Women all over the world use menopausal hormone therapy (MRT) to manage the disruptive symptoms of perimenopause and menopause. MRTs help minimize uncomfortable symptoms like hot flashes, mood swings, and night sweats, to name a few. In doing so, you can live more comfortably during this life phase.
But how exactly does it work, and should you consider asking your OB-GYN about taking it? We’ll discuss that in this article.
Managing Menopause and Perimenopause
To understand how MRTs work, we must first explore menopause and perimenopause—a period marked by hormonal changes that affect your body.
Perimenopause is the transitional phase leading up to menopause. During this period, the production of female hormones in the ovaries is erratic and chaotic. Estrogen levels can rise dramatically and can drop to very low levels. On average, it can begin 7-10 years before the final menstrual period.
During perimenopause, estrogen and progesterone levels fluctuate and cause irregular periods, heavy menstrual bleeding, hot flashes, night sweats, mood swings, and sleep disturbances.
Menopause, on the other hand, is marked by 12 consecutive months without a menstrual period, signaling the end of a woman’s reproductive years. The average age of menopause onset in the United States is around 51.
Menopause is when your ovaries ultimately stop producing reproductive hormones. The symptoms you started feeling during perimenopause may intensify.
How Does Menopausal Hormone Therapy Work?
Female hormones help regulate important bodily functions, and their decline during menopause and perimenopause disrupts this, causing the symptoms we discussed earlier. Hence, to manage symptoms, we can offer menopausal hormone therapy to manage these symptoms.
Estrogen replacement is typically the primary focus, as its deficiency is the main driver of many menopausal symptoms. Progesterone is added to prevent the risk of endometrial hyperplasia (excessive growth of uterine lining), which is caused by unopposed estrogen.
MRT can be administered in various forms, including pills, patches, gels, and vaginal rings. Each method gradually releases hormones into your bloodstream, allowing for consistent levels to be maintained. The result is a more stable hormone environment, which helps manage symptoms and restores a sense of well-being.
Physiological Effects of Hormone Therapy on Menopausal Symptoms
Menopausal Hormone Therapy has several positive physiological effects on the body, specifically targeting the most common and disruptive symptoms experienced during menopause. Understanding these effects can help you see how MRT can relieve symptoms and improve your quality of life.
1. Impact on Vasomotor Symptoms
Vasomotor symptoms, which include hot flashes and night sweats, are among the most common complaints during menopause. These occur because your body can’t regulate temperature effectively when estrogen levels drop.
Restoring estrogen with MRT helps manage this by aiding the function of the hypothalamus, the part of the brain responsible for regulating body temperature. In turn, you’ll notice that hot flashes become less severe and frequent, and you may be able to sleep better.
2. Benefits for Vaginal and Urinary Health
The decline in estrogen during menopause can lead to thinning of the vaginal tissues, resulting in symptoms such as dryness, itching, and discomfort during intercourse. Systemic (meaning for the entire body) may help restore the tissue of the vagina, vulva, and bladder. Some women will also need local vaginal therapy.
These options can include a cream, inserts, or a ring. Vaginal estrogen can also reduce the risk of urinary tract infections, so some would consider this a life-saving intervention. Systemic and local vaginal therapy can help restore elasticity to the vagina, vulva, and bladder. This restoration can improve sexual function and reduce sexual discomfort as well.
The effects on the vagina, vulva, and bladder are collectively termed the genitourinary syndrome of menopause. This inclusive term explains the urinary discomfort, frequency, urgency, and waking up at night (nocturia) that can interfere with the quality of life for menopausal women.
Some women will feel as if they have a urinary tract infection, but the urine culture returns normal. The pH in the vagina becomes more basic through the menopause transition. Vaginal estrogen helps to acidify the vagina.
3. Preventing Osteoporosis
Estrogen plays a critical role in maintaining bone density by regulating the activity of osteoclasts, the cells responsible for bone resorption. During perimenopause and menopause, a significant drop in estrogen levels disrupts this balance, leading to accelerated bone loss and an increased risk of osteoporosis.
Osteoporosis is characterized by weakened bones that are more prone to fractures. Without adequate estrogen, bone resorption outpaces bone formation, decreasing bone mass over time.
MRT helps prevent both by replenishing the body’s estrogen levels and restoring balance to the bone remodeling process. By maintaining a stable estrogen level, MRT reduces osteoclast activity, thereby minimizing bone loss and preserving bone density. This estrogen effect is only present while using hormone therapy. There will be bone loss again if the therapy is discontinued.
Protecting Cardiovascular Health
There is an accelerated risk of heart disease after menopause. A plausible theory is that estrogen provides protection against cardiovascular disease during the reproductive years. Women can experience a sharp rise in LDL cholesterol over the menopause transition that outpaces the rise expected from age alone. LDL cholesterol is known to have a causal role in the development of atherosclerosis.
Hormone therapy is not recommended for primary prevention of cardiovascular disease. It may offer protection in younger women who start within 10 years of their final menstrual period.
Hormone therapy cannot replace a healthy diet and adequate exercise. However, it can be part of an overall plan to help maintain cardiovascular health.
Menopausal Hormone Therapy—More Than Just Relief
Women’s health during midlife is critically important. Women are often at the peak of their careers when the woes of menopause may strike. Women in midlife and menopause have been underserved.
At the 2024 Menopause Society meeting, Dr. Rebecca Thurston reiterated her comment from last year’s NY Times article: “It suggests that we have a high cultural tolerance for women’s suffering.” Current estimates are that 1.8% of eligible women use hormone therapy. While every woman does not need hormone therapy, every woman should be entitled to a conversation about it.
If you’re experiencing the symptoms of menopause and would like to speak to a doctor about MRTs, feel free to contact us at Northside/Northpoint OBGYN. We will be more than happy to help you find the best options.
