s are one of the highest risk groups for unwanted pregnancy, notes Dr. Wolfman.
Hormones can be come in the form of oral tablets, patches or transdermal gels. For women whose main symptoms are vaginal discomfort, there are therapies specific for the vagina in the form of creams, rings or tablets.
For women who have symptoms during certain points in their cycle, physicians might add other medications or hormones for a few days a month on top of birth control. If the symptoms are primarily around mood, for example, other medications or cognitive behavioural therapy may be helpful, said Dr. Wolfman.
There’s no one-size-fits-all approach to hormone therapy for perimenopause. “It becomes an individual decision based on a woman’s personal risk, her family history and goals. So it’s a long discussion,” she said.
The take home?
Whether it’s out-of-whack periods or hot flashes that interfere with your ability to live your best life, symptoms can be addressed. And hormone therapy is often the best way to do that.