Hormone Replacement Therapy: Is it right for you?
by Anjeanette T. Brown, MD, FACS, Physician
photo by Girl with red hat for Unsplash
“It’s the fountain of youth, the rejuvenation of all things young and beautiful! It’s Hormone Therapy.”
I’m speaking to you ladies. Yes, you out there struggling through perimenopause with the interrupted sleep, low energy, hot flashes, weight gain, vaginal dryness, extra emotions, thinning hair, dry skin, and loss of breast fullness.
Can we talk?
I know you’re feeling tired, sweaty, fat, dry, with thinning hair and floppy boobs—All things SUPER sexy and desirable. And yes, I am being completely sarcastic.
I’m a surgeon who specializes in breast cancer, and I have also grappled with perimenopause at age 52. It’s not just my patients.
So how did we get here?
There are four main ways you reach this point: nature, surgery, cancer therapy, primary ovarian insufficiency. Let’s take a look at them.
The changes your body is going through can be caused by a natural progression from perimenopause to menopause (menopause is diagnosed after 12 consecutive months of being period-free).
Or, it can be from surgery like a hysterectomy or hysterectomy with ovaries removed. Note: if only your uterus is removed, then you still have some hormone production from retained ovaries. But if the ovaries are removed as well, then menopause is immediate.
It can be caused by Chemotherapy and Radiation Therapy. These cancer therapies can induce menopause. This should reverse after you stop treatment. Radiation will affect ovaries only if it’s administered in the pelvic area. If it’s administered to the other areas (like breast, head and neck), it will not start menopause.
Lastly, there’s primary ovarian insufficiency. This can occur in 1% of women under 40, leading to premature menopause. This is due to the ovaries not producing enough hormones for reproduction. This condition can be from an autoimmune disease or genetic disease.
Now, about those ovaries and their hormones.
The ovaries are responsible for progesterone and estrogen production, with egg release as the primary goal. But progesterone and estrogen are also important for brain, heart, and bone health.
That’s why after menopause, there is an increased risk for some medical conditions: cardiovascular disease (heart and blood vessels), osteoporosis (bone weakening), urinary incontinence (involuntary urine loss and/or urge or stress like when laughing), sexual dysfunction (decreased moisture and elasticity), and weight gain to name a few.
Given these increased risks, along with those super sexy and desirable things I mentioned before, of course you’re asking, What can I do?
There is an answer. It’s the fountain of youth, the rejuvenation of all things young and beautiful! It’s Hormone Therapy.
First, let’s discuss the different type of meds used for different issues:
Got hot flashes or night sweats (otherwise known as VasoMotor Symptoms), weight gain, bone loss,hair thinning?
Your doctor may recommend the daily pill and patch. They’re the most popular. There’s also gel or spray-systemic therapy.
Dealing with vaginal dryness or incontinence?
You might go for a low-dose vaginal product in the form of a vaginal ring, cream, or suppository.
With any of these methods, the primary goal is to replace the estrogen lost after menopause.
If your uterus is intact, doctors will suggest combination therapy. This protects the overgrowth of cells that could lead to uterine cancer with estrogen alone. But if you don’t have a uterus, there’s no blend needed for protection.
Who should avoid HRT?
You should know that studies have shown that some ladies should consider risks depending on the following factors: age, type of hormone therapy, health history and family history.
All of this is to say, it is a highly individualized process that can benefit healthy women with hot flashes, vaginal dryness/ itching/burning, prevention of bone loss/fractures, or early menopause.
So talk to your doctor to choose the best strategy and medications for you!
Ask about the delivery system (pill, patch, gel, spray, cream). Ask about minimizing the amount that is taken to prevent symptoms. Go to regular follow-ups for surveillance. Support your therapy with healthy lifestyle choices (healthy diet, activity/exercise, no smoking, lower stress).
What if you’re not a candidate for hormones?
We do have some options for non-hormone replacements: Keep a fan handy, limit caffeine and alcohol (as much as you can, I’m not going to suggest taking everything away from you), and practice relaxation techniques.
I know, I know. These aren’t great solutions, but they’re something.
Keep vaginal lubricants nearby. Do keep in mind that while they can help with intercourse, unfortunately they don’t thicken the vaginal lining to premenopausal levels.
Some other medications that have been helpful include antidepressants (paroxetine or gabapentin), and CAM (black cohosh), soy products (phyto-estrogen), and red clover. But these can have side effects as well. You’ll want to talk to your doctor about them.
Finally, here’s where I tell you the thing you don’t want to hear.
There are no great answers! Unfortunately, this time of life sucks for those suffering with menopause (me included). As a woman fighting the war of aging, eating well, exercising, watching your weight, trying to limit sugar, reduce my stress (yeah, right?), getting enough sleep (uh..ok), and trying to enjoy life, all I can say is, It’s a lot, I know.
So be informed. And do your best to be well!
Anjeanette Brown, MD, FACS is board-certified general surgeon, Certified by The American Board of Surgery, with a special interest in breast health. She is a member of the prestigious American College of Surgeons, Society of Surgical Oncology and The American Society of Breast Surgeons.
Dr. Brown is passionate about patient care, as well as educating others about the detection, diagnosis and treatment of breast cancer. With continuous research and mentoring, she has published several abstracts and has presented at multiple surgical conferences and events.
You may also enjoy…
