Changes in hormones during the time leading up to menopause can affect women in numerous ways. This phase of life, called perimenopause, can last from a few years to several years. And for some, bothersome symptoms - like hot flashes, sleep changes, vaginal dryness, and more - may start to get in the way of daily life.
While your OB GYN can provide you with several options to help you manage the transition to menopause, some women choose to take hormone replacement therapy, called HRT. These medications can ease some menopause-related symptoms, but like any drug, they have both pros and cons.
How HRT works
As you begin the transition toward menopause, your levels of estrogen may rise and fall - eventually decreasing over time. Your body gradually makes less of the hormone progesterone as well. HRT contains synthetic forms of estrogen and progesterone or estrogen alone. These synthetic hormones help replace the hormones naturally made by your body.
Some forms of HRT are taken by mouth as a pill, come in the form of a skin patch or implant, or are in a gel that's absorbed through the skin. Other forms are considered local HRT, which means they are inserted directly into the vagina. Local HRT might include a tablet, cream, or vaginal ring.
Benefits of HRT
For many women, HRT helps reduce common perimenopause symptoms. For example, studies have shown that HRT can help treat:
- Hot flashes: Vasomotor symptoms, including hot flashes, are one of the main reasons women may choose to take HRT. According to the National Institute of Aging, HRT is a very effective treatment for hot flashes for women who can use it.
- Sleep changes and night sweats: As many as 40-60% of women report sleep disturbances during perimenopause, according to a review in Sleep Medicine Clinics. HRT may help reduce problems with night sweats and insomnia.
- Vaginal dryness: A review in the journal of Cureus says that treatment with hormone therapy using local estrogen products, such as creams, tablets, or rings inserted directly into the vagina, was considering the gold standard for care for vaginal dryness caused by changes in the genitourinary tract.
- Bone density: Bone density levels tend to decrease as women reach menopause. A study in JAMA found that nine months of HRT significantly increased bone mineral density levels measured in the lower spine of older adult women.
Risks of HRT
While HRT offers benefits for women, especially when it comes to symptom relief, it may not be the right choice for every woman. The American College of Obstetricians and Gynecologists says that more research is needed on how HRT affects conditions like heart disease and cancer.
In general, you should talk with your OB GYN about these risks before starting HRT:
- Estrogen-only HRT may increase the risk of endometrial cancer, and HRT with both hormones may increase the risk of breast cancer.
- Both types of HRT are associated with an increased risk of blood blots and stroke due to deep vein thrombosis.
- Using HRT, especially pills, may increase your risk of gallbladder disease.
Some medical conditions, like previous cancers or a history of blood clots may mean HRT isn't a safe option for you.
Weighing the benefits and risks
If you are considering HRT, talk with your OB GYN about your individual benefits and risks. To minimize risks, the National Library of Medicine recommends taking the lowest dose possible for the shortest amount of time it's needed. Each time you visit your OB GYN, you should re-evaluate whether HRT is still working for you and if you should continue to take it.
Whether you choose HRT or not, what's most important is that you do have options to help ease the symptoms of perimenopause. Your OB GYN can help you choose the type of HRT that fits best with your health history or provide alternative treatments that are hormone-free.