The only certain things in life are death and taxes, they said.
But for millions of women out there, one more thing is certain: menopause.
From endless menstrual cramps, to excruciating labor and birth to raising kids and a man-child, you’d think the torture is over when your last kid leaves home, but nope.
Menopause just has to rear its ugly head.
Some women sail right through it; no sweat, no hair out of place.
For others, though, it’s a vastly different story.
If you’re one of them, this guide might just help you save your sanity – and a lot of bone.
Hormone Replacement Therapy (HRT) is the administration of the hormones estrogen and progesterone to a postmenopausal woman with the goal of replacing depleted hormone levels.
HRT continues to play an important role in the treatment of hot flashes, vaginal dryness, mood disorders, and insomnia that many menopausal women experience.
For most women women under age 60 years, the benefits of HRT far outweigh the risks. Although HRT has been linked to many side effects, including breast cancer, it is still the most effective treatment for menopause.
The most common reasons for starting HRT are:
- Vasomotor symptoms. VMS, including hot flashes, night sweats and palpitations, affect up to 80% of menopausal women. The main indication for HRT is to treat VMS.
- Urogenital symptoms. Vaginal dryness, painful sex, and painful and frequent urination affect more than 50% of menopausal women.
- Osteoporosis. Osteoporosis affects 1 in 3 postmenopausal women. It is a bone disease in which bone loses its density and becomes weak and brittle. Without the estrogen that previously protected the bones, these begin to break down more than they form.
- Premature ovarian failure
- Gender transitioning
- Surgical menopause due to medical causes or trauma
Absolute contraindications to HRT:
- Age 60 and above
- Active genital bleeding
- Hormonal cancer
- Current liver disease
- History of or active thromboembolic disorder
Caution is recommended to women with the following:
- History of breast or endometrial cancer
- High cholesterol
- History or current heart disease or congenital heart defects
- History of stroke
Estrogen alone or with progesterone remains the most effective therapy for hot flushes, palpitations, and night sweats. Whether oral, transdermal or vaginal, conjugated estrogen or estradiol, HRT reduces the frequency and severity of vasomotor symptoms by 65 to 90%. Most women feel relief within 8 to 12 weeks of beginning therapy.
Estrogen administered vaginally also provides relief from vaginal dryness, painful sexual intercourse and prevents recurrent urinary tract infections. It takes several months or longer to take effect. However, some studies suggest that the effects disappear upon discontinuation of therapy.
There is also strong evidence that HRT prevents further bone loss in menopausal women Studies have shown that HRT reduced nonvertebral fractures by 35% among women who started HRT before age 60. Other studies suggest that HRT increases bone mineral density by 5%, and reduces vertebral and hip fractures by 50%.
Estrogen treatment may also improve mood and manage depression. However, some women may need both HRT and an antidepressant to feel completely better.
Other benefits of HRT may include prevention of colorectal cancer, atherosclerosis, and Alzheimer’s and increasing muscle mass.
Read about the different types of HRT here.
For most women, using HRT for a max of five years at the lowest effective dose is safe and effective. Most risk factors associated with HRT increases with age and depends largely on current health status.
Both estrogen-only and estrogen plus progesterone HRT increase a woman’s risk for ischemic stroke, particularly during the first two years of starting treatment. Starting HRT before age 60 and using low-dose transdermal HRT may not have the same risk, however this is not been shown in controlled trials.
Starting HRT in women at ages between 50 and 59 may have some cardiovascular benefits, but in women above 60, HRT is more likely to worsen an existing heart disease or increase a woman’s risk of developing one.
Oral estrogen plus progesterone or estrogen alone causes blood clots in the lungs or even the brain in 2 per 1000 women. It appears that age, obesity, smoking, sedentary lifestyle and history of thromboembolic disease all increase these risks.
On the other hand, using transdermal HRT or cholesterol drugs with oral HRT can decrease risk for clots in postmenopausal women. Also, women who start HRT at an earlier age have lower risks compared to women over age 60.
Combined estrogen and progesterone causes breast cancer in about 5 per 1000 women. This risk decreases and returns to normal after five years of stopping HRT. Estrogen-only HRT does not increase breast cancer risk. Similarly, the Women’s Health Initiative found that the equine estrogen Premarin does not increase breast cancer risk when used for less than seven years.
On the other hand, estrogen alone HRT increases the risk for endometrial cancer, which is why it is only recommended for women who have had their womb removed.
Women are recommended to taper and completely stop HRT after four or five years to prevent increasing their risk of cancer. This can be hard for many women, though, since vasomotor symptoms especially hot flashes can last up to eight years.