If you’re having hot flashes or night sweats, you’re probably familiar with the DIY remedies.
Wearing layers. Using fans. Adjusting the air conditioning. Maybe even splurging on sweat-wicking sheets and pajamas.
You’re probably also familiar with hormone replacement therapy, or HRT for short, and its reputation. In the early 2000s, many women stopped taking HRT after a widely publicized study linked it to higher risks of breast cancer and heart disease. But science has learned a lot since then.
Jim Kappenman, M.D., an OB/GYN at Sanford Health in Fargo, North Dakota, wants patients to have the latest information.
In short: Today’s HRT is safe for treating the most disruptive symptoms of hormonal changes that come with menopause, and recent studies back that up.
“There’s been a lot of fear around use of the hormone replacement in the past. And I think rightly so,” Dr. Kappenman said. “It’s worth asking questions of your provider and obtaining knowledge of your family history to decide what’s right for you.”
What hormones does HRT replace?
Your levels of the hormone estrogen fall during perimenopause, the time leading up to the end of your period. It’s this drop in estrogen that causes symptoms like hot flashes, night sweats, irritability, sleeping difficulties, and issues in the urinary tract and vagina.
Hormone replacement therapy aims to ease those symptoms with medicine that contains estrogen only, or a combination of estrogen and progesterone.
Who qualifies for hormone replacement therapy?
If you have menopause symptoms that are bothering you, you can ask your health care provider about starting HRT. What kind of HRT your provider recommends depends on what stage of menopause you’re in.
They will first ask about your menstrual cycle history. Menopause is the absence of menstruation for a year or more, as long as you’ve ruled out pregnancy or other health reasons for your period stopping.
“Typically, people are going to experience some of these temperature regulation symptoms, however, a year or two prior to the absence of a period,” Dr. Kappenman said. “And so they may get some warning that things may start to change with their cycles in the coming years.”
In patients who have had their uterus removed surgically, Dr. Kappenman uses age instead of menstruation as a guide. The average age of menopause in the U.S. is 51. If hysterectomy patients are having trouble regulating their temperature, and they’re over 40 years old, they could be starting menopause and possibly benefit from HRT.
What types of HRT are available?
Tell your doctor which symptoms bother you the most so they can recommend the form of HRT that targets that area. Dr. Kappenman outlines these HRT options for his patients:
- Vaginal creams, rings, and dissolvable tablets can relieve vaginal dryness or discomfort by targeting the vaginal tissues. Vaginal rings also can reduce hot flashes. These localized therapies come in lower, less frequent doses, and have fewer side effects than oral HRT because they don’t go through your entire body.
- Skin sprays, gels, and patches take aim at body temperature issues like hot flashes and night sweats. Because they’re absorbed through the skin, they may cause more side effects than vaginal therapies but come with a slightly lower risk of blood clots and stroke than HRT pills.
- Pills and IUDs (intrauterine devices) offer systemic relief of hot flashes, night sweats and other common menopause symptoms. They deliver medicine throughout your body, and long-term health risks depend on the hormones and doses prescribed.
What are the benefits and risks of hormone replacement therapy?
Besides relieving menopause symptoms, benefits of HRT include some protection from osteoporosis and colorectal cancer. The risks of blood clots, stroke and breast cancer are very low, but they start to outweigh the benefits after age 60 or within 10 years of menopause.
Family and personal health history are important factors. Your provider may prescribe different types of HRT based on your individual health risks. Dr. Kappenman also tells patients it’s important to keep up with their preventive exams while taking HRT, including mammograms and clinical breast exams.
Because of this mix of benefits and risks, Dr. Kappenman asks his HRT patients every one to two years whether they still need it. If symptoms have improved after five years, he will talk with them about reducing or stopping HRT.
“The mantra we use when treating patients with hormone replacement therapy is: Try to use the lowest effective dose for the shortest duration necessary. And that’s based on how patients are perceiving their symptoms,” Dr. Kappenman said.
What are some alternatives to HRT?
If you can’t take hormone replacement therapy, you may be able to find relief beyond adding or shedding layers of clothing.
For vaginal concerns, some over-the-counter products such as vaginal creams and lubricants can help.
For hot flashes and night sweats, Dr. Kappenman said some anxiety and depression medications known as SNRIs (serotonin and norepinephrine reuptake inhibitors) have the additional benefit of regulating body temperature. The seizure medicine gabapentin also has temperature-regulating benefits. And a new group of medicines called neurokinin-receptor antagonists are showing promise as nonhormonal therapies for hot flashes.
Plenty of herbal supplements and bioidentical hormone therapies advertise relief of menopausal symptoms. Be sure to talk to your provider about any vitamins or supplements you’re taking.
Ultimately, you don’t have to go through menopause without relief. Your provider can help you find a treatment that’s both safe and effective for you. Find menopause care at Sanford Health.
Learn more
- What to expect through the stages of menopause
- Perimenopause: Beginning the transition into menopause
- Integrative care for women in midlife
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Posted In Fargo, Menopause Care, Women's
