What is menopausal hormone therapy?
Is it a viable treatment option for managing menopausal symptoms?
Does it lead to breast cancer?
What about Cardiovascular disease?
These are questions many women in midlife have that a lot of primary care physicians aren’t comfortable answering due to a lack of knowledge on the subject.
In 2002, there was an inaccurate study led by the Women’s Health Initiative (WHI) that caused many women to believe that MHT led to an increased risk of breast cancer and cardiovascular disease. The inaccuracies in the study were later clarified by newer studies that demonstrated the safety of MHT for women younger than 60 who are in good health, and within 10 years of menopause.
However, there are still many myths circulating about MHT, and many women wonder if it actually a safe option for treating their menopausal symptoms.
My goal is to answer the most common questions women have about MHT, and dispel some of these myths. In this article I will discuss the benefits and risks of MHT, symptoms MHT can help with, and what types of MHT are available so you can have more clarity on the subject overall.
Menopausal Hormone Therapy — what is it?
Previously referred to as Hormone Replacement Therapy (HRT), Menopausal Hormone Therapy is a term that encompasses the two different types of hormone treatment that are available that help alleviate hot flashes, loss of bone density, night sweats, and genitourinary symptoms of vaginal dryness.
There are two types of MHT; estrogen-progestogen therapy (EPT) and estrogen therapy (ET).
Estrogen-progestogen therapy is prescribed for women who still have their uterus because progestogen prevents hyperplasia (a build-up of cells) in the inner lining of the uterus. Essentially, it works to counteract the effects that estrogen has on the endometrium (the inner layer of the uterus) by regulating the amount of estrogen hormone receptors available in the tissue, which significantly decreases the risk of endometrial cancer.
Estrogen Therapy is the use of estrogen alone and is given to women who have had their uterus removed.
So, why is estrogen so important?
Well, as women, in the years leading up to menopause (also known as perimenopause) our bodies begin to produce less estrogen which lead to the symptoms we experience during menopause.
Estrogen has the ability to reduce the frequency and severity of some of these symptoms, including:
It also helps to increase blood flow in the brain, improve brain connectivity (allowing different parts of the brain to communicate with each other), and may even reduce the buildup of plaques in the brain that have been linked with Alzheimer’s disease.
Studies conducted by Dr. Lisa Mosconi (the director of the Women’s Brain Initiative at Cornell Medicine) and her team have shown that the longer a woman’s brain is exposed to estrogen the stronger it is, and may have a lower risk of dementia.
When is it best to start MHT?
The North American Menopause Society (NAMS) states that MHT is best for women younger than 60, or who are within 10 years of menopause, and have no high risk health conditions or contraindications.
It is recommended for those who have already tried low-dose vaginal estrogen, but have not seen an improvement in hot flashes, bone loss, and vaginal dryness or painful sex.
I highly recommend regular periodic evaluations after beginning MHT to ensure that it is managing your symptoms effectively, and that the right dose is being administered.
If you are experiencing vaginal dryness or painful sex, I would recommend trying over-the-counter vaginal moisturizers and lubricants before considering MHT. If these don’t provide relief, then consult your physician to see if other therapies like MHT are the right fit for you.
When is it best to stop MHT?
There really is no concrete answer for this because every woman’s body is different. This is a decision that should be made between a woman and her doctor based on her medical history and what is best for her specifically.
What are the risks of MHT?
As I mentioned earlier, many women think that MHT can increase their risk of breast cancer and cardiovascular disease. However, in reality, this depends on the woman and how longs she uses MHT.
The risk of breast cancer for the majority of women using MHT is extremely small. Estrogen-progestogen therapy (EPT) only slightly increases one’s risk of breast cancer if it’s used for more than four to five years. Women using estrogen alone (remember, this is only for women who have had hysterectomies) only have an increased risk of breast cancer if it’s used longer than seven years.
Regarding cardiovascular disease, MHT may have negative effects that lead to its progression when it is initiated among women older than 60 years of age, or women who have entered menopause 10+ years prior to starting MHT.
Additionally, if women older than 65 begin MHT, it may increase their risk of dementia.
Other risks include blood clots, gallbladder disease, and uterine cancer (this is greatly reduced with the use of estrogen-progestin therapy). These risks can be managed by using FDA-approved therapies and following the best practice prescribing guidelines, however, it is important to note that they are further increased by smoking, high blood pressure, or diabetes.
All in all, it is important to remember that…
Just like with any treatment, before beginning MHT, it is imperative that you discuss your complete medical history and any medications you’re taking with your physician to ensure you don’t experience a negative reaction to MHT.
If you do end up using MHT, I recommend checking in with your doctor every three to six months to monitor any side effects that could potentially occur and to determine whether or not you should continue treatment.
What are the benefits of MHT?
Besides reducing hot flashes, bone loss, and vaginal dryness some women have found that it also helps with sleep disturbance, mood swings, and feelings of depression. This may be due to the fact that they’ve experienced less nighttime hot flashes which can affect your quality of sleep and overall mood.
Does MHT cause weight gain?
In short, no, it does not. Weight gain naturally occurs for women between the ages of 45-55 (at an average of 2.2 pounds per year) and has nothing to do with MHT. As we get older our metabolism slows down and we don’t have the capacity to exercise the way we were able to in our youth. Our bodies aren’t able to process as many sweets, bread, pasta, and processed foods either.
On top of that, the hormonal changes that occur during menopause change how our body distributes fat, causing it to form around the belly instead of the hips, buttocks, and thighs. It even converts some of our muscle mass into fat, which is…less than helpful.
The main takeaway here is, MHT does not cause this, and it can actually help prevent fat from settling around the abdomen, which is an added bonus.
What are common side effects of MHT?
Many women experience breast tenderness while using MHT, but this can be resolved by adjusting the dose. For women using cyclin EPT (this includes taking estrogen daily and progestin 10-14 days out of the month) changes in mood, bloating, headaches, and vaginal bleeding can occur. Vaginal bleeding can be avoided by using a continuous EPT, but irregular spotting can still occur in the first few months of treatment. It is essential to let your healthcare provider know about any side effects during the initial stages of MHT. Any side effects you experience can likely be managed by adjusting the dose, delivery method, or both.
Are there any holistic options for managing menopausal symptoms?
Absolutely! If you focus on exercising, eating nutritious foods, getting quality sleep, and managing your stress levels, you can reduce a wide range of menopausal symptoms and even reduce your risk of cardiovascular disease, diabetes, dementia, and osteoporosis.
You can read about this more in depth here.
At the end of the day, whether or not to use MHT is completely up to you. My hope is that you have a more accurate understanding of what it is and how it may benefit your health.
If you’re curious about MHT, you can schedule an appointment with me here, and we can discuss the best options for you and your menopausal journey together.
Menopause can elicit negative self-talk like,
“I’m becoming less of a woman.”
“Wow, I’m getting old.”
“The best years of my life are behind me.”
To make matters worse, it also has negative connotations in our society. It is a ruthless combination of physical challenges and mental stressors which can make it a doozy of a transition. However, it doesn’t have to be.
If you’re experiencing menopause, remember that it is a natural time of transition in a women’s life just like any other, and it is completely normal.
Much like when young girls enter menstruation, many women enter menopause without knowing what is actually happening to their own bodies. As a physician who has treated several women throughout their menopausal journey, it is my goal to educate and support them during this season so they can continue to lead wildly fascinating lives.
If you currently find yourself in the midst of this journey, or about to embark on it, please know this:
The best days of your life aren’t over just because you’re entering menopause. There is still so much of your life to be lived and enjoyed, and I’m always here as support to help you throughout this process.
My hope is that this article can act as a resource for you to refer to throughout your own journey.
So, what exactly is Menopause?
It is a period in a woman’s life when they naturally stop having menstrual periods, marking the end of their reproductive years (no more birth control, yay!).
Before entering menopause, there is a period of time when our ovaries will start to produce less estrogen, causing our menstrual cycle to fluctuate. This is called perimenopause. Think of it as a pre-cursor to the main event. Perimenopause can last anywhere from 5 to 15 years, with some women entering perimenopause as young as their 30s.
Basically, once you’ve gone 12 months without a period, that’s when you’ll know you’ve officially entered menopause.
When this happens you will begin to experience at least one of the following symptoms (which I will go over in more detail below)…
Basically, a hot flash is exactly what it sounds like. It’s a sudden, overwhelming sense of heat beginning in the head and neck that can last between 5 and 30 minutes (sometimes longer). Your heart begins to race and you may even break a sweat.
A few common triggers include caffeine, alcohol and smoking. With that being said, all of our bodies are unique and react differently to different things, so it’s important to note what you consumed prior to experiencing a hot flash and avoid it if you can. This will help significantly in eliminating hot flashes, or at least the frequency at which they occur.
Getting a sufficient amount of sleep is essential for our overall health and well being, and during menopause, our bodies need more sleep than ever. Ironically enough, however, all the hormone disruptions going on in our bodies can hinder us from actually getting good night’s sleep.
Because of this, you’ll want to experiment with different ways to help prepare your body for sleep. I’ll go over a few helpful methods later on in this article.
Our bodies experience metabolic changes during menopause, so you may find that methods you’ve used to stay trim in the past don’t work as well, or at all. This can be frustrating, but I like to see it as an opportunity to adjust our lifestyle habits to work with our current metabolism.
Because our hormones levels are decreasing, this can also reduce our desire for sex.
Don’t be too hard on yourself when it comes to this. It does not mean that you don’t love your romantic partner or no longer find them attractive. Your body is simply changing, and it has nothing to do with them. The good news is, it is absolutely possible to increase your libido and experience climax during sex at any stage of your life, which I will get to later.
This is one of the most common symptoms of menopause and can even affect women in their 20s and 30s. Vaginal dryness is also prompted by a change in hormones, and can lead to more infections, odors, itching, irritations, incontinence and a decreased desire for sex. Unfortunately, this is not a symptom that goes away with time, but the good news is, there are plenty of solutions to heal your dryness.
This is the involuntary loss of one’s bladder control, which is not only inconvenient, but embarrassing. It can even take a toll on one’s overall confidence.
Incontinence happens because our vaginal tissue begins to thin during perimenopause and becomes less elastic over time. A great way to combat this is by doing Kegel exercises to strengthen your pelvic floor muscles, which will help significantly in regaining bladder control.
Fatigue and disconnect
The stress that comes from all the changes going on in the body during menopause can wreak havoc on your system. This chronic stress and adrenal fatigue can drain your energy significantly. Not to mention that some of the most important hormones in your body (cortisol, adrenaline and oxytocin) are waging war against each other.
It’s important to show yourself grace during this time. You’re not being lazy, your body is simply working against you, and that’s not your fault. There are ways to overcome this, which I’ll get to in a moment.
Brain fog and memory loss are a common occurrence during menopause, and it is nothing to be alarmed about. You’re not experiencing the early signs of Alzheimer’s, but rather, a decline of estrogen. Estrogen is responsible for glycolysis in the brain, so when your estrogen levels start to decline so does some of your brain function. Another thing to consider is that there are more factors at play here; feelings of overwhelm affect the way we think, our concentration, hormonal balance and even our memory.
Finding ways to exercise your brain to keep your mind sharp definitely helps combat this. Practicing meditation and adopting a keto-green diet is helpful as well.
With your hormones changing, it can feel like someone else has taken over your body. You might find yourself reacting in ways you normally wouldn’t, suddenly snapping at a loved one, and having to apologize later.
It’s enough to make you feel insane, but trust me, you’re not. You’re simply at the whims of your changing hormone levels, which can be disorienting to say the least.
Hormone imbalances can also trigger different issues throughout the body such as…
Lovely, isn’t it? But, not to worry, there are ways you can balance your hormones and get to feeling like yourself again (more on that later).
So, how do we heal or reduce these symptoms?
I’m sure after reading that laundry list of menopausal symptoms, you’re feeling pretty hopeless, but believe me when I say that there is so much hope! The most important thing is to tell your healthcare provider when you start experiencing these symptoms so you can develop a strategy to combat them.
Here are some methods I recommend to my patients that have proven to help immensely…
Adopt a keto-green diet
This means consuming foods that keep your urinary pH at an alkaline level of 7 or above. There are numerous benefits of keeping your urine pH more alkaline (rather than acidic) which include…
Maintaining a keto-green diet looks like eating low-carb alkaline veggies and avoiding food that promotes excessive acidity like processed foods, grains, white sugar, white flour and caffeine.
You’ll also want to get your protein through free-range meats and wild caught fish. Consuming healthy fats such as ghee, avocados, nuts, olive and coconut oil is essential in keeping your hormones balanced and giving you more energy as well.
Since our bodies are changing so much during this time, we need to give them the nutrients that they may be lacking. There are lots of supplements and bio-identical hormones that can help women through menopause, and I can help you find the perfect combination for you and your body’s needs.
A consistent sleep schedule
Getting a sufficient amount of sleep every night is essential for reducing stress. If you’re having trouble falling asleep, try out some of these methods:
Move your body
Exercise will improve your mood and help you sleep more soundly at night. It also reduces stress and anxiety, and even promotes the growth of new nerve cells and blood vessels in the brain while also increasing the production of chemicals that repair existing brain cells—bye-bye brain fog!
There are so many ways to exercise and it’s important to find what feels best to you. I’ve found that doing high-intensity interval training exercises can boost the size of the hippocampus, which is the area of the brain that controls learning and verbal memory.
Exercise your brain
Even though the brain isn’t a muscle, the same principle applies here. If you don’t use it, you’ll lose it. It’s important to find ways to mentally stimulate your brain so your mind stays sharp, which can be anything that will require you to really think.
This can look like…
Or, anything that challenges your brain specifically.
Incorporate key superfoods into your diet
Superfoods get their name because they are packed with nutrients that help provide your body with the essential antioxidants, vitamins and minerals that it needs to thrive.
Turmeric, for example, is great for reducing inflammation, promoting brain health and treating hot flashes.
Here are some great ones to try:
I know you’re probably thinking, “I’m sorry, Maca? What is that?”
Maca is a root grown in the Andes, and Peruvian natives use it to help promote fertility, increase libido and reduce fatigue. Some even refer to it as the Peruvian Viagra. Studies have shown that Maca can also reduce hot flashes, soothe anxiety and depression and balance hormones.
Pretty cool for a root, yeah?
If you retain nothing else from this article…
Remember this: menopause is a natural part of life and we should approach it as such. It’s nothing to be afraid of, and it doesn’t mean your life is over. Far from it, actually! Just think of all you’ll be able to do now that you don’t have to deal with PMS or your period anymore (woohoo!).
All of these suggested lifestyle changes that will help support you during your menopausal journey can feel really overwhelming at first, and that’s okay. The important thing is to take it one small step at a time, and incorporate these changes in a way that is sustainable for you. If you only have the energy to focus on your sleep schedule, start there. Then you can begin to incorporate other changes into your routine once you feel like you’ve mastered that one.
And, of course, I’m always here to support you throughout the entire journey. You are welcome to come see me anytime, and we can create a plan that will help you navigate menopause together.
You’re going to make it through to the other side of this with a newfound sense of confidence and freedom.
I promise you.