By: Red Hot Mamas
Published: April 10, 2015
Contributed by Dr. Paul J. MacKoul, MD- Red Hot Mamas Medical Expert
Hormone Replacement Therapy is Not a One-Size-Fits-All Solution for Menopause HRT should be based on a patient’s personal decision from sufficient information provided by a specialist
Menopause brings major changes to a woman’s life, and lots of questions about how to manage the physical changes, how to cope with the emotional changes, and how to feel empowered to make the right choices. Hormone replacement therapy is not a solution for every woman. For those who experience moderate to severe hot flashes, hormone replacement therapy (HRT) should be tailored to the individual needs of each woman.
Mild Symptoms May Not Need Hormone Replacement Therapy
Lifestyle changes can often significantly help those women who experience mild hot flashes. Lowering room, temperatures and keeping air circulating, weight management or loss, avoiding triggers like stressful situations (sadly, not always easy to predict) or spicy foods, and of course, dressing in light, easily removable layers. Many women find that hormone replacement therapy isn’t necessary.
As a word of caution, this is typically the time when some women start researching or using alternative therapies. While some have reported that these types of therapies provide a bit of relief, there are conflicting results from clinical trials on alternative treatments (isoflavones, black cohosh, and acupuncture) where there is no benefit compared to a placebo, and for others, clinical tests have shown no efficacy whatsoever (evening primrose, flaxseed, ginseng, dong quai, wild yam and a slew of others).
Menopause Hormone Replacement Therapy
When lifestyle changes aren’t enough, menopause hormone therapy is recommended, but therapy should be tailored to the individual.
These risk factors should be assessed:
- Existing heart disease
- Previous stroke
- History of breast cancer
For those with any of these conditions, or at a moderate or high-risk for these conditions, alternatives to hormone therapy should be suggested.
Estrogen therapy is the gold standard for patients to feel relief from hot flashes during menopause. The delivery system is important, and a gynecological specialist can explain the specific benefits of one delivery method over another. Oral tablets, transdermal patches, vaginal rings and topical preparations.
The most important factor for hormone replacement therapy is whether or not a woman has her uterus. While the ovaries are the source of hormones for the body, the uterus is adversely affected by too much estrogen. If a woman has her uterus, hormone therapy must include progesterone to balance the effects of estrogen.
Estrogen can cause overgrowth of the lining of the uterus, the endometrium, and increases risks for uterine (endometrial) cancer.
Medical Alternatives to Hormone Replacement Therapy
Patients with a history of breast cancer may have hormone receptors (proteins that are found in and on breast cells) that pick up signals from estrogen or progesterone telling cells to grow, eliminating the possibility of taking hormone replacement therapy for menopause symptoms. For these patients, non-hormonal medical treatments may include anti-depressants known as selective serotonin reuptake inhibitors (SSRIs): citalopram (Celexa), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Brisdelle, Paxil) and sertraline (Zoloft). These drugs, and the non-SSRI antidepressants including venlafaxine (Effexor) and desvenlafaxine (Pristiq), have been shown to decrease the frequency and strength of hot flashes by 50 to 60 percent.
Why Bio-Identical Hormone Therapy Is Risky
There has been discussion in the news recently regarding bio-identical hormone replacement therapy, specifically in Angelina Jolie’s New York Times Opinion piece. The name bio-identical makes it sound plausible, with a goal to match hormones by conducting a saliva test. However, this type of therapy hasn’t been proven to be effective, and in some cases where it isn’t matched correctly can cause growth in the uterine lining.
The Womens Health Initiative study indicates an increased risk of breast cancer, heart disease, colon and lung cancer with estrogen and progesterone use in patients who are postmenopausal with a uterus in place. Women with a hysterectomy and menopausal can use estrogen only with no increased risk.
It is important to take an active role in your health as you age. Your GYN specialist should work as your partner, and when it comes to hormone replacement therapy, it should be tailored to your specific needs. Things for you and your doctor to consider:
- Hot flash intensity and frequency.
- Medical history – Is the patient a candidate for menopausal hormone therapy (MHT)?
- Personal choice – Is the patient interested in MHT?
- Coexistence of other menopausal symptoms, such as depression, migraines, vaginal atrophy, sleep disturbances.
Dr. Paul J. MacKoul, MD, co-founder of The Center for Innovative GYN Care, completed his fellowship in gynecologic oncology at the University of North Carolina, and his residency in OB/GYN at the University of Maryland. He graduated from Medical School at Tufts University after completing a Masters degree at Vincent T. Lombardi Cancer Center at Georgetown University. He is a board certified specialist in both Gynecology and Gynecologic Oncology.