Hormone Replacement Therapy (HRT), now more commonly referred to as Menopause Hormone Treatment (MHT), is designed to supplement hormones that are lost during the menopausal transition. It uses low doses of estrogen, either as a monotherapy or in conjunction with progesterone, to manage menopausal symptoms and improve the quality of life during this transition. In this blog, we will delve into the types and forms of MHT, who are candidates for MHT, benefits, and potential risks and side effects of this treatment.
What Types of MHT Are Commonly Used?
MHT can come in a number of different forms and combinations.
- The main two groups of MHT are estrogen-only, and estrogen and progesterone combined therapies.
- Estrogen is used by itself for women who do not have a uterus, or in combination with progesterone for those with a uterus to protect the endometrial lining of the uterus. Estrogen therapy is primarily used to treat vasomotor symptoms (hot flashes and night sweats) and genitourinary syndrome of menopause (GSM) such as vaginal itching, dryness, irritation, and pain during sex.
- Progesterone is used in combination with estrogen, for those who have a uterus, to significantly reduce the risk of uterine, cervical, and vaginal cancer in women taking estrogen. Progesterone can also mitigate the symptoms of menopause, like night sweats, hot flashes, anxiety, and insomnia. Additionally, it may also improve brain function as well as breast, heart, cardiovascular, and nervous system health, and act as a natural antidepressant and therefore help with sleep.
- Testosterone is not currently approved by the FDA, but it can be used to address low libido and also help with brain fog, painful sex, fatigue, and weight gain. It’s important to have your doctor closely monitor testosterone levels to avoid side effects such as acne, hair growth on the face and body, hair loss on the head, and weight gain.
What Forms Is MHT Available In?
- Estrogen treatment types include pill, patch, gel, vaginal cream, suppository, and ring that is placed in the vagina. For those without skin sensitivities, the most commonly recommended form is a transdermal patch because it can provide more steady estrogen levels and has a lower risk of certain side effects. In addition, transdermal estrogen avoids passing through the liver, and can also decrease blood clotting risk. One note, those using a patch can also use vaginal estrogen if they have GSM symptoms that are not addressed with the patch.
- Progesterone is available in gelatinized capsules, gels, tablets, vaginal inserts, and injections. Progesterone should never be used as a cream since it can increase the risk of uterine cancer, and the large molecule does not absorb well through the skin.
- Testosterone is usually given as a cream or gel, which is rubbed into the skin so that it goes directly into the bloodstream.
Birth Control Pills
The pill isn’t typically prescribed for hot flashes or night sweats. However, it can help with those symptoms when it is prescribed for other reasons, which include bleeding issues, contraception, premenstrual syndrome (PMS), and premenstrual dysphoric disorder (PMDD). Many doctors start with low-dose birth control pills as a first intervention, especially when a woman is still having periods, because it provides contraception.
Candidates for MHT
For healthy women in their 50s, risks from hormone therapy are considered very low. For those who go through early menopause, before age 45, MHT is recommended to reduce the risk of osteoporosis. The medical community does not currently recommend starting HRT hormone therapy after age 60, as the data is limited. No definitive research has yet followed women who start in their 50s and stay on continuously into their 60s. Estrogen may not be recommended for people who are pregnant or breastfeeding, or who have a personal (not family) history of:
- Breast cancer, ovarian cancer, or uterus cancer
- Blood clots
- Heart disease or stroke
- Unusual vaginal bleeding
- Liver disease
In these circumstances, other medications and/or therapies may be recommended to help manage your menopausal symptoms.
Benefits of MHT
There are many other potential positive impacts of MHT.
- Vulva/Vagina: lessens vaginal dryness, pain, and itching; can decrease potential discomfort during intercourse and vaginal atrophy (thinning of lining).
- Sleep: improves sleep by decreasing anxiety, night sweats, and insomnia.
- Sex: makes sex less painful and increases libido.
- Bladder: strengthens the muscles of the bladder, which can reduce the frequency of urinary tract infections, urination frequency, and the risk of incontinence and other bladder problems.
- Weight Loss: can help with weight gain and assist in weight loss.
- Hot Flashes (Vasomotor): the most effective way known to reduce the frequency and intensity of hot flashes and sweats.
- Mood: curtails the frequency and severity of mood swings and decreases depression.
- Brain: helps improve concentration and focus; may reduce the long-term risk of Alzheimer’s disease and dementia.
- Anti-Aging & Skin: positively affects anti-aging of the skin by increasing skin collagen content, thickness, elasticity, and moisture levels, which results in the reduction of wrinkles and skin sagging.
- Muscles: maintains and enhances muscle mass and strength, while decreasing muscle aches and pains.
- Migraines: diminishes migraine symptoms and headaches.
MHT is not only effective for menopause symptoms but has been shown to reduce the risk of many other diseases. A pooled statistical analysis of thirty clinical trials found that women who began hormone therapy before age 60 had a 39% lower risk of death than women who didn’t take hormones. The North American Menopause Society, The American College of Obstetrics & Gynecology, the Endocrine Society, and at least 10 other medical associations in the US and abroad all agree that for the vast majority of healthy women, supplementing our body’s natural hormones as we age is the best way to treat menopausal systems, improve our quality of life and protect against many diseases. Longer-term, MHT can:
- Lower stroke risk
- Reduce the risk of cardiovascular disease
- Maintain bone density, thus reducing the risk of osteoporosis
- Improve insulin sensitivity, and reduce type 2 diabetes risk
- Lower the risk of colorectal cancer
- Protect the brain and reduce the risk of strokes and neurological diseases like dementia and Parkinson’s
What Risks and Side Effects Are Associated with MHT?
MHT may not be suitable for everyone. The age at which a woman begins hormone therapy is important for assessing the increased risk of heart disease, stroke, and dementia. Some of the potential risks and concerns associated with MHT include:
- Increased risk of blood clots
- Breast cancer risk, for some women
- Stroke and heart disease risk in some cases
- Endometrial cancer when estrogen is not used in conjunction with progesterone in women who have a uterus
Both estrogen and progesterone can have side effects including fluid retention, bloating, breast tenderness or swelling, headaches, indigestion, depression, and vaginal bleeding. Side effects usually improve over time, so it’s best to try the treatment plan you have been prescribed for at least 3 months.
How Long Can I Use MHT?
Generally, doctors like to prescribe the lowest dose for the shortest amount of time. There is mixed research regarding how long it’s safe to take MHT; a 2017 study found that taking MHT for five to seven years was not associated with long-term mortality risks. Current thinking may indicate that there is no established timeframe to stop HRT if it is still effective. As always, consult with your doctor.
What Are Alternatives to MHT?
For women who are not comfortable with MHT or have contraindications, there are alternative approaches to managing menopausal symptoms.
These alternatives include:
- Lifestyle Modifications: Adopting a healthy lifestyle with a balanced diet, regular exercise, and a good sleep regimen can help reduce the severity of menopausal symptoms. See Menowar’s blog on Changing Your Diet During Menopause for more information.
- Cognitive-Behavioral Therapy (CBT) & Hypnotherapy: CBT and hypnotherapy have both been clinically proven to women manage the emotional and psychological aspects of menopause.
- Herbal Supplements: Some herbal supplements, like black cohosh and soy isoflavones, have been reported to alleviate symptoms, although their effectiveness varies from person to person and there is no scientific data to support positive impacts.
- Mindfulness & Acupuncture: Meditation, yoga, and other mindfulness practices, as well as acupuncture, have had positive correlations to menopause symptom mitigation.
Summary
Menopause Hormone Therapy is a valuable option for women experiencing menopausal symptoms. However, it should be carefully considered in consultation with a healthcare provider due to its potential risks. Alternatives to MHT are available and may be more suitable for some individuals. Ultimately, the choice of treatment should be personalized to each woman’s unique needs and circumstances.
If you have any questions or want to work with Menowar on a customized menopause plan for you, schedule a free consultation here.
This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.
