Hormone replacement: should I or shouldn't I?
As women transitions to menopause, menopausal symptoms can be bothersome, and in some cases, very debilitating. If you don’t sleep, if you are taking your clothes off and on, and if sweat is pouring down your face while you are giving a presentation, then you need help. Many women have negative feelings about hormones, and will only sign on as the very last resort. Hormone therapy has many benefits and is actually very safe for most women.
You should know the facts, so that you can make decisions that will benefit your health.
HRT: how to make the decision
Because menopausal symptoms vary so much, a detailed history will elucidate the impact on a women’s life and function.
Hot flashes: a sudden feeling of warmth or heat, often coming from the head or neck, and associated with sweating, sometimes profuse. Hot flashes last several minutes. Afterwards, you might feel cold and damp. Hot flashes that occur a couple of times per day would be typical, but if they occur many times during the day, it would be considered excessive.
Night sweats are the night time version of hot flashes. A night sweat will wake you from sleep. In its severe version, your nightgown is soaking wet, or the sheets, and you need to change your clothes before you go back to bed. Often, women can fall back to sleep in a few minutes, but the disruption can lead to long periods of night time wakefulness, and loss of REM sleep, resulting in fatigue the next day. Sometimes women just experience a sleep disruption, and do not know if it is a night sweat that has awakened them. Studies demonstrate that not all hot flashes are perceived by the women, only about 60%,
Vaginal dryness occurs commonly after menopause, and can become worse as a women ages. The cause is a lack of estrogen in the vaginal wall,which causes the epithelial lining to thin. The blood vessels underneath the epithelium became sparse,
and less fluid traverses into the vaginal canal during sexual excitation. Intercourse can be painful, and sometimes impossible. Sometimes the vaginal wall loses length and elasticity. The tissues of the external genitalia and vulva become thin and dry also. These symptoms can involve the bladder, which is attached to the anterior vagina. After menopause, women often experience
urinary frequency, urgency, incontinence, and more frequent bladder infections.
Mood changes can occur with menopause. Especially if there is an underlying tendency toward anxiety or depression, these symptoms may be exacerbated with loss of estrogen. Some women will feel more irritable or anxious, and sometimes there is just a loss of well-being.
Changes in cognitive function can occur in menopause. Some women complain that they are forgetful, lose focus, and have trouble with concentration. This can be especially disturbing for women who have jobs that require these skills, and can cause women to lose self-esteem. Some women will also feel that their livelihoods are in jeopardy.
Other symptoms can include hair loss, painful joints, and facial hair growth.
A physician will take a medical history that will take into account all of these symptoms. Understanding the past medical history, including a history of breast cancer, breast biopsies, blood clots, heart disease, high cholesterol, hypertension. gynecologic cancers, and fractures, to name just a few, will help the physician determine if the risks of hormones are greater than the benefits.,
A family history of heart disease, blood clots, breast, ovarian and uterine cancers, and osteoporosis will also be taken into consideration.
Your doctor will determine if you have significant risks that preclude the use of HRT.
Sometimes it may be difficult to tell if symptoms such as sleeplessness are related to estrogen deficiency, so a “trial of estrogen” may be instituted to see if the symptoms will resolve with treatment.
Most women who are averse to taking hormones because of what they have heard from the media or friends, are actually at very low risk, and would benefit from an evaluation with a physician.