Should I Consider Hormone Therapy?
If you’re tired – literally – of insomnia, night sweats and oh-so-annoying mood swings, you, like millions of other menopausal women, have probably considered hormone therapy.
Vaishali Bhalani MD, an obstetrician and gynecologist at Premier Obstetrics and Gynecology, discusses hormone therapy and how to know if it’s right for you.
Hormone Therapy: What is It?
Hormone therapy uses one or more female hormones, commonly estrogen and progestin, to ease menopause symptoms. It can come in a variety of forms, including a pill, patch, topical gel or spray, vaginal cream, tablet or ring.
Women’s Health Initiative Study: What was the Impact?
Prior to 2002, doctors frequently prescribed hormone therapy to reduce the risk of heart disease and relieve a variety of menopause symptoms, including:
- Hot flashes
- Night sweats
- Sleep difficulties
- Vaginal dryness
- Anxiety
However, that year, the results of the Women’s Health Initiative (WHI) study revealed that prescribing hormone therapy could slightly increase a woman’s risk of heart attack, stroke, or developing blood clots or breast cancer, which led many doctors to rethink their recommendations.
“Since that study, there have been lower dosages and there have been different routes of administration . . . whether these different routes of administration are less risky, we don’t know until more studies are done,” Dr. Bhalani warns. "There’s no hard and fast rule that all women need to be on therapy.”
Individualizing Treatment
Dr. Bhalani reminds her patients that treating menopause symptoms takes trial and error to determine what works, which may mean trying a combination of hormone therapy and lifestyle changes, like breathing exercises, physical activity and dietary adjustments.
“I tell my patients it’s balancing the quality of life versus these life-threatening risks, when it comes to therapy,” she explains.
Tailoring treatment typically means reevaluating a patient’s plan of care on a yearly basis, which may involve asking:
- What are your symptoms?
- Do you need therapy anymore?
- Can we put you on a lower dosage?
- Can we change to a different route of administration?
"First, I’ll get my patient on a dose and route of hormone that we, together, are comfortable with, which may take a few visits as well as follow-up phone calls, and then I’ll say, 'Year-to-year, conditions change. You might have a change in your personal or family history, which may put you more at risk.'"
Or, for example, if one of Dr. Bhalani’s patients has been on an oral hormone therapy for five years and still wants to continue with hormone therapy, Dr. Bhalani may switch her to a patch. That way, “you can still be on something, [and] may be carrying less risk,” she points out.
Natural Hormone Therapy: Is It Safe?
Dr. Bhalani’s simple answer: “We don’t know.”
She mentions that unless you are ingesting the true root of the product, then it is still being processed in a lab, pharmacy or compound. “You know a natural pill is still processed somewhere.”
Hormone Therapy and Sexual Function
Once women begin the menopausal transition, they may experience a change in sex drive, Dr. Bhalani says. However, she stresses: “Hormone therapy is not treatment for increasing your sex drive and I think that’s important to understand.”
She reminds women that in terms of sexual function, many factors come into play, including finances, emotions, stress at work, and pain with intercourse – among others. “These things are not an overnight fix for women . . . it takes a lot of components in a woman’s life to tease out what she needs to do to help get back into having a comfortable sex life with her partner or significant other.”
*All professionals quoted in this article were affiliated with TriHealth at the time of initial publication.