Hormone Therapy – Is it the Solution for Your Disruptive Menopausal Symptoms?

Night sweats soak your sheets and hot flashes strike in the middle of a sales presentation. Mood swings hit, along with vaginal discomfort and dryness. Are you one of the many women entering menopause whose quality of life is compromised due to these symptoms?

Once your primary-care provider assesses your individual risk factors, a form of hormone therapy (HT) may be prescribed to provide the much-needed relief you are seeking.

According to Deborah Gobel, CRNP at Women’s Institute for Gynecology & Minimally Invasive Surgery, LLC, in York, Pa., hormone therapy, also referred to as hormone replacement therapy (HRT), “is the medication prescribed for hormone replacement after a woman enters menopause, whether through the natural aging process or in a younger woman who has her ovaries removed and is then considered in ‘surgical menopause.’”

Gobel says the treatment (HT) to replace the female hormones that the body no longer produces after menopause can be administered in a wide variety of methods, “from oral to transdermal (through the skin) with patches, gels, sprays, and creams, in addition to subdermal implants of pellets containing hormones.”

A fact sheet on the website of the American College of Obstetricians and Gynecologists describes hormone therapy as either systemic or local, depending on where and how the hormones work in the body.

“With systemic hormone therapy, hormones are released into the bloodstream and travel to the organs and tissues where they are needed in forms such as pills, skin patches, and gels and sprays applied to the skin,” says Gobel.

Local estrogen therapy is when the estrogen prescribed is released in small doses into the vaginal tissue via a vaginal ring, tablet, or cream to help relieve dryness and irritation.

While no longer prescribed to prevent heart disease or memory loss, hormone therapy can relieve the most common menopausal symptoms, including the type that Gobel refers to as “bother symptoms,” in addition to those that “interfere to such a degree that a woman’s quality of life is compromised.”

And apparently HT can have a positive effect on cholesterol, according to a study published in 2002 by the Women’s Health Initiative (WHI). Study findings indicate that the estrogen component in HT can increase your HDL, or what is known as good cholesterol, and decrease your LDL, or bad cholesterol.

So if you’ve reached the age of menopause and your daily life is consistently interrupted by “hot flashes” or by profuse sweating, your care provider may recommend hormone therapy to combat those recurring symptoms.

“Even more bothersome for women,” says Gobel, “are ‘night sweats’ that cause them to experience disturbance during their hours of sleep, and thus render them sleep deprived and less able to function during their day time hours.”

Some women report additional symptoms, including fatigue, perceived memory issues, muscle and joint pain, mood swings, and depression, which Gobel suggests could all be related to the lack of quality sleep rather than a direct result of menopause.

These are the symptoms from which Gobel says women can find relief with hormone therapy, thus creating a “general improved sense of well-being,” which, in turn, allows menopause to be experienced in a more positive light.

As energy levels and mood swings improve, Gobel says many women report feeling less overwhelmed during their waking hours—another positive result of HT.

Other common symptoms some women experience include vaginal pain, itching, or burning and dryness or discomfort with sexual activity. If this is the sole symptom reported, Gobel says, “It can be effectively treated with vaginal estrogen creams, tablets, or other modes of delivery directly into the vagina.”

She adds that a minimal amount of vaginal estrogen in the form of vaginal tablets can be administered transvaginally two to three times a week at bedtime, even if a woman has had breast cancer and for whom systemic HT should not be prescribed.

In addition to all women who have had breast cancer and thus should not undergo HT, there are further risk factors that preclude certain women from being viable candidates for HT.

Gobel says that list includes “women who have had a history of cardiovascular disease, stroke, or blood clots in the legs or lungs; some auto immune diseases; and other GYN cancers.”

Other contraindications, she says, “may include those women with a strong family history of breast cancer, women who are currently receiving treatment for high blood pressure or high cholesterol, those diagnosed with obesity/morbid obesity, and those who smoke.”

As with medication in general, there are risks of possible side effects when HT is prescribed. Gobel says they range from mild and bothersome to serious and life threatening and adds that all potential side effects should be fully discussed by your primary healthcare provider prior to the administration of HT.

“You should be well informed,” she says, “of the signs leading up to a potentially life-threatening side effect along with the less common, bothersome symptoms, so you are aware of what may be a normal side effect and what may be something that warrants investigation by your provider.”

She also recommends beginning with the lowest possible dose of HT, whether you are being treated for hot flashes or dryness and thinning of vaginal tissues.

The good news is that Gobel says many of the common, “bothersome” symptoms diminish within the first few months of the commencement of HT, further confirming that the sharing of pertinent “information from the start is paramount” to all women who undergo HT.

There should be a discussion of the more severe, potentially life-threatening side effects, including cancers of the reproductive organs—the uterus, ovaries, or breasts; risks of a cardiovascular event, such as a heart attack or stroke; and the possibility of the formation of blood clots in the lungs or legs.

Any woman exhibiting signs of these conditions should immediately discontinue HT. Any woman with a history of these conditions, Gobel says, should never be prescribed HT from the outset.

Less serious side effects to be aware of include fluid retention, weight gain, irregular bleeding in the post-menopausal state (if the woman has a uterus), mood swings, breast tenderness, and acne.

Gobel says that women with an intact uterus who may experience post-menopausal bleeding must be evaluated by a healthcare provider to rule out a pre-cancer or cancerous condition of the uterus.

Besides treatment for a range of life-disrupting menopausal symptoms, HT was formerly prescribed to help prevent cardiovascular disease. Gobel says HT should not be initiated or continued to prevent heart disease, as it does not prevent and may increase the risk of CVD in women who initiate therapy years after menopause.

The “window of opportunity,” Gobel says, “is such that HT does not increase CVD in women who initiate therapy close to the onset of their menopause (within five years of last menses).”

Even if your health risks are low and the benefits are great, how long you should be on HRT is another consideration. Gobel says she usually recommends the shortest time possible, although “use of vaginal estrogen can be for decades, as it does not have the systemic impact/absorption as do the other modalities of delivery of HRT.”

She is also partial to transdermal delivery and takes the “less is more” approach. Gobel says she is “pro hormones when prescribed with caution and consideration for each individual woman,” and stresses that “individual tailoring to each woman’s needs based on symptoms is very important.”

With so many options available today, all risks and quality-of-life issues must be thoroughly discussed, evaluated, and weighed before deciding on short- or long-term HT use. BW