Menopause can be unpleasant, whether you’ve reached that stage in your life now or it’s coming on the distant horizon. Hot flashes, moodiness and other symptoms can turn some women’s lives upside down.
Menopause in Brief
If the middle school and high school years were marked by “raging hormones,” then the late 40s and early 50s should be known as the “great hormone slow down.”
Around this time, women have moved out of their childbearing years and no longer need certain hormones—estrogen and progesterone—to sustain a pregnancy. This natural process, known as menopause, leads to those unwelcome symptoms such as hot flashes, vaginal dryness, moodiness, and even insomnia.
Because of the way hormones work in the body, hormone therapy should involve a physician.
Additionally, certain cancers are disqualifiers for treatment. If a woman has breast cancer that is estrogen-progesterone positive or uterine cancer, hormone replacement therapy is not prescribed because estrogen feeds into the cancer.
That’s why many women turn to hormone replacement therapy, which boosts the low levels of estrogen and progesterone that cause the symptoms associated with menopause. But, as with any medical intervention, it comes with certain risks. Here are three simple things to consider if hormone replacement therapy might be right for you.
Know Yourself
Menopause and the effects it has on the body can vary widely among women and involve many factors. Understanding your personal health and your own body is key.
“The average age that a woman goes through menopause in the United States is 51 or 52,” says Dr. Diana Kumar, an obstetrician and gynecologist with SCL Physicians. “Sometimes this happens earlier because of premature ovarian failure, smoking, chemotherapy, or surgery; if you take out the ovaries, a woman will go through what we call ‘surgical menopause.’”
Regardless of how and when a woman arrives at menopause, symptoms vary from woman to woman. “These symptoms can last anywhere from a couple months to 10 years,” she says. “That’s why some women come in looking for a solution.”
Taking estrogen or a combination of estrogen and progesterone can help to combat the discomfort of menopause such as hot flashes, moodiness, vaginal dryness and insomnia. However, these can lead to an increased risk for certain health conditions, such as stroke, blood clots in the legs, and cardiovascular disease.
If a woman still has a uterus, it’s important that she also gets progesterone to prevent endometrial hyperplasia, which is a precursor to endometrial cancer.
Like menopause, hormone replacement therapy is temporary. “Our goal as OB-Gyns is to treat your symptoms with the minimal dose of hormones for the shortest amount of time,” says Dr. Kumar.
Beware of Quick Fixes
Some women have turned to herbal remedies to help them through menopause, a practice some physicians do not generally recommend.
“There’s a whole line of natural remedies, however the American Congress of Obstetricians and Gynecologists' stance is that there is limited data to suggest benefit currently. Many of my patients do take them and believe they help…black cohosh, ginseng, and dong quai…but these all have their own risks. For example, you do not give black cohosh to someone with liver disease. With dong quai, there’s a theoretical risk of bleeding, so if someone is on a blood thinner, they shouldn’t use it.”
On a similar note, there are two types of bioidentical hormones. "There are the FDA-approved ones—these are the ones I prescribe—and the compounded ones from a pharmacy that may be advertised as plant-based or all natural,” says Dr. Kumar. “Phytoestrogens, such as soy products, are touted as natural sources of estrogen, but again, these products are not FDA-approved and have limited long-term data to suggest benefit.”
Talk to Your Doctor
Ultimately, if you are considering hormone replacement therapy, it begins and ends by having an informed conversation with your doctor. He or she can help you decide if it is right for you, and which method works best. “We give estrogen several different ways: a pill, a cream that can be put in the vagina, a spray that can be absorbed through the skin, a patch, and something called the Estring, which is like a little ring that goes into the vagina and secretes estrogen,” says Dr. Kumar.
Learn more about hormone replacement therapy from our health library.
