Can hormone therapy help menopause symptoms?

Hormone therapy — also known as hormone replacement therapy (HRT) or menopausal hormone therapy (MHT) — can be an effective way to treat symptoms of menopause. But it’s not for everybody, advises University of Chicago Medicine gynecologist Monica Christmas, MD, Director of the Center for Women's Integrated Health and the hospital's Menopause Program.

Depending on a person’s age, medical and family history, medication-related issues can include higher risks of cancer, dementia, blood clots, heart attack and stroke.

Hormone therapy (HT) helps to replace the hormones that your body stops making due to menopause. As hormone production stops — specifically estrogen — it can cause life-disrupting symptoms, such as night sweats, hot flashes and vaginal dryness that can lead to painful intercourse and urinary symptoms.

Christmas frequently prescribes HT for patients with these symptoms and has seen it to be extremely beneficial. However, not everyone with hot flashes and night sweats are candidates for HT. When HT is not recommended due to elevated risk factors, or for those who prefer to avoid HT, nonhormonal treatments can ease menopause symptoms, Christmas said.

“If you’re going to use HT, it should be started close to the onset of menopause and be regularly monitored by your doctor. You want to make sure the benefits outweigh the risks,” she said.

The risks outweigh the benefits if HT is started more than 10 years after the onset of menopause or over the age of 60.

Who can be helped by hormone therapy?

If you do not have significant risk factors, such as history of certain cancers, heart disease, stroke or deep vein thrombosis (DVT), you could benefit from HT if you meet at least one of these criteria:

• Have moderate to severe hot flashes or night sweats
• Have moderate to severe vaginal dryness, itching, burning, pain or bleeding with intercourse, urinary frequency or urgency, or urinary tract infections
• Experience menopause before age 45
• At risk of developing osteoporosis

Are there different types of hormone therapy?

There are two categories of HT: systemic therapy (higher doses) and local vaginal hormone therapy (lower doses).

Systemic HT is used to treat night sweats, hot flashes, premature menopause or to help prevent osteoporosis. The medicine is available as oral tablets, transdermal patches, a high-dose vaginal ring or emulsion.

For patients with a uterus, progesterone or a selective estrogen receptor modulator (SERM)) will need to be added to their HT regimen. There are some tablets and patches that contain both estrogen and progesterone, or estrogen and a SERM. For those without a uterus, they will only need estrogen therapy to manage their symptoms.

Low-dose, local estrogen therapy is applied directly to the vagina to help with vaginal and urinary symptoms. Because there is minimum systemic absorption, low-dose estrogen therapy can be started at any point after menopause without limits on duration of use. Low-dose estrogen therapy options include vaginal cream, vaginal tablets or a low-dose vaginal ring. Progesterone supplementation is not required.

What can I do if I don’t want to, or can’t, take hormone therapy?

If you cannot take hormone therapy or prefer a nonhormonal option, other treatments can help manage hot flashes, night sweats and vaginal symptoms. For example, certain antidepressants, along with other therapies such as cognitive behavioral therapy and hypnosis, have been shown to improve the frequency and bother associated with hot flashes and night sweats.

A new class of drugs will be on the market soon to help manage symptoms. Unfortunately, herbal supplements marketed to help with menopausal symptoms have not shown to be better than placebos in clinical trials.

There are two medications approved to manage menopause-related vaginal and urinary symptoms that do not contain estrogen: oral osphemifene and a DHEAS (steroid) vaginal insert. In addition, over- the-counter vaginal moisturizers and lubricants can help to minimize vaginal dryness and pain with intercourse.

Christmas makes it a priority to discuss healthy lifestyle interventions to ensure her patients are doing all they can to improve their overall health and wellness throughout menopause and beyond. Nutrition, regular exercise and self-care are extremely important.

Is hormone therapy covered by insurance?

It depends. Some, but not all drugs, may be covered. Insurance coverage, or lack thereof, is often the thing that frustrates Christmas the most when treating her symptomatic menopausal patients. Many times, certain medications will be covered by their insurance; however, they often are not the treatments patients prefer.

For example, the higher-dose vaginal ring will treat both hot flashes, night sweats and the vaginal symptoms. It only has to be placed in the vagina every three months. Neither the patient nor their partner will know it’s there. For most people, it is a highly desired option due to ease of use and convenience. Despite all of these benefits, it is often not covered under the formulary (list of drugs approved by the insurance company).

Talk to your clinician to determine the best option for you.

What if my menopause symptoms are only vaginal?

Hot flashes and night sweats will get better over time on their own, but vaginal systems will get worse if not treated. It’s important to tell your doctor if you have any vaginal pain, itching or other issues once menopause begins.

The takeaway is that HT can be a safe, effective treatment for many. However, it is important to discuss with your doctors if it’s the best option for you.

Does bioidentical hormone therapy work? Is it safe?

Bioidentical hormone therapy has a similar molecular composition to that which your ovaries naturally make. There are numerous FDA-approved bioidentical options available on the market to manage menopausal symptoms. It is important to recognize that bioidentical hormonal formulations carry the same risks as other synthetic hormone formulations.

Often when people refer to bioidentical hormone therapy, they are referring to custom-compounded formulations, such as pellets, creams, sprays, tablets, lozenges and injectables that are not FDA-approved. Because these formulations are unregulated, they can be more harmful. For those who prefer a bioidentical hormone therapy option, ask your healthcare provider about government-approved options.