HRT for perimenopause and menopause

Menopause and the lead-up to it (called perimenopause) is a time of huge change for women, both physically and mentally. While some women sail through this change, there are many others who suffer a range of symptoms that can have a debilitating effect on their quality of life.

As women age the two hormones produced by the ovaries, progesterone and estrogen, start to decline. Periods become erratic, heavier or lighter and then eventually stop altogether. Symptoms occur as the hormone levels fluctuate within a monthly cycle and start to decrease over time. Common symptoms include mood swings, hot flushes, trouble sleeping, anxiety, weight gain, vaginal dryness, night sweats, trouble concentrating, hair loss, irritability, and urinary problems. Fortunately, there are a range of treatment options and lifestyle choices to help ease this transition.

Hormone replacement therapy (HRT) is medicine that contains estrogen and progesterone to replace the hormones that a woman’s body stops producing after menopause. HRT can help relieve hot flushes, night sweats, vaginal dryness, thinning vaginal walls, bladder infections, mild incontinence, aches and pains, insomnia, memory loss, mood disturbances, decreased libido, palpitations, hair loss, and dry, itchy eyes. It comes in the form of tablets, patches or cream. For women with a uterus, the HRT they take will include both estrogen and progesterone. Taking estrogen only can overstimulate the cells lining the uterus and progesterone is used to counteract the risk of developing endometrial cancer. For women with no uterus (ie women who have had a hysterectomy), HRT will be an estrogen-only formulation. Vaginal estrogen therapy is often used for women that have more local symptoms such as vaginal dryness.

Added benefits of taking HRT are a decrease in the risk of diabetes, osteoporosis, bowel cancer and cardiovascular disease.

Common side effects of HRT are bloating, nausea, breast tenderness and breakthrough bleeding. There are long-term risks to consider including venous thrombosis, a small risk of breast cancer if used for more than five years and a very small increase in the risk of ovarian cancer.

Lifestyle changes that can make the symptoms of perimenopause and menopause easier to tolerate regardless of whether you take HRT or not are regular exercise (just not too close to bedtime), decreasing or eliminating alcohol, regular meditation or yoga, limiting caffeine consumption to mornings only, mindfulness, cognitive behavioural therapy (CBT), stopping smoking and eating a wholefood diet with a high intake of fruit and vegetables. It is very important to manage stress and any other chronic health conditions as well as maintaining a healthy weight. Lubricants can help relieve vaginal dryness and Kegel exercises can help strengthen pelvic floor muscles. For sleep disturbances, practicing good sleep hygiene techniques each night, magnesium supplements and a trial of the sleep hormone melatonin can help. Your doctor may recommend other prescription medicines such as anti-depressants for anxiety or mood disturbances.

There are complementary therapies and medicines available to treat perimenopause and menopause symptoms however there is little evidence to suggest these are any better than placebo. Most natural alternatives will only help one symptom at a time. Saint John’s Wort can help with mood swings and mild depression but won’t help with hot flushes. It can interact with several other medicines. Phytoestrogens are found in all plants but are highest in legumes such as beans and soy foods. Some women find these helpful but scientific studies don’t have strong evidence to show that they work. The decision to start HRT does not depend on a woman having gone through menopause. Perimenopause can start as many as ten years before menopause, in the late 30’s and early 40’s. Some women think they are too young or that their symptoms aren’t severe enough to start HRT, however, I am a strong believer that all people deserve a good quality of life and if that is suffering then it is time to do something about it.

This blog provides general information and discussion about medicine, health and related subjects. The information contained in the blog and in any linked mate­ri­als, are not intended nor implied to be a substitute for professional medical advice.