Navigating the changes your body experiences as you age can feel overwhelming, especially when it comes to your hormones. If you’re dealing with symptoms like mood swings, hot flashes, or sleep disturbances, you might wonder if hormone replacement therapy (HRT) is the right option for you.

Let’s explore what you need to know about HRT, how to identify symptoms that might warrant a conversation with your doctor, and the benefits and risks.

So, How Do You Know If Hormone Replacement Is Right for You?

Hormones play a critical role in regulating many of your body’s functions, and shifts in these levels can lead to noticeable changes in your health.

HRT is a medication containing female hormones, typically estrogen and progesterone, that replace what your body no longer produces after menopause, surgical ovary removal, or certain cancer treatments. Some HRT medications may also include testosterone and DHEA based on specific symptoms.

Women often experience significant changes or symptoms as they go through menopause, usually in their late 40s to early 50s. These symptoms can include:

• Hot flashes or night sweats: These sudden bursts of heat can disrupt your daily routine and make it hard to sleep.
• Mood swings or irritability: Changes in estrogen levels can affect neurotransmitters in your brain, impacting your mood.
• Sleep disturbances: Hormonal imbalances can interfere with your ability to fall and stay asleep.
• Vaginal dryness or discomfort: This common symptom can affect your comfort and intimacy.
• Decreased bone density: Estrogen helps maintain bone strength, and lower levels can increase the risk of osteoporosis.

Emily Emmet, M.D., an OB/GYN and physician on the medical staff at Texas Health Fort Worth, says that while every woman will go through menopause at some point in her life, some may not require HRT to help relieve symptoms.

"Menopause is different for every woman and the severity of symptoms will vary for each woman. Many women find that they only have very minimal symptoms that are tolerable and do not interfere with their quality of life. These women do not necessarily need to start hormone replacement"

However, for women experiencing severe symptoms that significantly impact their daily lives, such as constant hot flashes, severe night sweats disrupting sleep, or severe vaginal dryness causing painful intercourse. When symptoms are severe and are interfering with your quality of life, it may be time to chat with your doctor about hormone replacement.

Understanding Hormone Replacement Therapy

The North American Menopause Society states that most healthy, recently menopausal women can use HRT for relief of their symptoms, but there are a few exceptions. Women who have a history of stroke, breast cancer or uterine cancer, severe migraines, heart disease, or blood clots should not take hormone replacement and should speak to their doctor about alternative treatment options.

Here are some options you might discuss with your doctor:

• Estrogen-only therapy: Typically recommended for women who’ve had a hysterectomy.
• Combination therapy: Includes both estrogen and progesterone and is often suggested for women with an intact uterus to reduce the risk of uterine cancer.
• Low-dose vaginal products: These target specific symptoms like vaginal dryness and discomfort without significantly affecting the rest of the body.
• Bioidentical hormones: These are chemically identical to the hormones your body produces and may appeal to women seeking a more natural option.

Weighing the Benefits and Risks

Like any medical treatment, HRT comes with potential benefits and risks. In addition to reducing symptoms of menopause, HRT is widely used to help prevent osteoporosis and cardiovascular disease. However, a Women’s Health Initiative (WHI) study sparked controversy by suggesting HRT might increase the risk of cancer and stroke. Thankfully, Emmet says HRT and the understanding of its effects have come a long way since that study was published in 2002.

“The WHI study showed that combination (estrogen and progesterone) hormone therapy slightly increased a woman's risk of stroke and breast cancer,” she explains. “Women who were only taking estrogen had an increased risk of stroke, but no increased risk of breast cancer.”

Emmet adds that HRT is still proven effective at preventing osteoporosis and decreasing the risk of osteoporotic fractures. However, she cautions that the effects on cardiovascular health are still under investigation.

That being said, research is ongoing to see if hormone replacement is safer if started at a younger age, when a woman is first going through menopause. Because of these risks, it is important to talk with your doctor about your specific risk factors prior to starting hormone replacement.

Advocating for Your Needs

The decision to start — or stop — menopausal treatment is highly personal. You know your body better than anyone else. If you suspect a hormonal imbalance, trust your instincts and advocate for your health.

Emmet emphasizes the importance of working with your doctor to understand your personal risks and benefits and to create an appropriate dosage and combination of hormones based on your symptoms. Here’s how to start the conversation:

• Prepare for your appointment: Bring a list of your symptoms, questions, and any relevant family medical history.
• Be specific: Share how your symptoms affect your daily life and what you hope to achieve with treatment.
• Ask about options: Inquire about the types of HRT available and which might be the best fit for you.
• Discuss monitoring: Ensure you understand how your treatment will be monitored and adjusted over time.

“The goal of treatment is to be on the lowest dose of medication that can adequately treat symptoms,” Emmet says. “Most women will find significant improvement in their symptoms within one to two weeks, and common side effects can include vaginal bleeding (usually only when the medication is first started), breast tenderness, and headaches.”

While there's no strict recommendation for stopping HRT, using the therapy for up to five years is typical.

Taking the Next Step

Deciding whether hormone replacement therapy is right for you is a deeply personal decision. By staying informed and partnering with your doctor, you can make the best choice for your health and well-being. Remember, this is your journey, and you deserve a treatment plan that works for you.