Understanding Menopause Hormone Therapy

How MHT for Menopause Provides Relief

Menopause is a natural part of aging and can be a difficult transition for many women with a multitude of symptoms that affect quality of life. Hormone replacement therapy (HRT), now known as Menopause Hormone Therapy (MHT), can provide relief of symptoms and help reduce long term health risks associated with low estrogen levels.

The topic of MHT can be confusing… Is it safe? How long can one take it? What is it exactly? What is bioidentical? What are the risks and benefits? Should I use HRT in perimenopause? The list can go on. Part of the confusion arises from a study that was published in 2002 called the Women’s Health Initiative that inaccurately labeled all MHT as a risk for breast cancer and heart health. A whole generation of women went off MHT or did not start it because of this study. The results from this study have been reevaluated and more studies have been done that have shown MHT is safe for MOST women and can actually reduce long term health risks.

It is important to know the facts, so you can make an informed decision and make the choice that’s right for you. That’s where we come in. Let’s go over MHT, the different types and what you should consider as you think about your options for menopause symptom relief and your long-term health.

What is Menopause Hormone Therapy?

During menopause, your body stops making the same amount of hormones like estrogen and progesterone. As these hormone levels decrease, women frequently experience symptoms we typically associate with menopause like hot flashes, night sweats, and mood swings. Other lesser-known symptoms include joint pain, brain fog, and mood changes among others.

It also causes symptoms we don’t talk about as much like vaginal dryness, pain with sex, and bladder leakage. MHT for menopause is the process of supplementing those hormones to get them to levels that can relieve these symptoms.

Types of Hormone Replacement Therapy for Women

The type of menopause hormone therapy that’s right for you will depend on your needs and preferences. There are FDA approved and non-FDA approved formulations. Non-FDA approved is typically compounded by a pharmacy under the direction of a licensed provider. There is also bioidentical hormones and non-bioidentical hormones (synthetic) that can be FDA and non-FDA approved MHT. Bioidentical means that the hormones are more like the ones our bodies produce. Synthetic hormones and animal derived estrogens are chemically altered versions of what our bodies make. Let’s talk about the options available.

Systemic HRT

Systemic hormone therapy is just what it sounds like — hormone therapy for menopause that is introduced to your system via the bloodstream. MHT that works by getting hormones into the bloodstream using any method is considered systemic HRT therapy. Systemic hormones can be bioidentical, non-bioidentical, FDA approved, and non-FDA approved. Bioidentical estrogen includes 17-B estradiol (or just “estradiol”), estradiol cypionate and estradiol valerate and bioidentical progesterone is also known as “micronized progesterone” or just “progesterone”. Synthetic or animal derived estrogen is what was used in the WHI study and common examples are conjugated equine estrogens (“Premarin”) and synthetic conjugated estrogens which contains about 9 different types of estrogen plus more.

Systemic MHT also includes systemic progesterone or progestin use. Micronized progesterone is a bioidentical form of progesterone and progestins are synthetic. Provera is a synthetic progestin that was used in the WHI study. If a woman has a uterus, then a progestogen (either progesterone or a progestin) must be used as well to protect the lining of the uterus from growing too thick from estrogen which can lead to uterine cancer. If a person has had a hysterectomy, then progesterone or a progestin does not have to be used but many providers will still prescribe progesterone as it has other benefits in regards to mood and lower anxiety.

Systemic HRT Options for Menopause:

• Oral Tablets: Oral estrogen therapy for women experiencing menopause symptoms involves taking a pill, usually once daily. They are broken down in the stomach and the hormones are then delivered throughout the body via the bloodstream. This type of delivery is not as safe as through the skin (transdermal) as the estrogen in a pill is processed through the liver and this can increase the risk of blood clots. This type of estrogen therapy can be bioidentical or synthetic and can be FDA approved and non-FDA approved depending on the type of prescription.
• Transdermal: means that the hormone is delivered via the skin and is absorbed into the bloodstream. This is considered the safest way to use estrogen therapy.
• Patches: This type of transdermal estrogen is delivered via a patch that is applied like a sticker and worn on the abdomen or buttocks that is changed either once or twice per week, depending on the brand. There are also combined estrogen and progestin options available.
• Creams/gels/sprays: These are applied to the skin where it’s absorbed and delivered directly to the bloodstream.
• Injections: Injectable hormone therapy for women with hot flashes is available. These typically use estradiol cypionate and estradiol valerate and tend to cause higher fluctuations in estrogen levels and are considered to not be as safe as transdermal estrogen delivery.
• Pellets are a non-FDA approved delivery system of estrogen, progesterone and testosterone. They can cause fluctuating levels of hormones and sometimes it can be difficult to get the dose correct, but many women like this form of MHT.

Progesterone is also given systemically when a woman has a uterus. The reason for this is that estrogen stimulates the lining of the uterus to grow and progesterone helps to control this growth. This is typically given in a bioidentical form as an oral dose of micronized progesterone which can also help with sleep and anxiety and is taken at night. A synthetic progestin can also be given but is not helpful for sleep or anxiety and is more likely to give unwanted side effects. Testosterone is present in female’s bodies in higher amounts than estrogen and also decreases significantly in perimenopause and menopause. Symptoms of low testosterone include low sex drive, decreased muscle mass and low energy. There is no FDA-approved testosterone therapy for women and so many providers will compound creams, injections and other ways to deliver testosterone in overall low doses to help women with these symptoms. Most of these options all do the same thing in different ways. For many women, the choice between them comes down to the dosage and/or combination of hormones that works best for them or what method is more convenient to use.

Local HRT

Local HRT for menopause is a treatment applied to the vagina directly to target specific symptoms. They’re usually low-dose hormone therapy for women with health risks or those looking to treat things like vaginal dryness at the source.

Local HRT therapy Options for Menopause:

• Vaginal Estradiol Rings: These are flexible rings inserted into the vagina just like a diaphragm or menstrual cup. They deliver estrogen directly to the vagina without getting into the bloodstream. They need to be changed around every three months and deliver a low dose of estradiol to those tissues.
• Vaginal Creams and Tablets: These options are absorbed directly into the vagina without entering the bloodstream as well. They’re used mostly to treat specific vaginal symptoms of menopause like dryness. There are FDA approved creams and tablets and these can also be compounded without the chemicals in the FDA approved creams.

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Benefits of MHT

Hormones are an important part of your overall health. Menopause Hormone therapy, including natural estrogen replacement therapy, can have a lot of benefits. The imbalance caused by the sharp decrease in hormone production causes the symptoms women experience. Using MHT for menopause restores your hormonal balance, which helps to alleviate those symptoms. It’s especially beneficial for hot flashes, night sweats, vaginal dryness, brain fog, mood issues and insomnia. However, doctors are unsure if that’s from the HRT therapy itself or a side effect of the improved sleep.

Hormone therapy is not only for symptom relief but also promotes long term health benefits for your heart, brain, bones, skin, and mood.

Risks and Considerations

In 2002, a study found some serious risks associated with hormone replacement therapy for menopause. However, new research has found that those findings were due to a lack of distinction between kinds of hormones. Now, medical experts agree that MHT for menopause is safe and effective when done right.

They have since zeroed in on the factors that make MHT for menopause safest. The hormones used years ago were found to cause a heightened risk of heart disease, stroke, and breast cancer. They have since moved to bioidentical hormones that mimic the exact chemistry of your body’s natural hormones.

Bioidentical hormones approved by the FDA are safest and most effective when used in the lowest dose needed to find relief by women before the age of 60 and within 10 years of menopause. While MHT pills are processed by the liver and have a risk of blood clots, transdermal options don’t have the same risk.

Consult your physician to see if MHT for menopause is right for you. Make sure to discuss risk factors like smoking, family history, history of heart, liver, or clotting issues, weight, and age.

Final Thoughts

MHT for menopause can help reduce symptoms and increase quality of life. Several professional organizations (The Menopause Society, and the American College of Obstetricians and Gynecologists (ACOG)) have stated the benefits of MHT outweigh the risks for most women when started before age 60 or within 10 years of menopause. Discuss MHT with your doctor to see if you’re a good candidate and what regimen is best. Explore Joylux products for additional vaginal health support.