What Is Hormone Replacement Therapy And How Will It Affect Me?
The introduction of hormone replacement therapy (HRT) in the 1960s changed the way women approach menopause. Before that time, menopause had been seen as an end to a woman's femininity. At first, hormone replacement therapy promised to make it possible for women to avoid going through menopause altogether.
Since the 1990s, though, there has been some concern about the safety of taking hormones using hormone replacement therapy. Studies that concluded in the early 2000s revealed that there were indeed benefits but also some serious risks. Since that time, researchers and clinicians have worked diligently to develop robust treatment protocols that maximize the benefits patients receive while minimizing risk. This article will discuss what HRT is, its potential benefits and risks, and how medical providers help patients choose to pursue it.What is menopause?
Menopause is defined as the time in a woman's life when menstruation ends. That definition is somewhat lacking because it makes menopause sound like something that happens instantly. Menopause typically lasts from 10 months to 4 years. What's more, doctors don't consider that you've started menopause until you've gone without a period for at least 12 months.
Symptoms of menopause
The hormonal shifts that occur during menopause can sometimes cause unpleasant symptoms. The lack of hormones may cause symptoms like:
- Hot flashes
- Night Sweats
- Vaginal dryness
- Sleep disturbances
- Decreased sex drive
- Increased urinary frequency
- Redistribution of body fat
- Hair and skin become drier and thinner
- Thinning bones (osteoporosis)
- Joints become stiffer
- Forgetfulness
- Mood changes
Experts disagree about whether some of these symptoms are signs of menopause or simply natural reactions to the stage of life the women are in. For example, a person might forget things because they're at the height of their careers and so busy that they forget small things that seem less important.
Another example, mood swings, can happen at any stage of life, depending on what's happening to you at the time, and it doesn't always have anything to do with sex hormones. If you're suddenly suffering from irregular mood swings, see your medical doctor to rule out medical issues. After visiting your primary care professional, if no issues are present and you still have mood swings - your doctor may recommend that you see a therapist to get to the bottom of the concern.
Isn't menopause a natural process?
Menopause happens to every woman who lives long enough to experience it. It is a natural biological process. Despite this, there is some stigma surrounding menopause because it wasn’t openly discussed until fairly recently. Before the last few decades, many women would conceal their symptoms and may not have sought medical treatment.
Today, medical providers are quick to comment on menopause and recommend treatments if they feel they might benefit their patients. Stigma continues to reduce as more women openly discuss their menopause symptoms, and empirical research into menopause symptoms is ongoing.
What is hormone replacement therapy?
Hormone replacement therapy means taking hormone pills or placing hormone patches on your skin to boost either estrogen or estrogen and progestin levels. These are the hormones your body produces during your childbearing years. HRT replaces the hormones your body no longer produces with synthetic alternatives.
Although most people know taking hormone pills or using the patches as hormone replacement therapy, doctors are beginning to move away from that nomenclature. Calling it by that name gives people the mistaken idea that the hormone pills or patches boost your hormone levels back to what they were when you were younger. Typical doses are only high enough to alleviate menopause symptoms.
Who is HRT for?
Two main groups of women might benefit from HRT. The first is women who go through menopause because they've had a complete hysterectomy. These women have had both their ovaries removed, meaning their body is no longer capable of producing estrogen. They typically take estrogen only.
The second group is women who are going through menopause naturally. Originally, these women were given estrogen only. However, researchers discovered that the hormones affected the woman's uterine lining, increasing their risk of uterine cancer.
Who shouldn't do HRT?
Some women shouldn't take hormone replacement therapy. For them, the risks may outweigh the benefits. This includes women who:
- Have or have had breast, ovarian, or endometrial cancer.
- Have or have had blood clots in their legs or lungs.
- Have a history of stroke.
- Are smokers.
Primary benefits of HRT
The main benefits of hormone replacement therapy are decreasing physical menopause symptoms such as hot flashes and night sweats. HRT might also help with cognitive symptoms like forgetfulness and mood changes.
Other possible benefits of hormone replacement therapy
The two largest studies showed some other benefits of taking hormone replacement therapy, too. Women on the therapies avoided bone fractures with estrogen and progestin therapy and the therapy using estrogen-only.
Those taking the estrogen-only therapy also avoided developing or dying from breast cancer. Additionally, there has been some evidence that using HRT can reduce your risk of colon and rectum cancers.
What type of hormones do I need?
The type of hormone therapy you need (and whether you need it at all) depends on your unique body as well as your beliefs and preferences. If you have HRT, your doctor can explain what type of hormone replacement therapy is right for your situation.
Estrogen-only
Estrogen-only HRT is for women who don't have a uterus, typically because they had a hysterectomy.
Estrogen and progestin
Women who still have a uterus get combined therapy with estrogen and progestin.
What are the health risks of taking estrogen?
HRT comes with a higher risk of breast, ovarian, and endometrial cancers. HRT also comes with a greater risk of blood clots and strokes. However, these last two risks can be minimized through the use of transdermal hormone patches rather than pills.
Another health risk that can also lead to low self-esteem and difficulty in personal relationships is the problem of urinary incontinence. Women in the two studies who took the hormones were much more likely to develop urinary incontinence than those who didn't take the hormones.
Ultimately, a woman will work together with her healthcare team to determine whether the potential risks outweigh the benefits of HRT. Many medications have risks and side effects, and HRT is no different. Even though HRT has risks, many of those risks are subtle enough to justify the substantial relief that HRT may provide. In addition, many medical providers arrange for additional screening and tests to ensure that if a risk like cancer appears, it can be handled quickly and safely.
Other ways to manage menopause symptoms
You can do many things to make menopause an easier time for yourself and the people you care about.
Natural remedies
Many natural remedies have been used over the ages to help women with menopause. These include:
- Soy foods
- Flaxseed
- Dong Quai
- Black cohosh
- Vitamin E
- B Vitamins
- Evening primrose oil
- Black currant oil
These herbs and supplements have been used for centuries, but the scientific evidence for the herbal remedies is limited. Always check with your medical provider before taking any over-the-counter supplements with the goal of treating symptoms of a medical condition.
Managing relationship issues
Relationships can become problematic when you're having symptoms of any condition, not just menopause. Menopause causes problems that can interfere with intimacy between you and your partner. Between difficulties with your sex life and practical considerations like setting the thermostat in your home, you can feel like your relationship with your partner is in danger.
People often think of going to couples counseling before they get married, while they're raising children together, and when they're considering divorce. Many people don't consider that even if none of those things are true, your relationship can suffer and cause you major unhappiness. In relationship counseling, you can learn to communicate more effectively, appreciate each other more, and understand each other.
Overcoming negative attitudes about menopause
One thing women struggle with during menopause is outside opinions of what they're going through. Family members may falsely attribute mood disturbances to menopause when the emotions are natural responses to life stresses. But, because the woman is in menopause, the family member doesn't take their feelings seriously.
Couples counseling offers menopausal women a chance to sort out for their partner what is due to menopause and what is a symptom of a problem in the relationship. Emotions aren't bad, but they can be helpful because they shed light on problems that need to be resolved in the relationship.
Dealing with emotional ups and downs
Whether they're caused by hormonal changes or changes in your life situation, mood changes can be difficult to deal with during menopause. You can learn techniques for managing your moods from a mental health counselor. After visiting your primary care physician or another licensed medical professional to rule out medical issues, sessions with a licensed mental health counselor or therapist can put you back on track to good mental health. When you participate in therapy, You learn strategies to develop a more positive and realistic outlook on life and new coping and communication strategies for dealing with life's challenges.
Managing menopause with online therapy
As mentioned above, many of the symptoms of menopause have the potential to affect mental health and interpersonal relationships adversely. One possible solution is online therapy, either for yourself, you and your partner, or your family. Online therapists use the same evidence-based techniques as traditional therapists, and evidence suggests that most therapies are just as effective online as in-person. Couples therapy, for example, lends itself exceptionally well to an online model.
Online therapy also offers certain benefits. You can participate in online therapy from your home or anywhere you choose, removing the hassle of traveling to a physical office. Online therapy also commonly offers access to more therapists than may be available locally, giving you greater choice over your practitioner. Finally, online therapy is often cheaper and more cost-effective than in-person therapy, especially after considering the additional travel expense.
Frequently asked questions
How much does it cost for hormone replacement therapy?
The average cost of this type of therapy is between $30 and $90/month. However, most individual treatments are tailored, so the cost will vary from person to person. Hence, the overall cost of the procedure depends on some factors, like the dosage of the hormone that you need to balance your hormone levels and the specific treatment method adapted to your case.
Does insurance cover hormone replacement therapy?
If you already have medical insurance, ensure you visit your insurance service provider to know what they cover and what they do not cover. Their response normally depends on the coverage type that you possess – some insurance packages may cover hormone replacement therapy, other packages may not cover it. Most hormone therapies approved by the FDA are covered by most insurance providers. The level of coverage that you’ll have for each hormone therapy depends on your plan.
If you don’t have insurance, bioidentical hormone replacement therapy costs can range from $10 - $85/month, aside from the initial health examination costs that may add about $75 - $200 to the overall cost.
What are the signs that you need hormone replacement therapy?
Most people seek hormone replacement therapy to help manage the symptoms of menopause. Menopause is a natural process, but it can still cause unpleasant symptoms that may require medical treatment. Some of the symptoms that lead people to seek guidance from a medical professional include:
- Hot flashes
- Night Sweats
- Vaginal dryness
- Sleep disturbances
- Decreased sex drive
- Increased urinary frequency
- Redistribution of body fat
- Hair and skin become drier and thinner
- Thinning bones (osteoporosis)
- Joints become stiffer
- Forgetfulness
- Mood changes
Does HRT help you lose weight?
Evidence suggests that HRT does not directly lead to weight loss, but it can sometimes help change the proportion of fat distribution throughout the body. While HRT is not proven to help a person lose weight, there is evidence to suggest that weight gain is not inevitable. Many people believe that HRT will lead to an increase in body weight, but research indicates that weight gain is relatively unlikely, but body fat redistribution is fairly common.
How much do estrogen pills cost?
The cost of estrogen pills varies with the different estrogen formulations out there and ranges from less than forty dollars to hundreds of dollars. Further complicating the issue of cost is a person’s individual insurance plan. Some estrogen therapies help a relatively small copay, while others can be significantly higher. Your medical care provider will work with you to find a treatment that balances cost and effectiveness.
How much does testosterone therapy cost?
Testosterone therapy, a form of HRT used to increase the amount of testosterone in a person’s body, can cost anywhere from $50 to hundreds of dollars. The main complicating factors are the formulation of the medication, how it is administered, and whether it is covered under a person’s insurance plan.
How long can you take hormone replacement therapy?
There’s no limit on how long a person can take HRT, but their medical team will work closely with them to ensure that risks are well-managed. Evidence suggests that risks associated with HRT can increase over time, largely due to the effects of aging. For example, cancer risk typically increases with age, and the combination of reduced cancer defenses and HRT may lead to complications. However, there is no evidence to suggest that HRT will eventually lead to serious complications like cancer. Many medical practitioners use specific screening tools and schedules to ensure that their patient’s medical risks are managed.
Does HRT make you look younger?
Limited evidence suggests that HRT can help preserve a youthful appearance by slowing changes in skin elasticity and structure. However, research indicates that many people significantly overestimate the youth-promoting effects of HRT, which are likely extremely small. Medical providers are concerned about the misconceptions surrounding HRT and youth, as those misconceptions may lead a person to seek hormonal treatment for a lengthier period than they normally would, potentially increasing risks.
What does hormone replacement therapy do to your body?
HRT is most often prescribed when a woman undergoes menopause. During menopause, the body slows and eventually stops the production of two hormones: estrogen and progesterone. Although menopause is a natural process and rarely produces severe risks, it can produce unpleasant symptoms like hot flashes, mood swings, and a decreased sex drive.
HRT introduces synthetic hormones into the body to replace the estrogen and progesterone that have been depleted. Replacing estrogen is typically the most important for menopause symptom reduction, with progesterone being added to reduce the risk of uterine cancer. Women who have had a hysterectomy (surgical removal of the uterus) often take only estrogen.
The hormones replaced by HRT perform the same functions as those that were formerly produced by the body. By maintaining base levels of those hormones, menopause symptoms can be reduced or eliminated. However, discontinuing HRT typically means that menopause symptoms will return.
What is the best form of hormone replacement therapy?
The best form of hormone replacement therapy is the one decided on between you and your medical provider. There are many formulations and derivatives of HRT medication, each with pros and cons. Your medical provider will work with you to determine the best course of therapy that minimizes risks while maximizing symptom relief. There is no specific treatment that is deemed universally better than every other.
Who should not take HRT?
HRT comes with some risk potential, and those who are already at high risk in certain areas may not want to take HRT. This includes women who:
- Have a history of uterine or breast cancer
- Have a history of blood clots
- Have had a stroke
- Are current smokers
Medical providers regularly weigh the risks of HRT against potential benefits. If a person’s risk is too high, their provider may still be able to work with them to find ways to reduce symptoms other than HRT.
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