Navigating Menopausal Therapies
For women experiencing menopause, hot flashes and difficulty sleeping are hallmark symptoms associated with the transitional life phase. While other symptoms are possible, the previous 2 can be the most disruptive, often leading to depression and other unwelcome side effects. Hormone replacement therapy (HRT) is designed to help replace naturally found hormones in the body that are no longer produced.
How is HRT administered?
For most women undergoing HRT, 1 of 2 methods will be offered, systemic hormone therapy or a low-dose vaginal product. Systemic hormone therapy is usually absorbed through the body and provides a higher dose of estrogen. The hormones are typically delivered via a pill, ring, gel, skin, patch, or cream. Meanwhile, low-dose vaginal products are usually offered in a tablet, ring, or cream form and provide less estrogen. As a result, low-dose solutions usually only provide enough hormone to treat menopause symptoms specific to the vagina or urinary tract. Note that some physicians will also supplement with progesterone.
Finding the right HRT plan
Not every menopausal woman will be a good candidate for HRT or should take the same type of treatment. In particular, women with a hysterectomy should not take HRT with progesterone. By contrast, individuals who still have a uterus will usually require estrogen with progesterone. The dual therapy is designed to lower the risk of developing endometrial cancer, which could be triggered by taking supplemental estrogen alone in individuals with a uterus. By taking progesterone, the risk is significantly reduced.
Titration and HRT
While conventional HRT therapies focus solely on hormone replacement, another option can include titration. In some cases, a woman might undergo the treatment for several years. However, at some point, weaning the individual off of hormone therapy is recommended and necessary to avoid adverse side effects. Titration is a way to slowly lower the amount of active hormone until a woman is no longer supplementing estrogen. Depending on a woman's age, health history, and menopause symptoms, the doctor will best advise on when titration should occur.
How long should HRT last?
In truth, no set timeline is given for when to start or stop HRT. However, for the best results with the fewest side effects, women are encouraged to take the lowest dose possible. If titration is recommended, work with a physician and pharmacist to create a customized plan. If symptoms worsen, the treatment plan can be adjusted. The ultimate goal of HRT is to help women experiencing menopause minimize the bothersome symptoms and get back to enjoying life.