Understanding Menopause Hormone Therapy: A Comprehensive Guide

Written and edited by Sarah Bonza MD, MPH, FAAFP, DipABLM,MBC-HWC

Menopause is a natural phase in a woman’s life when her menstrual cycles cease, and her reproductive hormones, particularly estrogen and progesterone, decline significantly. This hormonal shift can cause a range of symptoms, including hot flashes, night sweats, mood swings, vaginal dryness, and sleep disturbances. To address these symptoms and improve overall quality of life, many women turn to hormone therapy or menopausal hormone therapy MHT (Hill et al., 2016). Menopause Hormone Therapy involves using medication to replace the hormones that the body is no longer producing in adequate amounts during menopause. FDA approved forms of MHT include pills, patches, creams, gels, and vaginal rings. As a physician with training in allopathic and functional medicine, I tend to only recommend FDA approve bioidentical hormone therapy for women.

The Role of Hormone Therapy in Menopausal Symptom Relief

Hormone Therapy plays a crucial role in providing relief from the various symptoms experienced during menopause. By replacing the declining estrogen and progesterone, MHT can help alleviate hot flashes, night sweats, and mood swings. It can also help with vaginal dryness and discomfort during intercourse.

Options in Hormone Therapy for Menopause Management

There are two primary forms of hormone therapy (HT) to manage menopausal symptoms. The first type is estrogen-only therapy (ET), which is the administration of estrogen, the hormone responsible for providing the most significant relief from menopausal symptoms. ET is specifically prescribed for women who do not have a uterus, typically due to having undergone a hysterectomy. The second type is combined estrogen plus progesterone therapy (EPT). In EPT, progesterone is added to estrogen therapy to safeguard women with a uterus from the risk of uterine (endometrial) cancer, which can be a consequence of taking estrogen alone.

Estrogen Pills

Estrogen pills are a commonly used form of estrogen therapy for menopause management. They are taken orally and can be an effective way to deliver estrogen hormones into the body. Estrogen pills have been shown to effectively alleviate menopausal symptoms such as hot flashes, night sweats, and vaginal dryness. They can also help improve bone density and reduce the risk of osteoporosis. However, estrogen pills have some limitations. They can increase the risk of blood clots, stroke, and certain types of cancer, especially when used for long periods of time or in high doses. (Delgado & Lopez-Ojeda, 2022)(Bilezikian, 1994)

Topical Estrogen Treatments

Topical or transdermal estrogen treatments, such as creams, gels, and patches, are another option for estrogen therapy in menopause management. These forms of estrogen therapy deliver the hormone directly to the skin, where it is absorbed into the bloodstream. Transdermal estrogen carries less risk for blood clots.(Estrogen Therapy: Overview, Menopausal Transition, Menopause and Hormone Therapy, 2021)

Vaginal estrogen

Vaginal estrogen is a specific form of estrogen therapy that is used to specifically target symptoms of vaginal dryness, urinary symptoms and discomfort during intercourse. Vaginal estrogen is available in different forms, including creams, tablets, and rings. These forms of estrogen therapy are inserted directly into the vagina and work locally to alleviate symptoms. There is minimal uptake systemically when using vaginal estrogen. (Krause et al., 2009)

Benefits of Combining Estrogen with Progesterone

Estrogen therapy, is effective in mitigating menopausal symptoms like hot flashes, vaginal dryness, and loss of bone density. However, integrating oral micronized progesterone with estrogen therapy has proven to enhance the safety and overall effectiveness of menopause treatment. Progesterone maintains a thin uterine lining, crucial in countering the thickening caused by estrogen alone — a condition that elevates the risk of endometrial cancer.

Progesterone’s impact also extends to improving mood and sleep quality, targeting the GABA receptors in the brain to provide calming effects that can alleviate mood swings and enhance sleep. Additionally, ongoing research suggests that natural progesterone, in conjunction with estrogen therapy, may lower breast cancer risk compared to the use of estrogen alone or with synthetic progestins.

It’s crucial to distinguish natural micronized progesterone from synthetic progestins (like levonorgestrel, drospirenone, and norethisterone) due to their differing structures and potential side effects, with progestins linked to mood issues and weight gain. Thus, the use of oral micronized progesterone with estrogen therapy in menopause treatment represents a comprehensive approach to not only alleviate symptoms and reduce associated risks but also to potentially enhance the overall well-being.

Weighing the Benefits Against the Risks of Hormone Replacement Therapy

When considering hormone replacement therapy for menopause management, it is important to weigh the potential benefits against the risks involved. The benefits of hormone replacement therapy include relief from menopausal symptoms such as hot flashes, night sweats, and vaginal dryness, as well as the prevention of bone loss and reduced risk of osteoporosis. However, it is crucial to acknowledge the potential risks associated with hormone replacement therapy.

Contraindications for Hormone Replacement Therapy

There are certain contraindications for hormone replacement therapy that should be taken into consideration. Some contraindications for hormone replacement therapy include a history of certain types of cancer (such as breast or uterine cancer), unexplained vaginal bleeding, active liver disease, a history of blood clots, and a history of heart disease or stroke. Therefore, before starting hormone replacement therapy, it is important for healthcare providers to thoroughly evaluate a patient’s medical history and assess any potential risks or contraindications.

Potential Side Effects of Hormone Replacement Therapy

Potential side effects of hormone replacement therapy can vary depending on the individual and the type of hormones being used. Common side effects of hormone replacement therapy include breast tenderness, bloating, headaches, mood swings, and nausea. Other potential side effects include increased risk of blood clots (for oral estrogen), stroke, heart disease, and breast cancer. Additionally, hormone replacement therapy has been associated with an increased risk of gallbladder disease and may worsen certain conditions such as migraines and asthma.

Making an Informed Decision on Hormone Replacement Therapy

When considering hormone replacement therapy, it is important for individuals to have a thorough discussion with their healthcare provider to make an informed decision. The healthcare provider should review the individual’s medical history, assess their symptoms, and discuss the potential benefits and risks of hormone replacement therapy. They should also discuss alternative treatment options and non-hormonal therapies that may be effective in managing menopausal symptoms (Hill et al., 2016).

References

1. Bilezikian, J P. (1994, August 1). Major Issues Regarding Estrogen Replacement Therapy in Postmenopausal Women. https://doi.org/10.1089/jwh.1994.3.273
2. Delgado, B J., & Lopez-Ojeda, W. (2022, June 28). Estrogen. https://www.ncbi.nlm.nih.gov/books/NBK538260/
3. Estrogen and Progestin (Hormone Replacement Therapy). (2023, February 18). https://medlineplus.gov/druginfo/meds/a601041.html
4. Estrogen Therapy: Overview, Menopausal Transition, Menopause and Hormone Therapy. (2021, October 11). https://emedicine.medscape.com/article/276107-overview
5. Hill, D A., Crider, M., & Hill, S R. (2016, December 1). Hormone Therapy and Other Treatments for Symptoms of Menopause.. https://pubmed.ncbi.nlm.nih.gov/27929271
6. Krause, M L., Wheeler, T L., Snyder, T E., & Richter, H E. (2009, May 1). Local Effects of Vaginally Administered Estrogen Therapy. Journal of pelvic medicine and surgery, 15(3), 105–114. https://doi.org/10.1097/spv.0b013e3181ab4804