Menopause Hormone Therapy (aka HRT) – an overview

Menopausal Hormone Therapy (MHT) is the most effective treatment for menopause challenges but many women opt not to take it or are denied it by their healthcare professionals. This article will give you a good understanding of what MHT is and why you shouldn’t fear it.

Menopause is the end of ovarian function, confirmed when a woman hasn’t had a period for 12 consecutive months.

The most common symptoms of menopause—hot flashes and night sweats—can bother 8 in 10 women, often beginning in perimenopause and lasting on average 7.4 years, with ethnic differences.

Lesser-known changes include sleep disturbances, fatigue, mood changes, irritability, anxiety, brain fog, decreased self-esteem and self-confidence, vaginal dryness, and pain with sex.

Bothersome menopause can reduce a woman’s quality of life and contribute to poorer health since hot flashes can be linked to cardiovascular, bone, and cognitive risks.

Menopausal Hormone Therapy (MHT) —formerly known as Hormone Replacement Therapy (HRT)—is the most effective treatment for hot flashes and night sweats.  Estrogen relieves hot flashes and improves sleep, mood, and cognition and, in some women, joint aches and pains. But estrogen stimulates growth of the endometrium, the lining of the uterus.  Adding progestogen protects the endometrium and decreases the risk of endometrial cancer.

The Women’s Health Initiative (WHI) trial results published in 2002 led to significant fear of MHT.  Many women avoid MHT for fear of breast cancer, but many factors affect breast cancer risk:  different formulations of estrogen therapy, different progestogens, dose, duration of use, regimen, how it is administered (orally, transdermally, or vaginally), and prior MHT use.

Newer observational data and reanalysis of older studies, including the WHI, suggest that the benefits of menopause hormone therapy outweigh its risks for healthy women younger than 60 or within 10 years of menopause.

MHT must be individualized considering personal and family health history, risk factors, expectations, needs, preferences, and values.

In the WHI trial, risk was greater for women with a uterus who had to take a progestogen along with the estrogen for uterine protection than for women with no uterus who took only estrogen.

The breast cancer risk increases with longer-term use.  For women who had to take the progestogen along with estrogen in the WHI trial, the risk of breast cancer did not increase until the fourth year.  Researchers found very little risk in those who took menopause hormone therapy for less than one year.

For women who have only localized vaginal symptoms such as vaginal dryness, itching, burning, and/or pain with sex, locally-applied low-dose vaginal estrogen rather than systemic estrogen is recommended. Due to minimal systemic absorption, a progestogen is generally not indicated and there should be very little increase in the risk of invasive breast cancer.

Would you like to know whether menopause hormone therapy is appropriate and safe for you?

Schedule a FREE Discovery Call with me. I’d be happy to talk with you about MHT– and your menopause, of course!