Navigating change: Menopause and hormone replacement therapy
Two million women in the United States enter menopause each year. Menopause is defined as not having had a menstrual cycle for one year. It usually occurs in women around the age of 51.
Perimenopause is the 7-10+ years before menopause when hormone levels decline. Four out of 5 women will report having bothersome symptoms, according to the National Institutes of Health (NIH). Some women experience symptoms as young as age 35. Post-menopause is the rest of your life after menopause. Hormone deficiency symptoms can continue for an average of about 7½ years, sometimes up to 12 years after symptoms first begin.
What are the symptoms of menopause?
Hot flashes and night sweats are typical symptoms associated with menopause. Other symptoms may include difficulty sleeping and insomnia, often due to night sweats, leading to a decreased energy reserve and fatigue. Women also experience brain fog, fuzzy thinking, decreased memory, difficulty concentrating, depression and anxiety, mood swings, tension, nervousness, headaches, bloating and abdominal weight gain, thinning of hair, palpitations sometimes with chest pain, vertigo, lower extremity swelling and achy joint pains.
Genitourinary symptoms of menopause develop over time due to low estrogen levels. These symptoms include vaginal dryness, itching, discharge and even bleeding. Women begin to experience painful intercourse and loss of sexual desire, urinary bladder discomfort, more frequent urinary tract infections (UTI) and even overactive bladder symptoms like frequency and urge.
Long-term estrogen deficiency contributes to osteoporosis that affects 35% of women over the age of 80. Two million fractures each year result in 500,000 hospitalizations in the U.S., according to the NIH. The most serious can lead to long-term care, significant loss of mobility or mortality.
What are some of the ways to help navigate menopause?
Medical experts generally agree that for women younger than 60, or those who are within 10 years of menopause onset and have no other concerning symptoms or conditions, that the benefit-risk ratio of hormone replacement therapy (HRT) is favorable for treatment. This can include treatment for symptoms or premature menopause, and it has also been shown to decrease bone loss and fracture. A study in the April 2024 journal Menopause cites the benefits of continuing low dose transdermal or vaginal bioidentical estrogen replacement therapy in women even beyond age 65.
FDA-approved bioidentical estrogen and progesterone hormones are available. These hormones are different from earlier studied hormones that showed concerns. Many non-hormonal menopause medications also exist for those who are not good candidates or choose not to use HRT.
Men have long benefited from FDA-approved medicines for erectile dysfunction and topical testosterone for low testosterone levels. Premenopausal women now also have FDA-approved medicines available for low libido. Other treatment options are available as well, so discuss your choices with your OB-GYN.
Are there any other health benefits of hormone replacement therapy?
Many studies have shown other benefits of HRT, although it has not been FDA approved. Findings suggest women generally live three years longer on HRT than without. Benefits include better heart health, cognitive function, mood, colon health, less joint pain and lowered rates of diabetes, making for a better quality of life.
SIU Medicine drives innovative, forward-thinking research and best practice clinical care for women from all walks of life. Our providers will be your ally, confidant and guide throughout your health care journey. If you have concerns about your health or are advocating for a female loved one, contact SIU Medicine’s OB-GYN care providers today by calling 217-545-8000 to schedule an appointment.
