Every woman who reaches middle age will experience menopause, the end of menstruation and fertility. At this stage in your life, your ovaries stop producing eggs and your body gradually produces less of the hormones estrogen and progesterone. Although each woman will experience a unique combination of symptoms, some hallmarks of “The Change” include: irregular periods, vaginal dryness, hot flashes, sleep disturbances like insomnia and night sweats, mood swings, and feelings of loss.
You may not be ready for menopause when it begins, but ignoring the symptoms won’t postpone this stage until you’re ready to deal with it. It will likely only make the process more uncomfortable. Addressing your symptoms will make for a smoother transition into this time in your life. Most symptoms—even the dreaded thinning of hair and increase of abdominal fat—can be treated and controlled to some extent.
Hormone replacement therapy
Hormone replacement therapy — medications containing female hormones to replace the ones the body no longer makes after menopause — used to be a standard treatment for women with hot flashes and other menopause symptoms. Hormone therapy (as it's now called) was also thought to have the long-term benefits of preventing heart disease and possibly dementia.
Use of hormone therapy changed abruptly when a large clinical trial found that the treatment actually posed more health risks than benefits for one type of hormone therapy, particularly when given to older postmenopausal women. As the concern about health hazards attributed to hormone therapy grew, doctors became less likely to prescribe it.
Hormone therapy is no longer recommended for disease prevention, such as heart disease or memory loss. However, further review of clinical trials and new evidence show that hormone therapy may be a good choice for certain women, depending on their risk factors.
What are the benefits of hormone therapy?
Systemic hormone therapy. Systemic estrogen — which comes in pill, skin patch, gel, cream or spray form — remains the most effective treatment for relief of troublesome menopausal hot flashes and night sweats. Estrogen can also ease vaginal symptoms of menopause, such as dryness, itching, burning and discomfort with intercourse.
Although the Food and Drug Administration (FDA) still approves estrogen for the prevention of the bone-thinning disease called osteoporosis, doctors usually recommend medications called bisphosphonates to treat osteoporosis.
Low-dose vaginal products. Low-dose vaginal preparations of estrogen — which come in cream, tablet or ring form — can effectively treat vaginal symptoms and some urinary symptoms, while minimizing absorption into the body. Low-dose vaginal preparations do not help with hot flashes, night sweats or protection against osteoporosis.
Long-term systemic hormone therapy for the prevention of postmenopausal conditions is no longer routinely recommended. But some data suggest that estrogen can decrease the risk of heart disease when taken early in postmenopausal years.
A recent, randomized, controlled clinical trial — the Kronos Early Estrogen Prevention Study (KEEPS) — explored estrogen use and heart disease in younger postmenopausal women. The study found no significant association between hormone therapy and heart disease.
For women who haven't had their uterus removed, estrogen is typically prescribed along with progesterone or progestin (progesterone-like medication). This is because estrogen alone, when not balanced by progesterone, can stimulate growth of the lining of the uterus, increasing the risk of uterine cancer. Women who have had their uterus removed (hysterectomy) don't need to take progestin.
Who should consider hormone therapy?
Despite the health risks, systemic estrogen is still the most effective treatment for menopausal symptoms. The benefits of hormone therapy may outweigh the risks if you're healthy and:
Experience moderate to severe hot flashes or other menopausal symptoms
Have lost bone mass and either can't tolerate or aren't benefitting from other treatments
Stopped having periods before age 40 (premature menopause) or lost normal function of your ovaries before age 40 (premature ovarian insufficiency)
Women who experience an early menopause, particularly those who had their ovaries removed and don't take estrogen therapy until at least age 45, have a higher risk of:
Coronary heart disease
Parkinsonism (Parkinson's-like symptoms)
Anxiety or depression
Early menopause typically lowers the risk of most types of breast cancer. For women who reach menopause prematurely, the protective benefits of hormone therapy usually outweigh the risks.
Your age, type of menopause and time since menopause play a significant role in the risks associated with hormone therapy. Talk with your doctor about your personal risks.