Everything You Need to Know Before Starting Hormone Therapy
In the 1980s and '90s, it seemed that the magic answer to the sweats, mood swings and sleepless nights lay in replacing depleted estrogen with drugs that mimic its effects on the body. Doctors' belief that HT also carried a heart-health benefit (estrogen helps facilitate blood flow by keeping blood vessels flexible) made it a go-to remedy.
Today the decision to start HT is more complicated. One of the biggest trials to look at the effects of combination HT (estrogen plus progestin) was called off in 2002 after researchers linked HT to a higher risk of heart disease—and breast cancer; further analysis showed it can also lead to higher chances of dementia in women who begin treatment after 65. Since then, the U.S. Preventive Services Task Force, a government-appointed panel of health experts, and other medical organizations have cautioned against using HT to prevent chronic disease. But it's still an effective way to relieve symptoms associated with menopause.
So where does all this leave you? Ultimately, it's up to you and your doctor to decide whether HT is right for you, but here are some general guidelines based on the latest research:
• If you're healthy and are experiencing hot flashes or night sweats, have lost bone mass and haven't had success with other treatments or went through early menopause (before or around 40), you're a good candidate.
• If you've had a stroke, a heart attack or breast cancer, HT is usually not recommended.
• If you have heart disease or a history of blood clots, you and your doctor will probably determine that HT's dangers are too great.
• If you're over 60, the risk of heart disease and cancer will likely outweigh the benefits of HT.
If you decide HT is the solution, here's how to keep your chance of side effects low:
• Take the smallest amount possible. Find the lowest dose you need to relieve symptoms for the shortest amount of time. The North American Menopause Society says it's fine to take estrogen with progestin therapy for up to three to five years; women using estrogen alone can be on it for seven years. Check in with your doctor every six months about how you feel and whether to continue.
• Pick the treatment that suits your symptoms. There are two kinds of hormone therapy: systemic and local (or vaginal). The systemic kind, which circulates through the body, comes in various forms—including pill, patch, gel and spray—and is used to treat symptoms like hot flashes, night sweats, and insomnia. If your symptoms are in the vaginal area only—such as dryness, itching or vaginal or urinary irritation—you don't need a systemic medication. A low-dose estrogen, available as a cream, a ring or a tablet, can be effective in treating these symptoms.
• Make healthy choices. Because the risk of heart disease increases after menopause, it's especially important to protect yourself by maintaining a healthy lifestyle. That means saying no to smoking and yes to eating lots of fruits and veggies, heart-healthy whole grains, nuts and legumes. Exercise regularly and limit your alcohol intake. Little changes like these will help make the big one more bearable.
Did You Know?
As many as 75 percent of perimenopausal women experience hot flashes.
Mehmet Oz, MD, is the host of The Dr. Oz Show (weekdays; check local listings).