Employee & Community Health

Is hormone replacement therapy right for you? 

10/11/2018 by Dr. Marcia O'Brien

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When women begin experiencing the uncomfortable — and sometimes embarrassing — symptoms of menopause, such as flushing, hot flashes, heavy sweating, or vaginal dryness or pain during intercourse, one of the first questions they ask is, “Would hormone therapy be right for me?”

The answer is, “It might be,” and depends not only your current symptoms, but also on your personal and family medical history. That’s why it’s important to have a good discussion with your provider to go over the pros and cons of hormone therapy (HT) to your individual circumstance.

Why take hormones?

Women might be prescribed hormones to alleviate or improve uncomfortable symptoms, such as hot flashes, flushing, sweating and sleep disturbances, as well as vaginal dryness and pain during intercourse. Women often experience these when they reach the age of perimenopause (around the time of menopause) or early in menopause (stopped having periods).

Hormone therapy — estrogen, progesterone or both — may be an option because your uncomfortable symptoms develop from low levels of these hormones. HT may be considered during perimenopause or menopause. It also may be prescribed if you have had a hysterectomy at a young age or experience ovarian insufficiency (your ovaries quit working) at a young age (under 45).

Talking with your provider, making informed decisions

When you talk over HT with your provider, here’s what they’ll go over with you:

  • Personal and family health history
  • Personal cancer risks or history, as well as family history of cancer, specifically breast or ovarian cancer
  • Personal and family history of cardiovascular (CV) disease, clotting disorders, and liver disease
  • Risk factors for CV disease, such as smoking, high blood pressure, diabetes, cholesterol problems and weight

They also may want you to be current on preventive screening for breast, cervical and colon cancer and screenings for factors that increase CV risk. Your provider likely will recommend addressing any concerns, including stopping smoking and treating high blood pressure, diabetes or cholesterol problems to lower your overall CV risk.

After gathering the information about your health, health history and risks, your provider will give recommendations about whether HT is appropriate for you — or information about other non-hormone options for treating bothersome symptoms.

Part of your discussion will include the risks of HT, which include potentially stimulating an undetected hormone-sensitive cancer, and increasing your risk for blood clots or CV events, such as stroke or heart attack.

And finally, your provider will go over the side effects of HT, including nausea, headaches, breast tenderness, vaginal spotting, bleeding or bloating.

Treating your symptoms

There’s a timeframe when HT is safer — usually at the onset of menopause (average age is 51) and for the next 10 years after your periods have stopped. Your provider will prescribe the lowest dose possible for the shortest amount of time needed to treat or reduce your symptoms. Your treatment is customized for you, since symptoms vary for each woman. HT usually is delivered through a pill or a patch; your provider will help you choose the best option for treating your symptoms.

You’ve probably heard or read about over-the-counter (OTC) herbal supplements that can relieve symptoms. Some of these are black cohosh, ginseng and ginkgo. These herbal remedies may or may not be helpful. If you’re interested in trying a supplement, check with your provider first, since the supplement may interact with medications you’re currently taking, and for some, may actually increase health risks.

If you’d like more information before talking with your provider, check out this Mayo Clinic article on HT. While your primary care provider is an excellent resource, you also may consider consulting with someone who specializes in menopause and menopausal symptoms.

Once you and your provider have decided HT is a good fit, be sure to follow up at a future appointment to review if HT is still right for you.

Dr. Marcia O'Brien is a Family Medicine physician at Employee and Community Health's (ECH) Mayo Family Clinic Northeast. She practices the full spectrum of family medicine, including hospital medicine, newborn nursery and obstetric care. One of her areas of specialty is women's health.