Hormones have always been good at messing with us. They get a bad rap, but we need hormones to regulate all of our bodily functions, from hunger to emotions.
During puberty, they transform many of us into moody, confused teenagers with a penchant for slamming doors and sulking. As we get older, our hormones can tell us precisely when we’d be getting our periods (perhaps even turning us into another version of our moody teenage selves). During perimenopause, estrogen hormones decrease which can lead to an all-new set of hormonal woes: hot flashes, sleeplessness, weight gain, vaginal dryness, and mood changes, to name just a few.
That’s why hormone replacement therapy (HRT) has become so popular. It sounds good in theory: With HRT, you replace the estrogen and progesterone that your body no longer produces on its own. But it’s not right for everyone, and it comes with some risks. Here we answer a few frequently asked questions.
Does everyone need HRT after menopause?
Not every woman will need hormone replacement therapy. But according to the Mayo Clinic, it could be something to consider if you identify with any of the following:
- You’ve experienced early menopause (before reaching 40)
- You’ve moderate to severe hot flashes and other menopause symptoms
- You’ve lost bone mass and have tried other treatments
How do I know if HRT is right for me?
Some doctors say that HRT could be an option for women younger than 60, within 10 years of menopause, and with no family history of breast cancer. The older you begin the treatment, the more you elevate your risks of heart disease, stroke, blood clots, and dementia. Menopause symptoms vary drastically from woman to woman, so talk to your doctor about treatment options for menopause symptoms that are right for you.
Are there risks in using HRT?
There are several serious risks associated with HRT. Women taking estrogen plus progestin are more likely to develop breast cancer, and that risk increases the longer those hormones are taken. Blood clots, stroke, and heart attacks are also more common in women taking either estrogen alone or estrogen with another hormone. Evidence suggests that the risk of getting dementia doubles for women over 65 taking estrogen and progestin. Finally, urinary incontinence is a risk for those taking both estrogen and progestin.
Studies have shown that women taking estrogen and progestin have an increased risk of breast cancer, and it’s more difficult to detect early on with a mammogram. However, once a woman stops hormone therapy, that risk goes right back down.
How do I use hormone replacement therapy?
There are a few different ways to take estrogen, including a pill, patch, gel, or vaginal suppository cream with a slow release. The pill is the most popular method, but there are pros and cons of each.
Oral estrogen on its own can lead to a greater risk of stroke and blood clots. When taken with progestin, it can also increase the risk of breast cancer and heart attack. It’s tough on the liver, so it isn’t recommended for those with liver damage.
The patch is a bit more convenient, especially for those who can never remember to take a pill regularly. The patch isn’t harmful to the liver either, so it’s a good option for those with liver damage. Some experts believe that the patch may not have as many side effects as the pill, but it may be too early to know for sure.
Estrogen gels are absorbed directly through the skin, and they’re another option for those with liver damage. The major downside to gels is that they haven’t been effectively studied yet, so there’s a lot we don’t know about their effectiveness.
Vaginal suppositories are applied directly to the vaginal area, either as a ring that you change every three months or via a tab that you use regularly. While suppositories may be effective for treating vaginal symptoms of menopause, they won’t help with other symptoms. They also have some of the same risks and side effects as the pill.
Will HRT make me gain weight?
No! This is a common misconception about HRT. While gaining weight is a frustrating reality for many menopausal women, studies have shown that HRT can actually help you lose extra belly fat. But here’s the kicker: Once you stop hormone replacement therapy, it’s likely that you’ll gain any weight you lost back. So if you’re thinking about HRT, or if you’re already using it, talk to your doctor about your long term plans and other options for weight loss during menopause.
What are natural alternatives?
From black cohosh for hot flashes to evening primrose oil for mood swings, Google leaves you thinking that there’s a natural supplement for every menopause symptom out there, and that simply isn’t true. Supplements aren’t regulated by the FDA, so we don’t have any substantial research that they actually work. And because they aren’t regulated, there’s no way of knowing how much of the product is actually in the pill bottle or what the appropriate dosage should be. Be sure to talk to your doctor before you try any supplement, for menopause symptoms or otherwise.