As far as life transitions go, menopause is quite a big one. Along with physically getting older (and more badass), your body is quite literally changing its internal physiologic landscape to match. As we talked about in our last article, perimenopause and menopause involve a drastic decrease in estrogen production by the ovaries. This change can lead to a variety of symptoms, ranging from hot flashes to vaginal dryness.
A lot of times these necessary side-effects of a changing body can be eased through non-medicinal pathways (i.e., exercise and diet). However, for those that experience the more severe side of menopause, lifestyle interventions may not be enough. Enter: hormone replacement therapy (HRT).
If you are struggling with the symptoms of menopause and have considered using hormone replacement therapy, you are most definitely not alone. Hormone replacement therapy is a commonly used method to ease many symptoms of perimenopause and menopause. Regardless of the reason, taking hormones can be intimidating. Hopefully this breakdown of HRT can help ease some of that anxiety, and give you some topics to discuss with your primary care physician when deciding whether it’s the right path for you.
**What exactly is hormone replacement therapy? **
The logical place to start our discussion on HRT would be with what exactly it is! As the name suggests, HRT is the process of replacing hormones lost through menopause with external sources. By that, I mean that through some form of medication, you are supplying your body with estrogen and/or progesterone that was lost as your body transitioned through perimenopause and into menopause/post-menopause (1). These hormones can be delivered through oral medication, skin patches, a vaginal ring, or some sort of topical cream/gel (1).
**What’s the reason to use HRT anyway? **
Unfortunately for us, the process of becoming a badass postmenopausal woman is paved by enduring the side effects of decreasing sex hormones. The central goal of hormone replacement therapy is to ease the symptoms that often accompany declining estrogen. The most commonly cited symptoms eased by this form of therapy are (2), :
- Easing severity of hot flashes and night sweats
- Treating vaginal symptoms (like thinning and inflammation of the vaginal wall; 3)
- Limiting loss of bone mass
- Mediating mood disturbances due to menopause
- Improving sex drive (4)
That all sounds great! Why wouldn’t I use HRT?!
Hold on, now. Before you all run to your primary care physician demanding HRT, we should acknowledge that taking hormones produced out of the body does have some unwanted risks and side effects. We’ll start with the non-life-threatening side effects, and gradually move up in intensity.
Some common, unwanted side effects associated with use of HRT are (5,6):
- Vaginal spotting/bleeding (usually for ~6 months)
- Breast soreness
- Weight gain
While these are certainly not ideal side effects to experience, there are some more severe risks that accompany HRT that you should consider before going all in. These include and cause increased risk of (1):
- Heart disease
- Blood clots
- Breast cancer
Just as when we were all excited about HRT, I should mention that these risks increase as age and time since your last period increases. More specifically, those that are 60+ years old and/or 10+ years have passed since their last period are at a greater risk of experiencing life-threatening side effects (1,4). If you are in this category and/or are worried about the stated risks, a quick chat with your primary care physician is the best way to get the answers you need!
Another unwanted side effect, that is easily avoidable, is the uncontrollable growth of the uterus following use of estrogen-only medication. As we have discussed many-a-time, estrogen’s role in pregnancy preparation is growth of the uterine lining. During the times when we experience a cycle, this growth is kept in check by the presence of progesterone. However, during menopause, progesterone levels are significantly lowered (7). In the lower-estrogen atmosphere of menopause this is fine-and-good, BUT if you introduce increased levels of estrogen without also increasing progesterone, this poses the threat of an uncontrolled growth of the endometrium. This can put you at risk for endometrial cancer (8).
**What if I don’t want to use HRT? **
If you came into this article already looking for alternatives to HRT, or if you just want to know what other options there are, good news, there are some (and we also covered them in our last article!)! There is not really a “one treatment fits all” approach to this, so bear with me. This is also not an exhaustive list, just some of our favs!
- For vaginal dryness or discomfort–try some vaginal moisturizers (9)
- For vaginal discomfort during sex–try some water-based lubricants (9)
- To limit bone density and muscle loss–try to do some weight bearing exercises 2-3x per week (4)
- For hot flashes–monitor what “triggers” them (i.e., alcohol, spicy foods, stress, etc.) and try to minimize/eliminate them (tracking with Wild.AI is a great way to monitor your symptoms 😉) ! (10)
**I’m still very confused about whether or not I should use HRT! **
As with many things in life, there is no “right” answer when it comes to HRT. And as with anything, we at Wild.AI (no matter how much we love you) can’t tell you what to do! If you feel like your experience with perimenopause and menopause have been considerably affecting your quality of life, then you can always talk about HRT with your primary care physician. They can help answer questions and address concerns you have about this form of intervention to create a plan with you!
Going through perimenopause, into menopause, is a BIG life change, but that doesn’t mean it should be unpleasant! Hormone replacement therapy can be a good option to help you enter this new stage as badass as ever, but it also isn’t the only way. Whatever direction you choose to move in this journey, remember that Wild.AI is always here to support. Tracking on Wild.AI can help monitor symptoms, track side effects of medication/at-home treatments, and help you reach new levels in both your training and life!
- “Comparing the Risks and Benefits of Hormone Therapy.” Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/menopause/in-depth/hormone-therapy/art-20046372. Accessed 1 Mar. 2023.
- Harper-Harrison, Gina, and Meaghan M. Shanahan. “Hormone Replacement Therapy.” StatPearls, StatPearls Publishing, 2022, http://www.ncbi.nlm.nih.gov/books/NBK493191/.
- “Vaginal Atrophy - Symptoms and Causes.” Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288. Accessed 15 Mar. 2023.
- Vigneswaran, Kugajeevan, and Haitham Hamoda. “Hormone Replacement Therapy – Current Recommendations.” Best Practice & Research Clinical Obstetrics & Gynaecology, vol. 81, 2022, pp. 8–21, https://doi.org/10.1016/j.bpobgyn.2021.12.001.
- Hormone Therapy for Menopause. https://www.acog.org/en/womens-health/faqs/hormone-therapy-for-menopause. Accessed 1 Mar. 2023.
- Estrogen And Progestin Combination (Ovarian Hormone Therapy) (Oral Route) Side Effects - Mayo Clinic. https://www.mayoclinic.org/drugs-supplements/estrogen-and-progestin-combination-ovarian-hormone-therapy-oral-route/side-effects/drg-20070172. Accessed 1 Mar. 2023.
- Catenaccio, Eva, et al. “Estrogen- and Progesterone-Mediated Structural Neuroplasticity in Women: Evidence from Neuroimaging.” Brain Structure and Function, vol. 221, no. 8, 2016, pp. 3845–67, https://doi.org/10.1007/s00429-016-1197-x.
- “Does Hormone Replacement Therapy (HRT) Increase Cancer Risk?” Cancer Research UK, 27 Feb. 2019, https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/hormones-and-cancer/does-hormone-replacement-therapy-increase-cancer-risk.
- Vaginal Atrophy - Diagnosis and Treatment - Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/diagnosis-treatment/drc-20352294#:~:text=To%20treat%20genitourinary%20syndrome%20of,the%20moisturizer%20every%20few%20days. Accessed 1 Mar. 2023.
- “Hot Flashes: Triggers, How Long They Last & Treatments.” Cleveland Clinic, https://my.clevelandclinic.org/health/articles/15223-hot-flashes. Accessed 1 Mar. 2023.