Hormone Therapy

Hormone therapy works extremely well to relieve common symptoms of menopause, including hot flashes, bone loss and vaginal dryness. But depending on your health situation and medical history, the risks of hormone therapy may outweigh the benefits.

To help you decide, here is the latest scientific information on hormone therapy, and what you should know before you see your doctor:

Changing Perspectives

Nearly two decades ago, doctors stopped prescribing hormone replacement drugs after two large studies revealed some risks of long-term use, including an increased risk of heart disease, blood clots, stroke and breast cancer. Recently, however doctors have softened this “cold turkey” approach after a more recent study showed estrogen and cyclic monthly progesterone given to healthy women ages 42 to 59 proved both safe and helpful in improving symptoms of menopause, as well as mood, bone density and several markers of cardiovascular risk.

Still, hormone therapy does carry risks for women with certain health histories or conditions and so may not prove the best option for everyone. Women with a history of breast cancer, blood clots, heart disease or liver disease in particular should look into non-hormone medications. Luckily, alternative medical treatments have expanded over the last decade to address certain health concerns.

Though not as effective as hormone therapy, some drugs typically used for other health issues such as depression, anxiety and epilepsy reduce hot flashes in many women without the same risks of hormone therapy. One of these drugs, a selective serotonin reuptake inhibitor called Brisdelle®, is the first non-hormonal drug approved by the FDA specifically for hot flashes.

Sleep medications will not reduce hot flashes but may help you sleep through them.

Targeting Therapies to Specific Needs

Alternative options also exist for women with specific health needs or concerns such as:

• Women who prefer not to take a pill — The methods to take hormone therapy have grown to include patches, gels and sprays in addition to pills. This allows providers to tailor the medication to each patient’s medical history and lifestyle. The transdermal patch, for instance, allows the body to absorb the hormones without going through the liver and provides a more consistent dose of hormones than other drugs, making it a safer option for women with certain risk factors. We also have Integrative Medicine providers with experience in Bioidentical Hormones.
• Women with vaginal dryness — This common symptom is caused by dropping estrogen levels and is often associated with painful intercourse. However, symptoms can be managed with vaginal estrogen, which comes in many forms including creams, gels, sprays, pills, vaginal pills and rings.

In general, starting hormone therapy within 10 years of your last period is now considered safe for most women who are experiencing symptoms that interfere with their quality of life or sense of well-being, such as hot flashes. Your provider is your partner and together you will find the right option for you for this time of your life. After your last period, your provider may recommend alternative, non-hormonal treatment. And remember, once on a therapy, allow at least 12 weeks to determine its effectiveness. Contact your doctor immediately if you have any health changes or concerns. Even if the therapy works, your doctor will want to see you regularly – probably annually – to reevaluate. Typically, about half of women are able to decrease or go off hormones completely after three to five years without returning symptoms. The other half remain symptomatic and may choose to continue therapy.