Perimenopause and Hormone Replacement Therapy
What is Perimenopause?
This is a transitional phase that women go through when the production of their estrogen levels begin to decline before your approach menopause.
Perhaps the one classic sign that indicates you’re heading towards menopause is when you have irregular periods. During this time, your periods can be either lighter or heavier, can last longer or shorter or can come more or less often than before.
Learn more about Periods During Perimenopause here.
Symptoms of Perimenopause
Apart from irregular periods, you may also experience some of these symptoms during perimenopause:
- Hot flashes
- Breast tenderness
- Fatigue
- Lower sex drive
- Headaches
- Worse premenstrual syndrome
- Vaginal dryness
- Weight Gain
- Urinary urgency
- Urine leakage when sneezing or coughing
- Mood swings, including depression
- Anxiety
- Urinary urgency
- Trouble sleeping
Women who experience these symptoms due to a decline in estrogen, can opt for hormone replacement therapy (HRT). And fortunately, there are many types of HRT such as patches, pills, and suppositories, etc.
Learn more about HRT for Menopause
What is Hormone Replacement Therapy?
Hormone replacement therapy is a medical procedure of taking estrogen and progestin into your body in exchange for replacing hormones during perimenopause. With these extra hormones, it can regulate the hormonal imbalances that lead to irregular periods and more.
Be advised that the best kind of HRT depends on your symptoms, health, personal preference and what you have to get out of treatment. If, for instance, you still have your uterus, you will be given both estrogen and progestin.
Although it is often renowned as the most effective treatment for perimenopause or menopause symptoms, they come with a set of risks as well. This doesn’t mean that opting for HRT is a bad thing in general, just that you need to consider its pros and cons with your doctor before you consider it.
So let’s take a look at the different types of HRT treatments available as well as the kind of benefits and risks associated with them.
Consult with your Doctor
If should obviously go without saying, but undertaking any sort of Hormone replacement therapy should be done under the close supervision of your doctor. It’s also not possible in most countries to get these medicines without a prescription from a doctor.
Not everyone needs hormone replacement therapy, so a discussion with your doctor will help you figure out what’s best for your individual circumstances.
Estrogen Pills
Estrogen pills are what is usually meant by HRT.
What is it?
The most common form of HRT or ERT (estrogen replacement therapy) is oral medication, specifically estrogen pills. Some of these pills include estradiol (Estrace), conjugated Estrogens (Premarin) and Estratab.
Pros:
Like other types of HRT, pills can reduce or prevent troubling symptoms of perimenopause, such as lowering the risk of osteoporosis.
Cons:
On its own, the hormone estrogen can cause a slight increase in the risks of blood clots, strokes, as well as other problems. And if combined with progestin, it can increase the risks of heart attacks and breast cancer. Oral estrogen can cause side-effects such as vaginal discharge, headaches, painful and swollen breasts, and nausea.
Learn more about Perimenopause and Estrogen Pills
Skin Patches
Next up on our list of the possible treatments during menopause are skin patches.
What is it?
Skin patches are other types of HRT, and some common examples include Climara, Vivelle-Dot, Estraderm and Alora. Estrogen and progestin combination patches such as Combipatch and Climara Pro are also available. Menostar, unlike other patches has a lower dose of estrogen and can only be used for lowering the risk of osteoporosis and not other perimenopause symptoms.
Pros:
Apart from having the same benefits of oral medication, this type of HRT has a number of other advantages. The patch is convenient in which you only need to stick it on without having to take a pill each day.
Patches are safer than estrogen pills for people with liver problems because they can bypass the liver and go straight into the blood. A 2007 study revealed that unlike oral estrogen, patches do not pose a risk of blood clots, even though more studies are required to confirm if patches are safer than pills.
Cons:
It’s still too soon to tell if patches are a safer option than oral estrogen, in spite of what some experts believe. At the moment, it can be assumed that patches pose the same risks as pills, like a small increase in serious problems such as cancer and stroke.
They also have milder side-effects such as vaginal discharge, swollen and painful breasts, nausea and headaches. The patches must not be exposed to direct sunlight or high heat as it makes the patches release estrogen very quickly, giving you a high dose at first and then a low one later.
Learn More about Perimenopause Treatment Options
Or, check out this short article: Treatment Options During Perimenopause.
Vaginal Rings, Suppositories and Creams
Next up on our list of possible HRT treatment options are vaginal rings and other similar products.
What are these?
These are the type of estrogen treatment that need to be applied directly into the vaginal area. In other words, these treatments are for women who struggle with vaginal itchiness, dryness, as well as pain or burning during intercourse.
Treatments include vaginal insertable rings (Estring or Femring), creams (Estrace or Premarin) and tablets (Vagifem). The scheduling could vary for each treatment, but vaginal creams can be used daily or several times a week. Vaginal rings need to be replaced every three months and vaginal tablets can be used daily for a couple of weeks and then twice a week.
Pros:
When it comes to the vaginal symptoms of perimenopause like dryness, these treatments are documented to be more effective than other forms of estrogen therapy. Like patches, these treatments can be more convenient than taking pills.
Some vaginal rings and suppositories are of low dose, which are beneficial because they can relieve vaginal symptoms without exposing the body to higher doses.
Cons:
Vaginal rings and suppositories can only help deal with vaginal symptoms of surgical menopause since they contain low doses of estrogen. They are not helpful against other symptoms such as hot flashes.
But even though suppositories, rings and creams with higher doses can help with those symptoms, they can expose you to other risks of estrogen therapy, such as cancer and stroke.
Topical Gels, Creams and Sprays
The last HRT option are topical gels, and various kinds of cream and sprays
What are these?
Estrogen gels are another way of injecting estrogen into your system. Examples include estrogen sprays (Evamist), creams (Estrasorb) and gels (Estroge and Divigell). Like patches, these treatments are absorbed through the skin and directly into the bloodstream. Although the directions on how creams are applied vary, they are typically used once a day.
Pros:
Estrogen creams are safer for people with liver problems than oral medications as they are absorbed through the skin and go directly into the bloodstream.
Cons:
Research on estrogen gels, creams and sprays is sketchy and even experts aren’t sure if they’re safer than oral estrogen. So it can be assumed that they pose the same risks as stroke and cancer.
Hormone Replacement Therapy Side Effects
Okay, so you’ve talked to your doctor and you’re considering HRT to deal with your symptoms of perimenopause. You probably want to know about the side effects. Here are a few of the most common ones:
- Bloating
- Breast swelling and tenderness
- Headaches
- Mood changes
- Nausea
- Vaginal bleeding
In order to minimize these side effects of HRT, you should use the most minimal dose possible to alleviate your symptoms such as hot flashes and night sweats.
Stay in communication with your doctor to find the correct dosage.
Is Hormone Replacement Therapy Safe?
There are a lot of myths and uncertainty out there about whether or not HRT is safe. However, there is a proven track record with it, and you should certainly consider it as an option if you’ve having terrible hot flashes and other symptoms during perimenopause.
Your doctor will have the most current information about treatment options available, including side effects, so talk with them about your options.
Are there People Who Shouldn’t do Hormone Replacement Therapy?
HRT isn’t right for everyone. You’ll need to discuss the risk factors with your doctor, as well as the severity of your perimenopausal symptoms to find out if it’s right for you.
However, there are some groups of people who should NOT consider using hormone replacement therapy:
- People with a history of blood clots, cancer, heart or liver disease, or stroke
- Someone who is pregnant, or trying to get pregnant
- Those who’ve had unusual vaginal bleeding
- If you’re not bothered too much by the symptoms of approaching menopause
Please note, there are also risks associated with HRT. Some of them include the following: heart disease, stroke, breast cancer, and blood clots. Please talk about these risks with your doctor.
Can Hormone Replacement Therapy Help me Lose Weight?
The Apple Shaped Body
One of the most common perimenopausal symptoms is weight gain. This is due to changing hormone levels.
It follows that regulating hormones through HRT could help stop weight gain, or even reverse this. Is it true though?
According to this study found, Hormone Replacement Therapy can actually help to reduce belly fat during the years before menopause.
However, according to the authors of the study, HRT is not really a replacement for exercise and a good diet. The effect or hormone replacement therapy on weight loss pales in comparison to those healthy lifestyle choices.
So, eat those veggies, and get walking if you don’t want to gain weight during perimenopause.
What about Supplements Instead of Hormone Replacement Therapy?
A common question that people have are a bit wary of HRT is whether or not supplements like ginseng can be equally effective.
Studies show that they’re mostly not! Results are kind of mixed at best. You can learn more here:
Natural Remedies for Perimenopause Symptoms.
Hormone Replacement Therapy: Have your Say!
What are your thoughts about hormone replacement therapy during perimenopause? Leave a comment below and let us know.
Reference: Mayo Clinic
Tammy Ford is the resident expert for all things Women’s Health (vaginal discharge and infections, perimenopause, menstrual cycles and more) and is also a chief tester of all things eco-friendly period products. She has a Master of Science in Nursing (MSN) and specializes in reproductive health.
You can contact her via email: [email protected]
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