If you have hot flashes, night sweats, sleep disturbances or other uncomfortable symptoms at midlife, do you have to just “suffer through it?” Or are there safe options for treatment?
“Absolutely, many options exist for treatment of perimenopausal symptoms. We consider your medical history when choosing the safest options for you. These can improve quality of life due to symptoms caused by shifting hormones,” said Annie Siewert, MD, Avera OB/GYN specialist.
A 2002 landmark study known as the Women’s Health Initiative (WHI) cited risks of breast cancer, stroke, heart attack and blood clots associated with hormone replacement therapy (HRT). “This is something to consider when choosing what type and routes of HRT. However, newer data has shown that HRT is safe in most women at the dosages that treat menopause symptoms,” said Dominque Boadwine, MD, Avera OB/GYN specialist.
“Right now, perimenopause and menopause are in the spotlight. I find that many patients are well informed. They are reading news, listening to podcasts, learning what might be a reasonable option for them, and advocating for themselves,” Catherine Schiltz, DO, Avera OB/GYN specialist.
“A common thing I hear women say is ‘I have hormone imbalance.’ Perimenopause is not necessarily an imbalance of hormones. However, how your body is responding to the changes in hormones can definitely feel imbalanced. This is perimenopause in a nutshell,” Schiltz said.
How to Start With Hormone Therapy
Women don’t need to go through hormonal testing for a definitive diagnosis, as results often vary greatly from time to time. “If you are having symptoms, clinically, we can call it what it is and treat your symptoms, as long as there is no contraindicated risk,” Schiltz said. Among contraindications to hormone therapy are a personal history of liver disease; breast, endometrial or ovarian cancer; blood clots; unexplained vaginal bleeding; and cardiovascular disease.
Hormone replacement therapy is not a one-size fits all. It’s also not an exact science; there is a certain amount of trial and error to find what is going to work best for you.
“I always talk to patients about transdermal estrogen therapy first. Oral estrogen pills are safe, but transdermal estrogen hormone therapy is the safest,” Siewert said. Transdermal estrogen may be a patch, cream or gel. If a woman has a uterus (has not had a hysterectomy), oral progesterone is needed along with estrogen therapy.
“I call it hormone stacking. We start with a dose of one thing, often estrogen, find out how this helps, and add additional things to the mix. When patients get to a happy place, we stay the course,” Siewert said. Formulations may be synthetic hormones or bioidentical hormones.
Perimenopausal sexual health is complex. There are indications for transdermal testosterone. Testosterone can have unwanted risks and side effects but can also help mood and energy. A balance can be achieved with your provider.
“Finding that balance is important,” Boadwine said. Too low a dose won’t make enough difference to curb symptoms, so mid-range is a good place to start.
If a woman is getting too much estrogen, it will show up as abnormal vaginal bleeding. Too much progesterone could result in symptoms like headache or nausea.
Oral contraceptives can be prescribed in perimenopause as treatment for symptoms as they serve to suppress ovarian function and even out the hormonal chaos that often accompanies this time of life. They also can be beneficial to help regulate the irregular bleeding that may occur during this time. Hormone dosage in oral contraceptives is typically higher than hormone replacement therapy.
Non-Hormonal Options
For women who don’t want to take hormonal medications or can’t for a medical reason, a non-hormonal option might help relieve symptoms. There are non-hormonal options that can be very effective at decreasing hot flashes and night sweats that may have secondary benefits to helping with mood and stress incontinence.
Lifestyle changes may help people feel better at all ages, including a healthy and balanced diet that is low in sugar and emphasizes whole foods including healthy grains, quality protein, fruit and vegetables; exercise; stress management; limiting alcohol intake; and good sleep hygiene.
See your primary care physician or OB/GYN specialist to start a conversation about treatment for perimenopause and menopause symptoms.
Read More
This is one in a series about women’s health before and after menopause. Watch for a new feature each month on topics including hormone therapy, sexual effects, exercise, nutrition, weight loss, mood, sleep, bone loss and more.
