Types of hormone replacement therapy for menopause

A mature woman sitting on the beach looking out at the ocean

Hot flashes, night sweats, insomnia, moodiness, vaginal dryness, low sex drive. If the symptoms of menopause or perimenopause are dragging you down, you might be considering what you can do.

When your ovaries produce less and less estrogen, that can bring on symptoms which affect some people more than others. One of the most common is hot flashes. On average, 85% of women experience them. For some people, hot flashes are occasional and just bring in a little sweat. Hot flashes can keep other people up at night or leave them frequently embarrassed when their face gets flushed during meetings at work.

When menopause ends, symptoms can hang on

What can be frustrating is that hot flashes, night sweats, low sex drive or other symptoms may not be over by the time you reach menopause, which is when you’ve not had a menstrual period for one year. Symptoms can last for five to 10 years after menopause.

If you’re struggling at any phase — before or after menopause — you can get relief. Depending on your symptoms and how severe they are, you may be prescribed medication to help. Taking a synthetic version of the hormones that your body no longer makes could eliminate or improve your symptoms.

There’s no one type of hormone replacement therapy that works for everyone. It’s important to know which options are safe and approved by the United States Food and Drug Administration.

Menopausal hormone therapy options:

Hormone replacement medication

There are several versions of hormones produced by drug companies and approved by the FDA. Ideally, you would only need to take estrogen to help with your symptoms. Since taking estrogen by itself can cause the uterus to bleed and increases the risk of uterine cancer, patients with a uterus should also use a form of the hormone progesterone, which prevents that.

These medications typically are covered by insurance. Estrogen is available in pills, patches, sprays, gels or vaginal rings. Progestins may be taken as a pill, patch or intrauterine device.

Pros: FDA-approved medications are available in a variety of forms and doses, allowing you and your health care provider to select a version that’s best for you.

Cons: Hormone replacement medications may increase the risk of blood clots, strokes, gall bladder disease and certain cancers, particularly if you’re already at risk for these problems.

Bioidentical hormones

These are hormones created with the same chemical structure as the natural hormones made in your body. The FDA has approved some bioidentical hormone products. Those are available by prescription and typically covered by insurance.

However, not all bioidentical hormone creams, pills or other products have been approved by the FDA. Those generally aren’t covered by insurance.

Pros: The FDA-approved bioidentical hormones are free of other chemicals that a patient may wish to avoid in other hormone replacement medications.

Cons: Taking bioidentical hormones that aren’t FDA-approved may come with risks. Bioidentical hormone products prepared by a pharmacist may not have been tested in the same way the FDA approved drugs are. Also, since the FDA doesn’t oversee how the product is made, there also may be impurities introduced in the process.

A bioidentical hormone product that’s not FDA-approved may have higher amounts of hormones than what’s recommended or what’s been studied in clinical trials. So, the long-term effects are unknown.

Pellet hormone replacement

A mixture of bioidentical hormones can be formed into the shape and size of a grain of rice. The so-called “pellet” is inserted under the skin. From the pellet, hormones are slowly released into the blood stream over several months.

Pros: Standard treatments such as creams, patches, and pills require you to remember to use them. Pellets deliver small amounts of natural hormones on a consistent basis. The effects can last from three to six months.

Cons: There are no FDA-approved pellets on the market. Sometimes pharmacies create pellets with more hormone than what’s necessary to relieve your symptoms, or the hormone in the pellet is absorbed into your bloodstream more rapidly than expected.

As a result, it’s possible for you to have more side effects or risks than you would have with an FDA-approved medication, for which the amount you’re exposed to is well-tested.

Frequently, pellets contain testosterone, a hormone made in higher amounts in men than in women. Testosterone is believed to increase sex drive and energy levels, but it can have adverse effects on cholesterol, heart disease, liver function and hair growth.

Diet changes/herbs

There’s a long history of trying to treat the symptoms of menopause with herbs and changes in diet.

Phytoestrogens are compounds found in plants that may function similarly to the way estrogen functions in the body. Foods that contain phytoestrogens include flaxseed and soybeans.

Sometimes, people take red clover or other herbs as supplements to try to find relief from menopause symptoms.

Pros: There’s no harm in trying either phytoestrogens or taking herbal supplements.

Cons: There’s no solid data that either are particularly helpful. And herbs and phytoestrogens may not be a good choice for you if you’re not a good candidate for hormone replacement because of your risk of blood clots and certain cancers. The chemicals that act like estrogen may not be safer for you than a synthetic form of estrogen.

When you shouldn’t take any type of menopausal hormone therapy

Avoid menopausal hormone therapy if you have…

  • an increased risk of getting blood clots
  • a history of estrogen-related cancers, such as breast or uterine cancers and some types of liver cancers
  • abnormal bleeding from your uterus around the time of menopause

If you’re having severe symptoms around menopause, replacing your hormones for a short period could be a good choice. They’re often given for five to seven years before you turn 60. After 60, the chances of blood clots, strokes, heart disease and dementia increase.

I generally advise my patients seeking menopausal hormone therapy to take the lowest dose that’s effective, for the shortest period of time that’s needed. You may find it eases your journey through midlife.

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