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Deciding About Hormone Therapy

Benefits and Risks

Navigating Menopause Symptoms

Many women encounter a range of symptoms during menopause, such as hot flashes and vaginal dryness. While some find these changes manageable, others face moderate to severe disruptions in daily life. Lifestyle changes and nonprescription remedies often help, but for more intense symptoms, prescription therapies, including hormone therapy (HT), become vital.

What is Hormone Therapy?

HT involves administering estrogen to elevate blood estrogen levels and alleviate menopause symptoms. Estrogen stimulates the uterine lining, so women with a uterus must also take progestogen to protect it. Those without a uterus only need estrogen. For specific symptoms like vaginal dryness, low doses of estrogen, which don’t significantly raise blood estrogen levels, are used directly in the vagina.

Making the Decision

Choosing HT is a personal decision. It hinges on symptom severity, health history, and personal views on menopause treatments. A healthcare provider can guide this decision, balancing benefits against potential risks.

Potential Benefits of HT

HT is highly effective for hot flashes and night sweats, often improving sleep, mood, and overall quality of life. It also addresses vaginal dryness and painful intercourse, and helps preserve bone density, reducing osteoporosis risks. For detailed guidelines on HT use in Canada, refer to CMAJ and Menopause Canada.

Assessing Risks and Personalizing HT Options

Understanding the Risks

While Hormone Therapy (HT) is highly effective for many menopausal symptoms, it’s important to weigh its potential risks. These risks can vary based on individual health profiles and the timing of therapy initiation.

  • For Women Under 60 or Within 10 Years of Menopause: For this group, the benefits of HT often outweigh the risks. However, it’s crucial to be aware of slight increases in the risk of stroke or blood clots, especially with pill forms of HT. The Canadian guidelines provide in-depth information on this topic.
  • For Women Over 65 or Starting HT Later: There is a potential increase in the risk of dementia, and if HT is initiated more than 10 years after menopause, there may be a slight increase in the risk of heart disease.
  • Breast Cancer Risk: Prolonged use of combined estrogen and progestogen HT might slightly elevate breast cancer risk. However, using estrogen alone does not significantly increase this risk at 7 years, though the risk may rise with longer use.

Navigating Side Effects

HT can sometimes cause side effects like breast tenderness, nausea, and irregular bleeding. These are generally not serious but can be bothersome. Adjusting the dose or switching the HT form can often reduce these side effects. Notably, contrary to common beliefs, HT is not associated with weight gain and might even lower the chance of developing diabetes.

Personalizing Your HT

Choosing the right form of HT is a personalized decision and might require trying different types until you find the one that works best for you.

  • Pill or Non-Pill: HT is available in various forms – pills, patches, gels, creams, sprays, or vaginal rings. Non-pill forms like patches or rings directly enter your bloodstream, potentially lowering the risk of blood clots compared to pills.
  • Estrogen Alone or With Progestogen: If you have a uterus, you’ll need to take progestogen with estrogen to protect against uterine cancer. This can be done through combined pills/patches or separate hormones. For women without a uterus, estrogen alone is sufficient.
  • Dosing: The goal is to use the lowest effective dose of estrogen for symptom relief. It may take some time to find the right balance, so patience and ongoing dialogue with your healthcare provider are key.

When to Stop Hormone Therapy

Deciding when to stop HT is an individual decision. Many women consider stopping after 4 to 5 years due to concerns about breast cancer risks. Others may choose to lower their dose or switch to non-pill forms. If symptoms return upon stopping HT, it may be necessary to reassess the risks and benefits of continuing therapy. This decision should be made in collaboration with your healthcare provider, considering your personal health history and preferences.

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