Menopause can bring a wave of uncomfortable physical and emotional symptoms, from hot flashes to night sweats, reduced libido, fatigue, brain fog, joint pain, weight gain, and mood swings. As much as nutrition, physical exercise, and counseling can help, many women have turned to hormone replacement, or HRT, for relief and to improve their quality of life.
But what exactly is HRT, and is it safe? Dr. Henry Prince, an OB-GYN at Premier Women’s Health in Manhasset and Woodbury, has been providing menopause treatment in and around Long Island for decades. Here, he addresses common questions and shares essential information that women should know before starting treatment.
What Is Hormone Replacement Therapy (HRT)?
Hormone replacement therapy is exactly what it sounds like: a treatment that replaces the hormones your body stops producing during menopause, such as estrogen,testosterone and progesterone. “HRT replaces hormones your body no longer makes,” Dr. Prince explains. “It’s most commonly used for women in menopause, but any time after age 40 is considered normal to start considering it if symptoms are severe.”
More than 90% of women in the menopausal transition report at least one symptom, but as many as 40% don’t receive any prescribed treatment. Dr. Prince says that the hesitancy in starting HRT comes from misconceptions about the risks or that it is unnatural.
“People will say, ‘My body is supposed to stop making hormones.’ But the reality is, life expectancy in the early 1900s was much shorter. Now we’re living into our 80s and beyond. Hormones can help support a better quality of life as we live longer,” shares Dr. Prince..
For women experiencing hot flashes, night sweats, vaginal dryness, loss of libido, fatigue, brain fog or bone loss, HRT can be life-changing. It helps maintain vaginal health, reducing discomfort during intercourse, and protects against osteoporosis by slowing bone loss.
Types of Hormone Replacement Therapy
There’s no one-size-fits-all solution for HRT, and it is available in different forms categorized by the delivery method (i.e., how the hormones get into your body):
- Oral
- Patches
- Pellets
- Creams and gels
Dr. Prince emphasizes that providers “try to avoid oral estrogen because it increases the risk of blood clots.” Transdermal options, such as patches and pellets, do not exhibit the same risk profile. Patches are a common choice for many women because they deliver hormones through the skin, thereby bypassing the liver and reducing the risk of clotting.
One emerging method Dr. Prince has explored with his patients is HRT pellets, which are small, bioidentical hormones placed just under the skin via a small incision.
“Pellets provide a steady dose of hormones for about six months. It’s a convenient option for many women who don’t want to manage daily pills or creams,” he says.
It’s important to note that hormone pellets are not suitable for everyone. If you are considering them, you should work closely with your Square Care provider to weigh the potential benefits vs the risks.
Who is a Good Candidate for HRT?
Hormones fluctuate and decline throughout the entire menopause transition. On average, the transition is a five- to seven-year period that starts when women are between 45 and 55 years old. At the onset of menopause, HRT can be a great option to provide fast relief.
“Most women start to feel relief from hot flashes and night sweats within a week or two of starting HRT,” says Dr. Prince. However, he advises that some symptoms, like vaginal dryness, may take longer to improve. If you don’t notice changes within the first couple of months, your provider may adjust your dosage.
The “Golden Window” of Opportunity For Starting HRT
When to start HRT is a commonly asked question, and the answer depends on several factors. Menopause is a transition, and while technically defined as 12 consecutive months without a period, Dr. Prince says some patients with severe symptoms may seek treatment earlier. “If it’s been six months without a period and a woman is really suffering, I’ll treat her, though it’s important to monitor for irregular bleeding.”
There’s also a time when the risks of HRT outweigh the benefits. “We now know that starting HRT within 10 years of menopause onset is safe and does not increase risks of heart attack or breast cancer,” explains Dr. Prince. Anytime after that, you may be at an increased risk of cardiovascular problems.
Perimenopause and Hormone Replacement Therapy
However, Dr. Prince counsels, HRT can be tricky for perimenopausal women because there’s likely still intermittent ovarian function. “Giving estrogen in perimenopause can cause excess estrogen when the ovaries kick back in, leading to irregular bleeding. We can treat specific symptoms like low libido with testosterone or use progesterone to help with mood, but estrogen needs to be used cautiously,” he explains.
Safety and Risks
For many years, HRT was thought to increase the risk of breast cancer and heart disease, primarily due to early findings from the Women’s Health Initiative study. However, Dr. Prince says that the medical community misinterpreted those results. “The lead author of the study clarified that the findings were misunderstood,” he explains.
Key findings in the Women’s Health Initiative (WHI) found that the increased risk of breast cancer was observed in women who received estrogen and a synthetic progestin call provera. There was no increase in the risk of breast cancer for those women studied who were taking estrogen alone. The study also showed that when HRT is started within the first 10 years of menopause, there is no increased risk of heart disease above the control group.
That’s why timing matters when it comes to HRT, and you should work closely with your Square Care provider sooner rather than later if you’re experiencing menopause symptoms.
Additionally, before starting HRT, it’s essential to have a mammogram within the past year and address any abnormal vaginal bleeding or any other abnormalities in your personal or family medical history.
What About HRT And Weight?
One of the most common questions women have is whether hormone replacement therapy causes weight gain. According to Dr. Prince, the culprit may just be age. “When I first started practicing, many patients on HRT seemed to gain weight, then, after the WHI study when those patients were no longer on HRT – they still gained weight. The truth is, metabolism changes during menopause and may lead to weight gain, not the hormones themselves.”
That said, some women might experience temporary water retention or mild breast tenderness when starting HRT, but these effects usually resolve within a month or two.
Finding Hormone Replacement Therapy Near Me
If you’re navigating menopause symptoms and wondering whether hormone replacement therapy is right for you, the providers at Square Care Medical Group are here to help. With personalized treatment plans that include HRT pellets, patches, and more, our experts can guide you safely through the options.
Request an appointment with a Square Care provider today to learn more about how hormone replacement therapy can help you feel like yourself again. With convenient offices in Suffolk and Nassau County, as well as Queens, we’re here to make finding menopausal care easy and convenient.
HRT Treatment FAQs
How do I Know if I Need Hormone Replacement Therapy?
If you’re experiencing disruptive menopause symptoms like hot flashes, night sweats, or vaginal dryness, low libido, fatigue or brain fog, talk to your Square Care provider to see if HRT could improve your quality of life.
How Long Before HRT Starts to Work?
Most women start noticing relief from hot flashes and night sweats within one to two weeks, though symptoms like vaginal dryness may take longer to improve.
Is Hormone Replacement Therapy Safe?
Yes, when started within 10 years of menopause and under the care of a qualified provider, HRT is considered safe.
How Long Should You Stay on HRT?
How long you stay on HRT is a highly personalized and complex decision. You should make the decision collaboraitvely with your Square Care provider and ensure you’re monitoring your physical, mental and emotional well-being while undregoing treatment.
Is HRT Covered by Insurance?
In many cases, yes, HRT is often considered medically necessary and therefore covered by insurance, but coverage can vary depending on your provider, the medications used and the specific plan, so it’s best to check with your insurer.
Does Hormone Replacement Therapy Cause Weight Gain?
There’s no evidence that HRT itself causes weight gain, but menopause-related metabolism changes can lead to added weight, with some women experiencing temporary water retention when starting treatment.
Does Hormone Replacement Therapy Help with Weight Loss?
While HRT isn’t a weight loss treatment, it can help stabilize hormones, which may make it easier to manage weight when combined with healthy lifestyle habits.