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Will Hormone Replacement Therapy Solve Your Problems?

While some women scoot through menopause with nary a problem, others suffer. Frequent and extreme hot flashes, mood swings, insomnia and a host of other symptoms can make life challenging.

Hormone replacement therapy, or HRT, can alleviate or eliminate these discomforts, but it has possible risks. Is it right for you?

The short answer: Try other ways to curb your symptoms first. If they don’t work, use hormone replacement therapy for the shortest time possible, and of the mildest dose possible, to improve your quality of life.

What Is Hormone Replacement Therapy

When you stop menstruating, you enter menopause, the so-called “change of life.” Your body stops producing all the hormones it used to. If the transition is too uncomfortable, you might undergo hormone replacement therapy, which is also referred to as menopausal or postmenopausal hormone therapy.

HRT involves replacing the hormones your body no longer produces in abundance naturally with artificial versions. They can be introduced into your system via several methods:

  • Tablets or pills that you swallow
  • Pellets inserted under the skin
  • Implants
  • Vaginal inserts
  • Patches
  • Skin creams
  • Skin gels
  • Sprays for the forearm
  • Vagina rings
  • Skin patches

What Is in HRT?

There are three basic types of HRTs. The specific hormones you receive will depend on your body.

A combo. If you still have your uterus, you’ll probably receive both estrogen and progesterone or progestin. With this “combined hormone therapy,” estrogen will help alleviate most of your symptoms; progesterone will block the estrogen from going to the uterus, since HRT increases your chance of getting uterine cancer.

Estrogen alone. If you no longer have a uterus, you can use estrogen on its own since you won’t need the progesterone to protect you from uterine cancer.

Testosterone. Some women receive testosterone via pellets, which have been shown to alleviate symptoms of menopause. However, few women know about or use them.  The U.S. Food and Drug Administration (FDA) has not yet approved testosterone therapy, but it has been an option for years. The treatment has been licensed to use in England and Australia for more than six decades.

Hormone replacement therapy, especially the estrogen-based options, decreases hot flashes, night sweats and insomnia. It also has other benefits:

  • It can help build bone strength, which can keep osteoporosis at bay
  • It can make the vagina less dry, making intercourse easier without artificial lubricants
  • It might curb your chances of getting colon cancer

The Downsides of Hormone Replacement Therapy

HRT seemed like a miracle solution for women with severe menopausal symptoms, but in 2002 the Women’s Health Initiative released the results of a large study that showed the therapy comes with risks. Notably, the study found that women who had hormone replacement therapy were at greater risk for breast cancer and heart disease than women who didn’t have HRT. Further studies spelled out a more complex answer about who should and should not receive this treatment.

There’s no black-and-white answer as to when the benefits will outweigh the possible downsides. For example, you should not have hormone replacement therapy if you have a history of breast cancer; a family history of a BRCA gene; a history of stroke or thrombotic events such as transient ischemic attack (TIA); active liver disease; unexplained vaginal bleeding; or if you’re at high risk for endometrial cancer.

Alternatives to Hormone Replacement Therapy

It’s always best to try to feel better without introducing substances to your body. Lifestyle changes are your best first bet.

  • For hot flashes, crank up the air conditioning and/or sleep without clothing.
  • For vaginal dryness, insert topical estrogen products (ask your doctor for a recommendation) into the vaginal canal. During sex, use a commercial lubricant or a natural one such as coconut oil.
  • For a variety of symptoms, add soy products to your diet such as tofu and edamame.
  • Talk to your doctor about trying low doses of antidepressants to treat vasomotor symptoms, including hot flashes and night sweats. Examples are the SSRI paroxetine, which has been approved by the FDA to treat hot flashes, as well other nonhormonal medications. Several, including clonidine and gabapentin, have not been FDA approved but have been shown to help.
  • Exercise regularly and take multivitamins. Both can help you feel more energetic.

If your menopausal symptoms are so bad that you can’t control them with non-medical means, you might improve your quality of life by having hormone replacement therapy. Go to your gynecologist for counseling and make an informed decision together.

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