Going through menopause? Here's a guide to see if hormone replacement therapy is right for you

• Hormone replacement therapy (HRT) restores the balance of estrogen and progesterone.
• Menopause can disrupt this balance so restoring it may help relieve menopausal symptoms.
• There are 3 types of HRT: estrogen-only, progestin-only, a combination of estrogen and progestin.

Hormone replacement therapy is used to treat symptoms of menopause, like hot flashes and mood swings.

Menopausal symptoms happen in the first place because your ovaries are not producing as much of the hormones estrogen and progesterone.

So, to combat these hormonal changes, hormone replacement therapy restores and balances estrogen and progesterone levels to relieve symptoms.

"Hormones can help restore some of the body functions that change after menopause, and relieve some of the physical effects of menopause," says Samir Hage, DO, an OB-GYN with Redlands Community Hospital.

There are a few different types of hormone therapy that can help target these symptoms and the right one for you will depend on your medical history and the severity of your symptoms.

Bioidentical vs. standard hormone therapy

Bioidentical hormones are man made hormones that are very similar to those naturally produced in the body. They are made by pharmaceutical companies or compounding pharmacies. Those made by pharmaceutical companies go through FDA approval and hormone levels are regulated. Compounding pharmacies make the hormones but they are not FDA approved. Although some people think that custom made bioidentical hormones are safer, this has not been proven in scientific studies.

Signs you may need hormone replacement therapy

If menopausal symptoms are impacting your quality of life, you may benefit from hormone replacement therapy, depending on your medical history, the severity of your symptoms and how well you respond to medication.

Note: Some women choose to use hormones to alleviate symptoms but there are also other ways to manage symptoms without hormones if a woman prefers.

Side effects of menopause that hormone replacement therapy can help relieve include:

• Hot flashes
• Difficulty sleeping
• Mood swings
• Vaginal atrophy, which is characterized by vaginal dryness and pain during sex
• Night sweats
• Cold flashes
• Urinary urgency
• Dry skin, eyes, and mouth

Types of hormone replacement therapy

There are three types of hormone replacement therapy. These are:

• Estrogen-only: This type of treatment typically comes in pill or patch form and doctors often prescribe them at low doses to be taken daily. Estrogen can also be prescribed as a cream, gel, spray, or vaginal ring to help restore elasticity to the vagina. If the uterus is still present, progesterone must be prescribed to prevent cell changes of the uterine lining that may lead to cancer.
• Progestin-only: Some women may take progestin-only medications in addition to estrogen-only treatments. Progestin-only treatment options come in pill form and are also generally given in daily low doses, says Felice Gersh, MD, an OB-GYN and founder of the Integrative Medical Group of Irvine. Progestins are added to protect the uterus against cell changes that may occur from estrogen alone.
• A combination of estrogen and progestin: Just as the name suggests, these medications combine doses of estrogen and progestin and typically come in pill or patch form.

There are only three progestin-only medications currently approved by the US Food and Drug Administration (FDA). They are:

• Prometrium, pill
• Provera, pill
• Aygestin, pill

But there are many more estrogen-only and combination medications approved by the FDA. Here's a look at a few different medications that are available for these two types of hormone replacement therapy:

*Prempro is still on the market despite lawsuits against its manufacturer, Pfizer, for claims Prempro causes breast cancer. Combination hormone replacement therapy is associated with a increased risk of breast cancer when used for an extended period of time, so discuss these risks with your doctor if you are considering this drug.

It's important to note that some of these medications are generic and may be just as good as brand names, but more affordable. So, make sure to ask about generic versions if you're prescribed a brand name.

Choosing the right hormone replacement therapy for you

Choosing the right type of hormone replacement therapy for you depends on a few individual health factors.

For example, someone who has had a hysterectomy (removal of the uterus) typically does not need to take progestin. But if you still have your uterus, you will need to take both progestin and estrogen medications, says Kimberly Langdon, MD, an OB-GYN with Medzino, a telehealth provider.

This is because taking estrogen alone can stimulate the endometrium or the lining of the uterus. When the endometrium is no longer shed (aka your period), as is the case in menopause, estrogen can cause an overgrowth of cells, which can increase your risk of endometrial cancer. So to reduce that risk, it's recommended you take a combination pill to counteract the estrogen and prevent an overgrowth of cells.

Aside from that, finding the right kind of hormone replacement therapy is a bit of trial and error, Langdon says. It basically comes down to whatever option makes you feel better. If your symptoms are more severe, for example, you may need a higher dosage or a different combination of medications.

In general, most people start to feel relief from menopausal symptoms within one to two weeks of starting hormone therapy, Hage says. But some symptoms, like vaginal atrophy, can take weeks or months to subside.

Side effects of hormone replacement therapy

Common side effects of hormone replacement therapy include:

• Breast tenderness
• Spotting
• Mood swings

You are more likely to experience these mild side effects in the first week or two after starting hormone therapy, Hage says, but they usually go away within a few weeks after starting the therapy.

Less common side effects of hormone replacement therapy include:

• Headaches
• Fluid Retention
• Skin irritation, particularly under an estrogen patch
• Black or brown spots
• Increased breast density

In most cases, side effects can be managed by changing the dosage or type of medication, Langdon says.

Risks of taking hormone replacement therapy

Hormone replacement therapy is generally well-tolerated, but does come with some risks, Gersh says. These include:

• Increased risk of blood clots, particularly for people over the age of 60 who started menopause more than a decade ago.
• Increased risk of gallbladder/gallstone problems, which appears to be highest for people who are on hormone replacement therapy for more than five years.
• Increased risk of breast cancer, particularly for those who are on combination hormone replacement therapy for five years or longer, which can increase the risk by as much as 75% The use of estrogen alone for an average of seven years is not linked to an increased risk of breast cancer.

Insider's takeaway

Hormone replacement therapy can treat symptoms of menopause, like hot flashes, mood swings, and vaginal atrophy.

There are three types of hormone replacement therapy and the right one for you will depend on your medical history and the severity of your symptoms.

If you are experiencing symptoms of menopause that are negatively impacting your life, talk with your doctor about whether or not hormone replacement therapy is a good fit for you.

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