HRT in Perimenopause

You’re having hot flashes, or maybe you’ve noticed changes to arousal and your sex drive has decreased. Over the past few months, you just haven’t quite felt like yourself. These could be just a few signs that you are in perimenopause. 

In this article, we cover the basics of perimenopause, including main symptoms. Then, we’re going to delve into hormone replacement therapy (HRT): what it is, how it could help, and the risk factors associated with it.

What is Perimenopause?

Perimenopause is the term for the time that begins with transitional phase through complete entry into menopause and the whole process start to finish can take as long as ten years, though you’ll likely not pick up on all of it. Every woman is different, so it’s hard to pinpoint how long perimenopause could last for you. Perimenopause is a hormonal shift in the body and results in some specific changes within the body.

Common symptoms of perimenopause include:

• Fatigue
• Irregular Periods, sometimes with heavier than average bleeding
• Vaginal Dryness
• Increased Urinary Frequency and Urgency
• Mood Fluctuations, such as increased irritability or Depression and Anxiety
• Hot Flashes or Night Sweats
• Sleep Disturbances

What is HRT?

Hormone replacement therapy, or HRT, can be used to reduce the symptoms of perimenopause. The primary indication for HRT is the vasomotor symptoms more commonly known as “hot flashes.” HRT typically means taking two hormones, estrogen and progestin.

Estrogen naturally decreases with age and contributes to most of the perimenopausal symptoms. Taking progestin alongside estrogen in HRT reduces the possibility of developing uterine cancer, which is associated with taking estrogen alone. Estrogen may be prescribed on its own in specific cases where the patient has no uterus. This is referred to as “estrogen therapy.”

When you discuss HRT with your OBGYN, you’ll likely talk about the best way to deliver your therapy for your needs. There are two common delivery methodologies used by OBGYNs today:

• Low Dose Vaginal Delivery Products – Typically reserved for patients who are only experiencing urinary or vaginal symptoms of menopause, vaginal delivery products come in the form of creams, rings, and tablets. As the name suggests, these preparations dole out low doses of hormones, and as result they produce limited effects. 
• Systemic HRT – When patients have more widespread symptoms and need a more comprehensive symptom relief, physicians will deploy what’s known as a “systemic HRT.” These delivery devices include rings, creams, pills, patches, and sprays, and more. You’ll be able to discuss which of these applications is most suitable for your situation and your presentations. The higher doses of estrogen these methods offer are absorbed evenly by the body, so they can be used to treat more widespread and common perimenopause symptoms. 

How Can HRT Help in Perimenopause?

Hormone replacement therapy has been shown to reduce vaginal dryness. It is also supported as the most effective treatment for hot flashes and night sweats. A positive side effect of HRT is that it can also help protect against bone loss and prevent spine and hip fractures, which are associated with menopause, though we don’t specifically prescribe it for these indications.

There are many different forms of estrogen available, including patches, gels, sprays, and pill form. Progestin can be administered separately from estrogen or combined in a pill or skin patch. If vaginal dryness is your main concern, you also have the option of local treatment using a ring, tablet, or cream.

Are There Any Risks Associated with HRT?

If you are considering HRT, it is important to be aware of the risks. Estrogen-only therapy (ERT) is not recommended to women who have not had their uterus removed, as this is associated with uterine cancer.

There is a small risk of heart attack on HRT. This is influenced by other factors, such as age and pre-existing medical conditions. There’s also a small increased risk for breast cancer, stroke, and deep vein thrombosis (formation of a blood clot). Some oral forms of HRT come with a slightly greater risk for gallbladder disease.

Less serious adverse effects commonly associated with HRT include nausea, breast tenderness, bloating, weight gain, and breakthrough bleeding. These typically last a short time at the beginning of your transition into HRT.

How to Manage Risks Associated with HRT

Because HRT has been associated with certain long term risks and complications, most patients and physicians discuss concrete ways that those risks can be reduced. Patients can help manage HRT risks by:

• Checking in regularly with your OBGYN or healthcare provider. Scheduling regular conversations about benefits and risks can help you know when to complete your treatments.That’s why most OBGYNs will encourage regular follow-up care when you’re on HRT.
• Take the lowest dose possible to manage your symptoms. Patients can help manage risk by working with their OBGYN to ensure they aren’t taking any more hormones than they need to. To be sure, symptom relief is the priority–that’s what makes HRT successful. But successfully managing symptoms with the lowest possible dose can help you minimize many of the long term risks associated with HRT.
• Keep a healthy lifestyle: Maintaining a healthy diet and regular exercise regimen can help you minimize your overall risk of adverse impacts. 

Managing your risks will depend on your situations and your symptoms, so the best approach is often one that has been individualized for you. Talk to your OBGYN about the best ways to minimize and manage your risks around hormone replacement therapy to help you ensure you minimize any possible risks.

Contraindications to HRT

Some conditions are contraindicated with HRT. In these unique cases, HRT may not be the best way for you to treat your symptoms of perimenopause. These conditions include endometriosis, fibroids, porphyria, active liver disease, hypertriglyceridemia, and thromboembolic disorders.

If you have a history of breast cancer or endometrial cancer, HRT may not be right for you.

Before starting HRT, your health professional should adequately screen, counsel and test to ensure you are a good candidate for this kind of treatment.

If any of the above conditions resonate with you, don’t be discouraged. There are other avenues you can explore to lessen the symptoms of your HRT. If your perimenopause symptoms impact the quality of your life, ask your health professional about your other options outside of HRT.

How to Know if HRT is Right for You

If you’re considering hormone replacement therapy, you should be evaluated by a medical professional. A baseline should be established by analyzing your blood and urine closely. Tests may also include ultrasonography, electrocardiography, and mammography.

Your health professional may also test your serum follicle stimulating hormone (FSH) levels. This helps with monitoring, especially in women who intend to take HRT orally. Serum estradiol levels may also be looked at. This helps monitor women who continue to have symptoms even after they begin HRT.

There’s a Lot to Consider

There are proven benefits to HRT in perimenopause, but there are also some risk factors to consider. If you’re considering starting hormone replacement therapy, discuss it with your healthcare professional thoroughly so that you can decide with confidence whether or not it’s suitable for you.

If you’d like more information, please call our Wilmette or Glenview offices to schedule an appointment.