Doctors used to believe that the loss of hormones during menopause was just something that women needed to deal with — and stop complaining about. However, recent research has made it clear that going without hormones may be detrimental to women’s health in a number of ways. This has led to more doctors recommending menopause hormone replacement therapy.
What Is Menopause?
To understand why it is often beneficial to replace hormones during menopause, it’s first necessary to ensure you understand what menopause is.
Menopause occurs when you have no eggs left in the ovaries and it is therefore not possible for you to ovulate. At the same time, the ovaries stop producing sex hormones. This means you no longer have as much estrogen and progesterone and you only have around half the amount of testosterone as you did before. The year or so leading up to menopause is called perimenopause.
The decrease in hormones results in the symptoms of perimenopause and menopause, which (according to Cleveland Clinic) include:
- Irregular periods
- Hot flashes
- Night sweats
- Vaginal dryness
- Urinary urgency
- Insomnia
- Emotional changes
- Dry skin, mouth, and eyes
- Tender breasts
- Racing heart
- Headaches
- Joint or muscle aches
- Changes in sex drive
- Difficulty concentrating
- Weight gain
- Hair loss
Each person experiences menopause differently, meaning you may have any combination of the above symptoms. This is part of what has made treating menopause so difficult — until recently.
Why Does Menopause Cause These Symptoms?
Numerous systems in the body have estrogen receptors, including the organs, joints, bones, and brain. When there’s no estrogen in the body, your body is unable to function at an optimal level. For instance:
- Estrogen acts as an anti-inflammatory hormone, including on the bones, joints, and lungs. The lack of estrogen leads many women to suffer from symptoms like frozen shoulder, hip pain, and other types of joint pain as well as asthma that doesn’t respond well to typical bronchodilators.
- Optimal estrogen levels result in healthy amounts of serotonin and norepinephrine, which are low in people suffering from depression.
- Low estrogen may cause the blood vessels in the brain to contract, resulting in headaches. For this reason, symptoms like low mood, anxiety, and migraines are common during menopause.
- The sinoatrial node in the heart is responsible for sending a signal to control the heartbeat. Estrogen keeps this regulated. A reduction in estrogen leads some women to suffer from palpitations.
- The genital urinary system is highly sensitive to estrogen. A loss of estrogen leads to a decrease in elasticity and an incapability to make mucus in the vagina, which may result in dryness, incontinence, and recurrent UTIs.
There are similar effects on other areas of the body from the lower levels of progesterone and testosterone. This makes sense when you consider that, during the decades leading up to menopause, your body was thriving when it was receiving these hormones from the ovaries. The solution is to replenish the supplies with hormone replacement therapy during perimenopause and menopause.
Previous Thinking About Menopause Hormone Replacement Therapy
In the past, women would only receive menopause hormone replacement therapy if they were experiencing severe symptoms and nothing else was working. As NPR reports, this is due to findings that taking combination estrogen and progestin (synthetic progesterone) was leading to a higher incidence of breast cancer and stroke. As a result, many women decided to stop taking the treatment and healthcare providers became hesitant to prescribe it.
However, this was two decades ago. More recent research shows quite a different picture.
Recent Research Reveals the Benefits
The menopause hormone replacement therapies on the market today feature different types and lower levels of hormones than those that had dangerous side effects. Recent research has determined that the benefits of menopause hormone replacement therapy outweigh the risks of the treatment. This is what a study published JAMA found, which followed 161,808 postmenopausal women over a 20-year period. The study determined that hormone replacement therapy had a low risk of adverse effects and was effective at treating many of the symptoms of menopause.
Other studies have found that hormone replacement therapy reduces the risk of serious conditions. Research published in Post Reproductive Health found it has an impact on osteoporosis, whereas a study published in The Cancer Journal found it reduces cardiovascular disease.
Osteoporosis occurs when the bones are too porous. This happens in menopause because the natural breakdown of bones increases when estrogen levels are low. Unfortunately, women with osteoporosis typically only receive a diagnosis once they’ve already suffered a fracture — and 50% of women will suffer an osteoporotic fracture at some point. However, osteoporosis is preventable in most women with hormone replacement therapy.
Women taking hormone replacement therapy have a lower risk cardiovascular disease, which lowers mortality from events like heart attacks. This finding is particularly significant when you consider that there is no evidence that statins reduce the risk of death from cardiovascular disease in women, only in men.
The studies also agree that women see the most benefits if they start hormone replacement therapy at the right time, which is typically between the ages of 50 and 60.
Who Can Receive Menopause Hormone Replacement Therapy?
Most people are good candidates for hormone replacement therapy in menopause, including some who may have been considered at high risk of adverse effects in the past. For instance, women who have a higher risk of blood clots may simply need to take estrogen in a form other than oral, such as in a patch, cream, or gel. Even some women with a history of breast cancer may be able to receive treatment. It’s important to talk to your doctor to find out if this is a possibility for you and to determine what type of hormone replacement therapy would be most suitable.
For more information about menopause hormone replacement therapy, check out this interview with Dr. Mari Claire Haver.
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