Curious about whether HRT for menopause is right for you? We’ll give you the lowdown here, including how it can help and when to be cautious.
If you’ve started looking into HRT, meaning Hormone Replacement Therapy, for your menopause symptoms, you may have come up against a whole bunch of sometimes conflicting advice.
Don’t worry — we’re here to clear the air so you can decide whether it’s a path you want to explore.
And before we get going, know that this is most certainly a journey you want to go on with your doctor.
So while we can help you sort through the facts, the next step is to give your healthcare provider a call so that you can explore your options.
With that in mind, let’s dive in.
In this article: 📝
- What is menopause, exactly?
- What is HRT?
- What are the signs that you need hormone replacement therapy?
- When should you start taking hormone replacement therapy?
- What exactly does HRT do?
- How does HRT make you feel?
- What are the HRT side effects?
- How long does it take for HRT to kick in?
What is menopause, exactly?
Technically, you enter menopause on the day twelve months after your last period.
It usually happens somewhere in your late 40s or early 50s, but there are outliers.
People who have their ovaries removed, for example, will go through menopause after the surgery, and there’s a strong genetic component in the early menopause mix too.
As your reproductive years come to an end, your body goes through a big transformation.
There are some perks — like no longer having to factor menstrual wear into your budget.
But there can also be challenges to deal with.
You know — the infamous night sweats, vaginal dryness, sleep disturbances, migraines…
For some, these symptoms are a mild annoyance.
For others, they’re downright disruptive.
Many menopause symptoms are related to the hormonal changes your body goes through at this time.
One of the headline sex hormones, estrogen, is responsible for managing your menstrual cycle, but it also helps out with other body functions.
It’s linked to bone and brain health, as well as the urinary system.
After menopause, your ovaries stop producing estrogen as it’s no longer needed to manage your monthly cycle.
But, unfortunately, your hormone levels don’t tend to wind down smoothly.
During perimenopause (that’s the time leading up to when your period stops), estrogen levels can dip or spike before they eventually drop off.
Researchers think that this hormonal rollercoaster is one of the main reasons for uncomfortable menopause symptoms like the hot flash.
What is HRT?
HRT stands for Hormone Replacement Therapy.
The term refers to different types of medication that can balance out the sex hormones in your body.
You may be familiar with the typical use of HRT for women experiencing menopause symptoms.
This is also referred to as menopausal hormonal therapy.
But there are various other reasons you may undergo HRT, including birth control, treatment for certain cancers, and transitioning from the sex you were assigned at birth.
What are the signs that you need hormone replacement therapy?
Menopausal hormonal therapy can relieve symptoms associated with menopause.
(We’re looking at you, hot flashes and vaginal dryness.)
So if you’re experiencing menopause symptoms, it may be worth looking into HRT.
HRT can also protect your long-term health by helping to prevent bone loss and osteoporosis.
And it’s been proven to reduce the risk of fractures.
When you hit menopause — defined as twelve months after your periods stop for good — your ovaries stop producing high levels of estrogen and progesterone.
That’s because these hormones are no longer needed to maintain your menstrual cycle or support pregnancy.
For many people, the menopause transition happens around their late forties or early fifties. But that’s not the case for everyone.
Some people go through surgical menopause earlier than this if their ovaries are removed, meaning their hormone levels are also affected.
Lower levels of these hormones — particularly estrogen — can impact our overall health and well-being in various ways.
The most notorious are vasomotor symptoms.
They include hot flashes (surges of heat through your upper body) and night sweats, which can be disruptive for some people.
Lower estrogen levels also impact your lower half.
What is known as Genitourinary Syndrome of Menopause (previously called vaginal atrophy) includes symptoms that impact your reproductive and urinary systems.
Some of the most bothersome symptoms include vaginal and vulval dryness and irritation, and pain during sex (called dyspareunia).
And it’s not uncommon for your bladder and urethra to get an invite to the party. You may need to pee more frequently and/or feel discomfort when you do.
Urinary Tract Infections (UTIs) are the most common reason for antibiotic prescription in older adults.
And there is a clear link between lowered estrogen and these conditions.
How do I know if I need hormone replacement therapy?
If you’re experiencing menopause symptoms that are getting in the way of your daily life and causing you distress, HRT may be a good option for you.
HRT can help with the following symptoms:
- Vasomotor symptoms (i.e. symptoms related to your blood vessels and how they narrow or dilate), including hot flashes and night sweats.
- Vaginal dryness
- Mood swings
- Itchy skin
- Brain fog
- Joint pain
- Sleep disturbances
- Hair loss
Some studies have also shown that estrogen therapy can help prevent osteoporosis and lower the risk of a range of other health conditions, including diabetes and colon cancer.
When should you start taking hormone replacement therapy?
It’s up to you to decide if HRT is an avenue you want to explore.
But if you do decide to take HRT, you can usually start once you begin to develop menopause symptoms.
This is typically between the ages of 45 and 55, but we’re all unique and have different timelines and needs.
The best thing to do is check in with your doctor to see if HRT is right for you.
They’re the best person to tell you if, when, and how long you should take it.
The menopause transition can be filled with all sorts of ups and downs.
Not only do you experience major physical shifts but it’s also a time of life that can be filled with serious life transitions.
For many, changes to career and family can be destabilizing at this time.
If you’ve had fertility struggles, menopause can also be an emotional experience.
What exactly does HRT do?
HRT can help to increase the estrogen levels in your body.
This gives you a reprieve from the symptoms caused by low estrogen levels.
There are various options for HRT that can be prescribed depending on your particular symptoms, health profile, and family history.
Because there are risks and side effects involved, your first step is to talk to your doctor to see if HRT is right for you.
Both non-hormonal and hormonal treatments are available for the treatment of these menopausal symptoms.
So if HRT is not the route for you, don’t be disheartened.
If HRT is appropriate for you, there are different avenues you can take.
It’s loosely divided into two categories: estrogen-only therapy and estrogen plus progesterone/progestin therapy (also called combination therapy).
Here’s what to know about each.
This is an estrogen-only option.
It comes as a pill, patch, vaginal ring, cream, gel, and spray.
It’s an effective treatment for a bunch of menopause symptoms, most notably hot flashes and night sweats.
It also staves off the risk of osteoporosis.
Lower-dosage estrogen treatments are also available to relieve the genitourinary symptoms of menopause.
They come in pill, vaginal ring, and cream form.
If you still have your uterus (i.e., you haven’t had a hysterectomy), you will likely be prescribed a combination of progesterone and estrogen.
That’s because estrogen on its own may increase your chances of uterine cancer.
Up until you reach menopause, estrogen is responsible for the build-up of the endometrium (the lining of the uterus) to prepare your body for the implantation of a fertilized egg every month.
And your body has an in-built way of flushing out extra tissue — your period.
But if you are no longer having periods, there’s no place for this lining to go.
That means there’s the potential for excess build-up, which can lead to cancer.
Luckily, adding progesterone to the mix can help stave off this risk because it thins the endometrium.
How does HRT make you feel?
So we’ll give you the good news and the bad news here.
If you’ve been struggling with menopause symptoms like hot flashes and vaginal dryness, HRT could relieve your suffering.
It may even help out with other symptoms like menopause itch.
And while you may not explicitly notice the effects, HRT can improve your bone health, reducing your chance of osteoporosis.
It may even lower your risk of colon and breast cancer and diabetes.
But it’s not without its risks.
What are the HRT side effects?
According to the National Cancer Institute, research has shown that HRT could have these side effects:
- More vaginal bleeding
- Increased risk of dementia for women on HRT older than 65 years old
- Greater risk of stroke, blood clots, and heart attacks. (Importantly, this risk dropped off once they stopped taking the medication.)
The NHS in the UK also reports that you may feel unwell when you start taking it and might have breast tenderness, headaches, and indigestion.
It also increases the risk of breast cancer, particularly with long-term use.
And there are conflicting reports on the link between HRT and dementia.
Some studies say it reduces the risk and some say that people on HRT are more likely to develop dementia.
With this in mind, the usual recommendation from health professionals is to take HRT at the lowest dosage for the shortest amount of time.
And HRT is probably not suitable if you have added risks of certain health conditions, including high blood pressure and liver disease.
It’s important to understand that the hormones in HRT are not identical to those produced by our bodies.
They either come from plant or animal sources or are made in a lab.
And while those prescribed by a doctor are approved for safety, there are a number of menopause products available without a prescription that are not approved by the FDA and have little scientific evidence to back them up.
Because of the potential health risks of HRT, experts recommend that you take the lowest dose you need to alleviate your symptoms.
And some people should steer clear of it completely.
HRT is likely not appropriate for you if you have had or have:
- Endometrial or breast cancer
- Blood clots
- A high risk of having a stroke or heart attack
- Liver disease
- Abnormal vaginal bleeding
Luckily, there are other options available.
The FDA has approved the use of a drug called Paroxetine for the treatment of hot flashes.
And recent research has shown that Cognitive Behavioral Therapy (CBT), a form of talk therapy, can help reduce symptoms too.
Alternative therapies like mindfulness meditation and acupuncture show promising results.
And there are plenty of “natural remedies” on the market that claim to relieve menopause symptoms.
But these supplements, essential oils, and herbal remedies are not well-regulated or studied, so ask your doctor if they’re a good idea before going ahead.
How long does it take for HRT to kick in?
It may take a bit of time for your menopause symptoms to ease up once you start taking HRT.
Your doctor may suggest you try it for three months to see if it works for you.
And they may adjust your dosage along the way.
It’s important to know that other treatments are available if HRT is not right for you.
The FDA has approved an SSRI (used to treat depression, amongst other conditions) called paroxetine for the treatment of hot flashes.
Alternative therapies like mindfulness meditation and hypnotherapy are also showing promise in early trials.
And some women have found treatments containing phytoestrogens (estrogen-like compounds that occur in plants) to be effective in the treatment of some menopause symptoms.
But it’s important to note here that the research is very young here, and we don’t have long-term studies of the safety of many of these products.
It does seem hopeful, though!
Whether you are experiencing severe symptoms or not, this time of life can be challenging.
Seeking support in the form of group or individual therapy can go a long way.
Cognitive behavioral therapy (CBT), for example, has been proven to help with a range of symptoms you may be experiencing at this time, from anxiety to sleeplessness.
And leaning on each other can also really help.
That’s what your Peanut Menopause community is here for.
You don’t have to do this alone.