Historically, women have viewed menopause with dread and misunderstanding. But sooner or later, we're all going to go through menopause. If you weren't sure before, the first hot flash could be enough to bring the truth home. Some women will only experience mild menopausal symptoms, but some women will suffer, throughout the day and the night, for years.
Note: This article focuses only on the relief of menopausal symptoms, but the estrogen (specifically estradiol) deficiency associated with menopause can have other important health consequences every woman needs to understand and discuss with her health care provider.
Many women turn to hormone replacement therapy to find relief. Hormone replacement therapy (HRT or HT) goes by many names. It's called menopausal hormone therapy, estrogen replacement therapy (ET), and estrogen plus progestogen therapy (EPT).
While hormone therapy is an area that can be confusing at first, learning a few definitions and descriptions can help bring some clarity.
Estrogen Therapy (ET)
Estrogen-only therapy is often the course recommended by doctors for women who have had a hysterectomy, which involves surgical removal of the uterus. Estrogen comes in the forms of nasal sprays, pills, patches, skin gels, vaginal creams, vaginal tablets, and vaginal rings. A low dose of estrogen is most commonly given daily through a pill or patch.
Most of these plant-derived products are bioidentical to a woman’s naturally-produced estrogen, which is called estradiol. There is also a class of products called conjugated estrogens, also made from plants. Finally, and most often prescribed, are conjugated equine estrogens, (CEE) available as pills and a vaginal cream. The FDA has approved these products and continually monitors them for product purity and consistency.
Combination or Estrogen Plus Progestogen Therapy (EPT)
Combination therapy (EPT) consists of an estrogen and a progestogen. This treatment is prescribed to women who still have a uterus. The addition of natural progesterone or a progesterone-like hormone is to protect the lining of the uterus from overstimulation by unopposed estrogen. Progesterone and progestogens come as pills, skin patches, and vaginal creams. All these products are approved and continually monitored by the FDA.
Compounded Bioidentical Therapy
Bioidentical hormones, like most prescription hormones, are derived from plants and are similar or identical to those our bodies create. Unlike commercial products, compounded therapy involves a custom-made, individualized treatment to fit the patient's needs and to circumvent any allergies or intolerances. This also allows for greater flexibility in dosage. The preparations are sometimes available for a lower price, though the salivary tests required to customize the compounds can be expensive. These tests are not considered a reliable measure of hormone levels in a woman’s bloodstream.
The North American Menopause Society has issued a concern regarding custom-compounded hormones, stating, ”No rigorous studies have been conducted to prove that these products are safe. There is less oversight for quality, purity, and consistency.”
Possible Hormone Therapy Benefits and Risks
Menopause symptoms such as hot flashes and night sweats, as well as associated anxiety, sleep issues, and vaginal dryness, may diminish or disappear altogether. The risk for osteoporosis may also decrease.
Women may face increased risk for blood clots, breast cancer, endometrial cancer, and uterine cancer. A woman's vulnerability to gallbladder disease and cardiovascular diseases such as heart disease, deep venous thrombosis, and pulmonary embolus, as well as stroke, may also rise with estrogen use. However, recent studies have found these risks to be lower than once reported for most women. According to MedlinePlus, “At this time, short-term use (up to 5 years) of hormone therapy at the lowest possible dose to treat the symptoms of menopause still appears to be safe for many women.”
Deciding whether or not to use hormone therapy requires research, thought, and discussion with your doctor. But if HT is right for you, you may be able to say goodbye to hot flashes and other unpleasant symptoms of menopause.
Hormone therapy. National Library of Medicine. Retrieved November 29, 2015. https://www.nlm.nih.gov/medlineplus/ency/article/007111.htm
Hormone Replacement Therapy for Menopause. WebMD. Retrieved November 29, 2015. http://www.webmd.com/menopause/guide/menopause-hormone-therapy
Conjugated Estrogens (Oral Route). Mayo Clinic. Retrieved November 29, 2015. http://www.mayoclinic.org/drugs-supplements/conjugated-estrogens-oral-route/description/drg-20075319
Compounded Bioidentical Menopausal Hormone Therapy. The American Congress of Obstetricians and Gynecologists. Retrieved November 29, 2015. http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/Compounded-Bioidentical-Menopausal-Hormone-Therapy
Bioidentical Hormone Therapy. The North American Menopause Society. Retrieved November 29, 2015. http://www.menopause.org/publications/clinical-practice-materials/bioidentical-hormone-therapy
The North American Menopause Society (NAMS). The Menopause Guidebook, 7th Ed. 2012. P. 52.Read more in Your Guide for Menopause & Hot Flash Treatment Options