vibrant healthy woman going through menopause transition

9 signs you might benefit from hormone replacement therapy

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Medically reviewed by Dr. Andrea Goodwin on 1/10/2024.

Every woman transitions to menopause, but few know where to go for help. University College London notes that 90% of women never learned about menopause in school so they lack basic knowledge on how to navigate this phase of their life. Don’t worry. Dr. Goodwin can help!


🧑‍⚕️ Dr. Andrea Goodwin co-authors each article and reviews for medical accuracy. She is board-certified in Family Medicine and Obesity Medicine and has helped thousands of patients manage the effects of aging, menopause, and obesity. She treats patients in 37 U.S. states and resides in Mississippi with her family. You can learn more about her background here. Her credentials are listed here.

American Board of Family Medicine
American Board of Obesity Medicine


In the following article, we outline the benefits and risks of hormone replacement therapy and why it might be an effective treatment for combatting the adverse side effects of menopause.

What are the signs that you need hormone replacement therapy?

A woman’s body doesn’t stop producing estrogen until after menopause, but symptoms usually surface during perimenopause (the menopause transition) as the body’s estrogen levels diminish.

Menopause can be a challenging and confusing time for many women, but it doesn’t have to slow you down, get you down, or suck the joy out of life!

If you think you’re experiencing menopause transition, talk to your doctor or schedule an appointment with Dr. Goodwin to help you find a treatment option that’s best for you. Low-dose hormone replacement therapy can be an extremely effective treatment option with minimal risk.

These are the most common symptoms during menopause transition and are signs you need hormone replacement therapy.

Change in your period

A change in your normal period cadence might be a leading indicator of menopause. Pay attention to your body and make sure to discuss it during your visit. These are the most common changes you might experience according to the NIH.

  • Your periods happen close together
  • You have heavy bleeding
  • You have spotting
  • Your periods last more than a week
  • Your periods resume after no bleeding for more than a year

Less desire for sex

Estrogen deficiency can decrease your desire for sex (low libido). This is most commonly caused by hypoestrogenism which can thin the tissue in the vagina and pelvic floor. Genitourinary syndrome of menopause (GSM) can cause other symptoms like genital dryness, burning, irritation, diminished lubrication, and decreased blood flow to the vaginal tissue. All of these factors can make sex less desirable.

Hot flashes

A hot flash occurs when you experience a sudden feeling of heat in the upper part of your body or even your entire body. This feeling can be accompanied by heavy sweating followed by cold shivering. Not fun!

The frequency of hot flashes varies among women. They can occur several times per hour, multiple times a day, or less frequently every week. Hot flashes typically last about 30 seconds up to 10 minutes.

Other symptoms include red blotches that may appear in the chest, back and arms. Your face and neck can also become red and hot (i.e., flushed).

Night sweats

Hot flashes that occur at night, disrupt sleep, and lead to sweating are referred to as night sweats. Night sweats are another common symptom caused by diminishing levels of estrogen. Estrogen helps the hypothalamus (the part of the brain that controls your body heat) function properly by regulating your body’s temperature.

Many other serious illnesses can cause night sweats so it’s important to consider all other symptoms and discuss them with your physician.

Chills

Chills often occur after experiencing hot flashes and sweating. The body rapidly heats up and produces sweat, which can lead to chills, shivering, and feeling anxious.

Excessive sweating

Some women complain about excessive sweating, especially at night (see night sweats above). Remember, estrogen helps the brain regulate your body’s temp (the hypothalamus in the brain serves this purpose).

Vaginal dryness

Lower levels of estrogen can lead to vaginal atrophy which is the thinning, drying, and inflammation of the vagina walls.

Insomnia

Insomnia occurs when you have trouble falling asleep, staying asleep, or getting good-quality sleep. Women often cite trouble sleeping due to experiencing night sweats and more frequent urination.

Stress and anxiety

Changes in mood due to higher levels of stress and anxiety are common among women during peri- or post-menopause. It’s important to discuss these feelings with your doctor or mental health professional to determine the cause and treatment. Doing the basics can help. Make sure you’re eating well, getting enough sleep, and limiting alcohol and caffeine intake.

Bladder control

Loss of bladder control is called incontinence. Without adequate estrogen, the urethra (tube from the bladder to the outside world) starts to thin. This can also lead to more frequent urinary tract infections (UTIs). Although incontinence can happen for a variety of reasons, it might indicate you are entering a menopause transition. Hence, it’s important to communicate these issues to your doctor to avoid bladder infections and discomfort.

What is hormone replacement therapy?

Hormone replacement therapy is a form of treatment that replaces the estrogen your body stops producing after menopause. Medication can be delivered in many ways (e.g., pills, troches, topical creams, gels, etc.). The key is talking to your doctor about the form factor and dosage (amount) before trying.

There are two main categories of medication.

Low-dose vaginal products include creams, tablets, or ring form. This form minimizes the amount of estrogen absorbed by the body and is usually used to treat vaginal and urinary symptoms of menopause.

Systemic hormone therapy comes in a pill, skin patch, gel, cream, spray, or troche (a pill that dissolves under the tongue and contains multiple hormones or just one). These methods typically contain a higher dose of estrogen which is absorbed throughout the body.

Talk to Dr. Goodwin about which treatment option is most appropriate for you.

How can hormone replacement therapy benefit you?

Hormone replacement therapy can ease or relieve many of the symptoms associated with peri- and post-menopause.

Replenishing your body’s estrogen levels can benefit 3 distinct areas of your life:

  1. Sex. Boost your sex drive and relieve vaginal dryness, itching, burning, and discomfort during intercourse. It’s no secret that physical intimacy fosters connection which can benefit your relationships.
  2. Sleep. Troublesome hot flashes and night sweats can be extremely disruptive to sleep and daily life. Getting a good night’s sleep benefits nearly every aspect of our lives.
  3. Preventative health. Estrogen has been shown to protect against osteoporosis – which reduces bone loss and the risk of fractures.

When you’re feeling your best, life is more enjoyable and your relationships and overall wellbeing improve.

Is hormone replacement therapy right for you?

Most medications have associated benefits and risks. Hormone therapy is no different.

For healthy women with bothersome hot flashes, aged younger than 60 years or within 10 years of menopause, the benefits of hormone replacement therapy generally outweigh the risks. If you fall into this category and want to explore treatment options, book a virtual appointment with Dr Goodwin today.

What are the risks and how can they be mitigated?

Clinical trials and studies have shown the risks of hormone therapy vary depending on your age, health history, and the type of therapy administered. In many cases, the risks can be minimized or eliminated simply by taking the right treatment. We ensure this by prescribing only with adequate lab work and a full physical exam.

The risks are greater for women age 60 or older or who begin treatment greater than 10 years from the onset of menopause.

In the largest clinical trials, hormone replacement therapy (specifically Prempro) increased the risk of the following, but many can be managed or minimized through effective treatment and follow-up.

  • Blood clots
  • Breast tissue can become more dense making cancer screening difficult
  • Cancer, particularly breast cancer.
  • Increased risk of a miscarriage if taken while pregnant
  • If estrogen is prescribed without progesterone, the lining of the uterus can thicken (endometrium) which increases the risk of endometrial cancer. We prescribe progesterone along with estrogen to minimize this risk.
  • Long-term use (specifically without estrogen) is associated with a higher risk of cognitive decline. However, cognition can improve if the right combination of hormones is prescribed. Adding progesterone to estrogen can improve cognition

If you’re in the menopause transition period, you’re generally healthy, and age 60 or less, hormone therapy is generally a safe option.

In short, get evaluated by an expert

Talk to your doctor or schedule an appointment with Dr. Goodwin. She’s terrific!

Get treated in 5 simple steps with a LivWell Clinic provider:

  1. Schedule your video visit with Dr. Goodwin here: Get Started Now
  2. Fill out the medical questionnaire we send to your email.
  3. Complete your video consultation with Dr. Goodwin. She will examine your medical history, and symptoms, and order your lab work.
  4. Get your lab work done.
  5. When your lab results are ready, Dr. Goodwin will review and discuss treatment options with you. If you’re prescribed medication, it will be shipped to your house by our partnered pharmacy.


🏥 LivWell Clinic is a wellness primary care clinic accepting new patients in 37 U.S. states. Click this link to schedule an appointment today.


FAQs

How much does hormone replacement therapy cost?

The cost of hormone therapy has 3 components:
1. the initial visit ($120)
2. the lab work (this varies by lab and type of insurance you have)
3. the medication (if prescribed).

Is hormone replacement therapy covered by insurance?

LivWell Clinic does not bill your insurance but we can give you a superbill which you can submit to your insurance. We accept credit card, debit card, or HSA/FSA/HRA health card.

Can hormone replacement therapy cause cancer?

There is a very slight increased risk of breast cancer in women on HRT, especially women >60 years old, women who use high doses of HRT, women who use HRT for a longer period of time, and women who are currently using HRT.

Can hormone replacement therapy cause breast cancer?

There is a slightly increased risk of breast cancer in women receiving HRT. The risk increases with the following: a woman’s age (lowest risk in 50’s, higher risk in 60’s and 70’s); how long HRT is used (less than 5 years does not increase risk as much as >5 years; current use is slightly higher risk than use over 5 years ago; the specific type of hormone given. Breast cancer may be found at a later stage in patients receiving HRT as the breasts tend to be more dense in patients on HRT.

Is hormone pellet therapy safe?

Pellet therapy for women is no longer considered a good option. HRT can be administered in other forms than pellets that are safer.

Can hormone replacement therapy cause high blood pressure?

HRT provided via a gel, cream, or spray has not been shown to increase blood pressure; however, when HRT is administered as a pill, there is some evidence that shows it may increase blood pressure.

Can hormone replacement therapy cause anxiety and depression?

Recent studies suggest that receiving HRT via gel, cream, or spray is not a cause of anxiety or depression. Taking HRT in a pill form is more likely to increase anxiety or depression than using a gel, cream or spray.


Ucl. “Nine in Ten Women Were Never Educated about the Menopause.” UCL News, 27 Apr. 2023, www.ucl.ac.uk/news/2023/apr/nine-ten-women-were-never-educated-about-menopause.

Mayor Clinic Staff. “Hormone therapy: Is it right for you?” Mayo Clinic, 6 Dec. 2022, https://www.mayoclinic.org/diseases-conditions/menopause/in-depth/hormone-therapy/art-20046372. 8 Jan 2024.

NIH National Institute on Aging (NIA). “What is menopause.” nih.nia.gov, 30 Sept. 2021, https://www.nia.nih.gov/health/menopause/what-menopause. 8 Jan 2024.

Cleveland Clinic. “Night Sweats.” Cleveland Clinic, 6 Sep 2022, https://my.clevelandclinic.org/health/symptoms/16562-night-sweats. 8 Jan 2024.

Kathryn A Martin, MDRobert L Barbieri, MD. Treatment of menopausal symptoms with hormone therapy. UpToDate, Topic 7450 Version 55.0, Wolters Kluwer Health,. 20 Nov 2023, https://www.uptodate.com/contents/treatment-of-menopausal-symptoms-with-hormone-therapy?search=low estrogen&source=search_result&selectedTitle=4~140&usage_type=default&display_rank=3#disclaimerContent. 8 Jan 2024.

Richard J Santen, MDCharles L Loprinzi, MDRobert F Casper, MD. Menopausal hot flashes. UpToDate, Wolters Kluwer Health,. 31 Aug 2023, https://www.uptodate.com/contents/menopausal-hot-flashes?search=low estrogen&topicRef=7450&source=see_link. 8 Jan 2024.

Jan L Shifren, MD. Overview of sexual dysfunction in females: Epidemiology, risk factors, and evaluation. UpToDate, Wolters Kluwer Health,. 4 May 2022, https://www.uptodate.com/contents/overview-of-sexual-dysfunction-in-females-epidemiology-risk-factors-and-evaluation?search=low. 8 Jan 2024.


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