From hot flashes to insomnia, menopause and its unpredictable symptoms can be an unwelcome visitor.
Although it’s sometimes ominously referred to as “The Change,” it doesn’t have to be scary.
“Some lucky women breeze through menopause no problem,” says Ngozi Uzogara Wexler, MD, medical director of the Ob/Gyn department at MedStar Montgomery Medical Center. “But for many others, hormonal changes cause symptoms that may really affect quality of life.”
During menopause, menstrual periods stop and the ovaries no longer produce estrogen. “The average age of menopause is 51, but this varies quite a bit,” says Dr. Wexler. “Many women experience menopause like symptoms for years leading up to full menopause, a period called perimenopause that often begins during your 30s or 40s.”
As hormone levels change, some women experience symptoms beyond changing menstrual cycles. These can include hot flashes, sleep problems, night sweats, vaginal dryness, decreased libido, mood swings, and weakening bones. Hormone replacement therapy, or HRT, is one treatment option for reducing those symptoms and regaining a sense of control.
“HRT comes with both risks and benefits, so there’s a lot of confusion about whether or not this treatment is recommended,” says Dr. Wexler. “Long story short? Every woman is different.”
HRT involves taking estrogen to supplement the body’s diminishing natural supply. For women who are only suffering from vaginal dryness, estrogen may be taken in a “local” application as a vaginal ring, cream, or tablet. Women with other symptoms can take the hormone “systemically” in the form of a pill, cream, gel, patch, spray, or vaginal ring. Most women who have not had a hysterectomy also take a hormone called progestin, which helps reduce the risk of uterine cancer.
For many women, HRT brings relief from pain and discomfort—both mental and physical. Plus, systemic HRT can help prevent hip and spine fractures, and combined estrogen and progestin therapy can reduce the risk of colon cancer.
The downside? Research has shown that HRT can slightly increase the risk of heart disease in older women, breast cancer in women who take combined estrogen and progestin therapy, stroke, and blood clots. The risks vary based on age, how long you’ve been in menopause, whether progestin is administered along with estrogen, the hormone dose and delivery method, existing medical problems, and family history.
HRT presents the lowest risks and highest benefits to women with severe symptoms brought on by early menopause or a hysterectomy (surgical menopause). Risks increase with age—but, depending on individual factors, may still be outweighed by the benefits. To reduce risks, your doctor will prescribe the lowest effective dose and see you for regular follow-up care.
For women for whom HRT is not the best option, there are many alternatives to consider. A class of antidepressant medication called SSRIs can often help with hot flashes and non-hormonal vaginal moisturizer can help treat dryness. Exercise and acupuncture can also reduce symptoms.
“If you’re suffering with menopause symptoms, it’s worth talking to your doctor about all your treatment options,” says Dr. Wexler. “There are so many effective ways to get you feeling better—just ask.”