During menopause, your body goes through a hormonal shift. Think of it like backwards puberty – your hormones are decreasing instead of surging. The ovaries stop producing estrogen, and your periods stop. Just like puberty, this shift can bring on a host of symptoms:
- Hot flashes
- Night sweats
- Mood swings
- Vaginal dryness
- Trouble sleeping
- Pain with sexual intercourse
For many women, their symptoms can start even before the last period. This transition phase is called “perimenopause,” and can include all of the unpleasant features of menopause. Ah, the joys of aging.
One of the ways to ease these symptoms is hormone therapy – replacing the hormones your body is no longer making.
You might think the first step to hormone therapy is getting your hormone levels tested. But here's the truth: during menopause, hormones like estrogen and progesterone are in flux. Testing your levels only gives a snapshot of what's happening in that moment – it doesn’t tell the whole story. Testing can be expensive and unnecessary.
Providers can diagnose and treat based on your symptoms rather than lab work. If you’re experiencing classic menopausal symptoms, your healthcare provider may recommend hormone therapy without any tests at all.
Your provider may test your levels of follicle stimulating hormone (FSH) or estrogen, or may want to check your thyroid if your periods are irregular. However, these results should always be used in conjunction with symptoms.
Estrogen Therapy During Menopause
One of the main hormones affected during menopause is estrogen. As levels drop, you may experience an increase in menopausal symptoms. To help manage these symptoms, your provider may recommend estrogen therapy based on which symptoms are the most bothersome.
There are two main types:
1. Low dose vaginal estrogen (Cream, suppository, or vaginal ring):
This form delivers a small amount of estrogen directly to the vaginal tissues. It's absorbed locally, with minimal absorption into the bloodstream.
Best for:
- Vaginal dryness or irritation
- Pain during sex
- Frequent urinary tract infections
- Urinary urgency or discomfort
Because it is localized, vaginal estrogen is not associated with an increased risk of cancer and is considered safe even for many people who can’t take oral estrogen.
2. Systemic estrogen therapy (Pill, patch, spray, cream, or higher dose vaginal ring):
Systemic estrogen circulates throughout the body and is used to treat full-body symptoms of menopause.
Best for:
- Hot flashes
- Night sweats
- Bone loss
Important considerations:
- Oral estrogen may increase the risk of blood clots, stroke, heart disease, gallbladder disease and some cancers.
- Transdermal forms (patch, spray, or topical cream) are absorbed through the skin and carry a lower risk of these complications.
- If you still have your uterus, you’ll also need to take progesterone to decrease your risk of uterine cancer.
- If you have a history of breast or endometrial cancer, heart attack, stroke, blood clots, or liver disease, your provider will likely recommend non-hormonal treatment options for you.
Your provider will recommend a method of hormone replacement that fits your symptoms, medical history, family history, and preferences.
To minimize risks, providers recommend using the lowest effective dose for the shortest duration of time. This should also include close monitoring from your healthcare provider. As always, your medical provider will be there to help you weigh the risks and benefits and possible alternatives before starting hormone therapy.
As with most medications, there are possible side effects of taking hormones. These could include vaginal spotting (if you still have a uterus), breast tenderness, bloating, or headaches.
Bioidentical hormones beware: If it looks too good to be true, it probably is.
Even though the word “bioidentical” may seem more natural or less risky, the research on efficacy and safety of these hormones is lacking, and compounded bioidentical hormone products are not FDA-approved. Some delivery methods, like pellets implanted under the skin, can deliver unpredictable hormone levels and come with risks. Always talk with your healthcare provider before starting any type of hormone treatment – especially those marketed as “natural.” Remember that natural does not always equal safe.
Menopause can be rough, but help is available – and it doesn’t require extensive testing. If you’re struggling with symptoms, talk to your healthcare provider to weigh the risks and benefits.
Our Women's Health team can guide you through options tailored to your needs.