Hormone therapy for menopause? 2023

Hormone therapy, also known as hormone replacement therapy (HRT) or menopausal hormone therapy (MHT), is an effective method for treating menopausal symptoms. But it’s not for everyone, cautions Monica Christmas, MD, Director of the Center for Women’s Integrated Health and the hospital’s Menopause Program at the University of Chicago Medicine.

Depending on a person’s age, medical history, and family history, medication-related complications may include an increased risk of cancer, dementia, blood clotting, heart attack, and stroke.

Hormone therapy (HT) helps to replace the hormones that your body ceases making due to menopause. The cessation of hormone production, particularly estrogen, can result in life-disrupting symptoms, such as night sweats, hot flashes, and vaginal dryness, which can contribute to painful sexual and urinary symptoms.

Christmas prescribes HT to patients with these symptoms on a regular basis and has found it to be exceedingly beneficial. However, not all individuals with hot flashes and nocturnal sweats qualify for HT. Christmas stated that nonhormonal therapies can alleviate menopausal symptoms when HT is contraindicated due to elevated risk factors or for individuals who prefer to avoid HT.

“If you are going to use HT, you should begin it close to the onset of menopause and have your doctor monitor you routinely. You must ensure that the benefits outweigh the hazards,” she explained.

If HT is initiated more than 10 years after the onset of menopause or after age 60, the risks outweigh the benefits.

Who benefits from hormone therapy?

If you do not have significant risk factors such as a history of certain malignancies, heart disease, stroke, or deep vein thrombosis (DVT), you may benefit from hair transplantation if you meet at least one of the following criteria:

• Have moderate to severe hot flashes or nocturnal sweats
• Have moderate to severe vaginal dryness, irritation, burning, pain, or bleeding during sexual activity; have urinary frequency or urgency; or have urinary tract infections.
• Experience menopause before age 45
• Predisposed to develop osteoporosis

Exist in various forms of hormone therapy?

There are two categories of HT: systemic therapy (higher dosages) and local vaginal hormone therapy (lower doses).

Systemic HT is used to treat night sweats, heat flashes, premature menopause or to help prevent osteoporosis. The medicine is available as oral tablets, transdermal patches, a high-dose vaginal ring or emulsion.

For patients with a uterus, progesterone or a selective estrogen receptor modulator (SERM)) will need to be added to their HT regimen. There are some medications and patches that contain both estrogen and progesterone, or estrogen and a SERM. For those without a uterus, they will only need estrogen therapy to manage their symptoms.

Low-dose, local estrogen therapy is applied directly to the vagina to assist with vaginal and urinary symptoms. Because there is minimum systemic absorption, low-dose estrogen therapy can be initiated at any point after menopause without limits on duration of use. Low-dose estrogen therapy options include vaginal ointment, vaginal tablets or a low-dose vaginal ring. Progesterone supplementation is not required.

What options do I have if I do not want or cannot take hormone therapy?

Other treatments can help manage heat flashes, night sweats, and vaginal symptoms if you are unable or unwilling to take hormone therapy. It has been demonstrated that certain antidepressants, in conjunction with other therapies such as cognitive behavioral therapy and hypnosis, can reduce the frequency and discomfort of heat flashes and night sweats.

Soon, a new class of medications will be available for the treatment of symptoms. In clinical trials, herbal supplements marketed to alleviate menopausal symptoms did not perform better than placebos.

There are two medications licensed to treat vaginal and urinary symptoms associated with menopause that do not contain estrogen: oral osphemifene and a vaginal DHEAS (steroid) insert. In addition, over-the-counter vaginal moisturizers and lubricants can help reduce vaginal dryness and discomfort during sexual activity.

Christmas makes it a priority to discuss healthy lifestyle interventions with her patients to ensure that they are doing everything possible to improve their overall health and well-being during menopause and beyond. The importance of nutrition, regular exercise, and self-care cannot be overstated.

Is hormone replacement therapy covered by health insurance?

It depends. Not all medications may be covered. When treating symptomatic menopausal patients, Christmas is frequently most frustrated by insurance coverage, or the lack thereof. Frequently, certain medications are reimbursed by the patient’s insurance, but they are not the treatments that patients prefer.

For instance, the vaginal ring with a higher dose will treat both heat flashes and night sweats, as well as vaginal symptoms. It only requires vaginal placement every three months. Neither the patient nor their companion will know it’s there. It is a highly desired option for the majority of people due to its usability and convenience. Despite all of these advantages, it is frequently excluded from the insurance company’s formulary (list of approved medications).

Talk to your clinician to determine the best option for you.

What if my only menopausal symptom is vaginal?

Hot flashes and night perspiration will get better over time on their own, but vaginal systems will get worse if not treated. Once menopause begins, it is essential to report any vaginal pain, itching, or other symptoms to your doctor.

The takeaway is that HT can be a safe, effective treatment for many. However, it is essential to consult with your physicians to determine if this is the best option for you.