I am a woman of "that" age - when things start changing in my body. I also had a hysterectomy (removal of the uterus) at the age of 35. So, I know how those changes caused by hormones can be no fun! I have heard a lot about hormone therapy, and I wondered if it was something that would be good for me. I talked to Sarah Bartlett, MD, from The Christ Hospital Physicians - Gynecology, to see just what it's all about.
What is hormone replacement therapy or hormone therapy?
To kick off the conversation, Dr. Bartlett explained hormone replacement therapy by saying, "HRT is more commonly called HT or hormone therapy now. It typically refers to administering estrogen to women around menopause to help alleviate some of their menopausal symptoms. The estrogen is generally what gives them the benefits they desire, but we also give progesterone to protect the uterus from excess stimulation by the estrogen."
Who would benefit from HT?
As a woman who has had a hysterectomy, my first thought was that HT was only for women like me, but I was wrong. Dr. Bartlett explained that many women can benefit from HT. She says, "Hormone therapy (HT) or estrogen therapy (ET) is most often sought by women who have already had their last period and are experiencing unpleasant symptoms of menopause. Notably, perimenopause can occur over several years leading up to menopause, and this can actually be worse for some women, so it is not unusual for doctors to offer hormone therapy prior to full menopause."
When it comes to women who have had a hysterectomy, it can also help very much. "Women who have had a hysterectomy no longer need uterine protection from progesterone, so they often times have simpler therapy with estrogen alone. Those who still have a uterus will need both estrogen and progesterone. Women who have had their ovaries removed prior to natural menopause often have significant menopausal symptoms because of the abrupt changes in hormones after surgery. These women frequently choose hormone therapy. Women who must have their ovaries removed at a much younger age for a medical condition are often encouraged to use hormone therapy for health indications as their bodies are still expected to have normal hormonal levels," Dr. Bartlett explained.
How do I know I need HT?
Hot flashes are no fun—and same goes with insomnia and all the other symptoms of menopause. I wondered if that was a sign that I needed HT. According to Dr. Bartlett, it is an indicator. She elaborated that there are other signs such as night sweats, worsening mood changes, brain fog, joint pain and even bothersome changes in skin and hair. She went on to say, "Some women also have vaginal dryness, urinary tract infections, and pain with intercourse. Some of these symptoms start well before menopause while they are still having regular periods. Many of these can be addressed with different forms of hormone therapy, possibly birth control pills, and an array of other non-hormonal medications for those who cannot safely use hormones."
Are there risks and/or side effects with HT?
The first thing that came to my mind was, "Am I going to gain weight with HT?" I am sure I am not alone in thinking that! Plus, what other side effects would I have to deal with? Dr. Bartlett says, "Hormone therapy does not typically cause weight gain, though estrogen and progesterone use can cause water retention and some bloating. Different kinds and doses of these hormone affect women differently. Notably, hormone therapy does NOT cause weight loss, either, though feeling better and sleeping better can contribute a lot to a woman's overall health."
My friends have also talked about the possibility of using HT, and they wondered if I could ask Dr. Bartlett about the risks. She says, "There are definitely risks, though the exact risk to an individual woman depends on many factors including her personal health history, her family history, her age, her weight, number of children, results from prior mammograms, and other medications. The most well-known risk is increased breast cancer. This is generally a modest increase for a low- or average-risk person, but there are ways your doctor can calculate your personal risk. There is also an increased risk of blood clots, including cardiac disease and stroke. Like the breast cancer risk, this varies based on numerous factors, and there are tools your doctor can use to have an individualized approach so you can make a decision together as to if the benefits outweigh the risks for you. Abnormal vaginal bleeding can also occur and needs to be evaluated but isn't always dangerous. Women will occasionally report breast tenderness, though this can be reduced but adjusting the hormones as well. Doctors experienced in hormone therapy should be knowledgeable in managing any potential side effects."
Will my insurance cover HT?
It's a question that comes up with any health care concern. Dr. Bartlett gave me the answer we all want to hear by saying, "YES! There are many different kinds of hormone therapy available, including patches, creams, pills, vaginal rings and vaginal inserts. There are many that are FDA-approved and are covered by insurance. Some are now generic and much more affordable. There are other therapies that are used off-label, and you might have to pay out of pocket for those, but I typically recommend starting with the preparations that have adequate data to support them and choosing those that are affordable."
This is all comforting news for many women just like me. HT can improve quality of life. I could really do without the hot flashes and insomnia, as well as the night sweats. They can really make you miserable…I KNOW! But luckily, hormone therapy with The Christ Hospital can help.
Find a women's health expert at The Christ Hospital who can help with hormone therapy.