The Menopausal Mood Swings! The Hot Flashes! HRT Can Help, Safely

Hormone replacement therapy, or HRT, has bounced from being viewed as idyllic to sinister and back again in the last half-century. Now we’re at a happy medium.

It was all but a fantasy come true in the mid 20^th century, a miracle drug that — poof! — made menopause symptoms dissipate.

Then HRT was the devil, when a 2002 study showed it could raise your risk of breast cancer and stroke. Doctors scaled way back, prescribing these hormone-based meds only when women’s hot flashes or other menopausal discomforts were unbearable.

In early 2024, American women learned that HRT is A-OK after all -- as long as you’re under 60 and meet certain criteria. The Women’s Health Initiative said this, and it’s the same group that has examined HRT all along. Why the green light? The researchers kept researching, deeply, and discovered that plenty of menopausal women can reap more good than harm by taking HRT for up to 10 years.

HRT — What It Is and When To Take It

What is HRT? It’s a family of products that provide estrogen, or estrogen and progesterone, to replace what your body made abundantly during your reproductive years. The replacement of those hormones eases typical discomforts your body might experience as menstruation ends:

• Hot flashes
• Night sweats
• Mood swings
• Trouble sleeping
• Vaginal dryness

You’ll be prescribed just estrogen if your uterus has been removed, both estrogen and progesterone if you still have your uterus.

HRT can take several forms:

• Pills
• Pellets
• Patches
• Creams and gels
• Nasal sprays
• Vaginal tablets and creams
• Vaginal ring

What You Can Take Instead of HRT

If your age, your risk factors or your fear level make HRT an unwise choice, consider the alternatives to alleviate menopausal discomforts.

• Fezolinetant. This nonhormonal drug hit the market in 2023. It’s an oral medication that tempers the neurokinin 3 (NK3), which controls body temperature. You’ll need to have your liver tested before you take it.
• Gabapentin, paroxetine and oxybutynin. These medications are designed for other purposes, but are sometimes prescribed to ease menopause symptoms. They do not contain hormones.
• Local hormones. Some vaginal creams and inserts make vaginas less dry, yet your body will not absorb the hormones into the bloodstream, as with other HRTs.  
• Lubricants. It won’t do a thing for other symptoms, but sometimes a good over-the-counter lubricant can substitute for your natural lubricant and make intercourse comfortable. They won’t help with vaginal discomfort at other times though. Laser therapy and radiofrequency energy are can also help with vaginal dryness.

What To Ask the Doctor

If your menopausal symptoms are bad enough to make you distressed, ask your OB-GYN if HRT is a good fit for you. Start with these questions.

• Will HRT cause breast cancer? The answer will depend on you. If you’re under 60, haven’t had breast cancer, haven’t tested positive for breast cancer genes and don’t have a strong family history of breast cancer, you should be in the clear.
• Will HRT cause blood clots? Thrombosis is a risk if you’ve had blood clots before, or if you’re a smoker.. Otherwise, you’ll likely get a green light.
• Will HRT cause heart issues? No. Studies show that HRT doesn’t increase your cardiovascular risk, if started up to 10 years after the onset of menopause, or if you have a history of heart attack, angina or stroke.
• What are the side effects of HRT? HRT is made like birth control pills are, only using smaller doses, so the side effects will be similar: headaches, tender breasts and nausea, among others. Most will subside over time.

If you’re severely uncomfortable and have no risk factors, it might be worth trying HRT. Start with the minimum dose, which will probably ease your issues. Check in with your doctor every three months, then talk about weaning yourself off after three to five years.

While it’s best not to take medications you don’t need, there’s also no need to suffer. If your hot flashes, night sweats or other menopausal symptoms make you miserable, look into hormone replacement treatment.