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How to Relieve Post-Menopausal Symptoms with HRT

We talk a lot about menopause and a little about perimenopause (the phase leading up to menopause), but there is still a lot of misinformation about postmenopause. Postmenopause is the time of a woman’s life following menopause. During this stage, you may notice that some of the menopausal symptoms you have been experiencing start to subside, but many continue, and some actually get much worse. 

Hot flashes and night sweats are good examples of symptoms that gradually decrease in postmenopause. But as your hormones estrogen, progesterone, and testosterone continue to decrease during postmenopause, you are at increased risk for a number of health conditions, such as osteoporosis, type 2 diabetes, and heart disease.

This article reviews the benefits of hormone replacement therapy (HRT), the timing of HRT use,  and other alternative therapies for the management of postmenopausal symptoms.

What Can I Expect During Postmenopause?

Once you are postmenopausal, you may regain some of the energy you lost during menopause due to sleep disruptions, but you may also be at higher risk for certain health conditions. Hormone replacement therapy (HRT) and/or healthy lifestyle changes can help reduce the risk of some of the conditions associated with decreased hormones during postmenopause. 

The most common menopause symptoms and risks during postmenopause include (1,2):

  1. Vasomotor symptoms (hot flashes and night sweats), and decreased sleep quality,
  2. Increased risk of cardiovascular disease, 
  3. Difficulty concentrating, anxiety, moodiness and/or irritability, 
  4. Reduced energy, and quality of life, 
  5. Poorer health status, and bone loss,
  6. Skin, and hair changes,
  7. Decreased libido, and painful sex,
  8. Ongoing weight gain,
  9. Vaginal changes that create genitourinary syndrome and incontinence.

Vasomotor Symptoms – Hot Flashes and Night Sweats Causing Sleep Disruptions

Vasomotor symptoms, or hot flashes and night sweats, are probably the most discussed symptom when talking about menopause. Hot flashes are a sudden feeling of warmth that spreads over the body, creating flushing and sweating, especially on the face and upper body. The experience of hot flashes can range from mild/light flashes to severe heat that lasts from 30 seconds to 10 minutes. Severe hot flashes that occur during sleep and are accompanied by profuse sweating are ‘night sweats.’

Because they are so disruptive, hot flashes and night sweats are associated with decreased sleep quality, difficulty concentrating, irritability, reduced quality of life, and poorer health overall (1). Menopause can cause women to wake up many times during the night, tossing, turning, and suffering from insomnia. Untreated hot flashes are associated with increased bone loss and are linked to an increased risk of cardiovascular disease and mental changes (1).  

Hot flashes and night sweat usually last about 7.4 years but the average length of time varies based on the ethnic group — 5 years among Asian women, 7 years among white women, 9 years among Hispanic women, and 10 years among black women (1). 

Hormone replacement therapy (HRT) is the most effective option for women to relieve hot flashes and night sweats. Both oral and transdermal estrogens (creams or patches) relieve hot flashes and night sweats typically within 2 weeks (1). 

Cardiovascular Health

Untreated, persistent hot flashes have been shown to increase the risk of cardiovascular disease and dementia (1). HRT has been suggested as an effective way to treat both (1). Post-menopausal women have a 2–3 times higher risk of heart disease, stroke, and type 2 diabetes than premenopausal women. This increased risk is caused by increased blood pressure, high blood sugar, excess body fat around the waist, and elevated cholesterol levels associated with menopause (3).

Consider increasing your awareness of heart disease and cardiovascular disease prevention. Preventing heart disease and stroke is critical because together they are responsible for the death of 1 in 3 women each year. The good news is that cardiac and stroke events can be prevented. The changes in heart health may be one of the most overlooked risks associated with the drop in hormones during menopause and postmenopause. HRT can help relieve these risks (4). 

Mental & Cognitive Adjustments, Mood swing, Anxiety, Irritability, & Depression 

Many women are alarmed when they have trouble remembering things, experience mental blocks, or have difficulty concentrating as they enter menopause. This can be a concerning time for women and can hurt all aspects of daily life.

These mental changes are likely caused by fluctuating estrogen levels. The dizzying spinning sensation may be accompanied by a feeling of light-headedness or unsteadiness. Menopausal mood swings are very common. When estrogen levels drop, so does the production of mood-regulating neurotransmitters, resulting in fluctuating mood swings. 

Fixing the underlying hormonal imbalance is one of the most effective ways of reducing menopausal mood swings. When a woman’s estrogen level drops, so do levels of a chemical in her brain, called ‘serotonin.’ This drop can lead to depression and mood disorders. Depression, anxiety, and overwhelming fear during menopause can be caused by the sudden drop in estrogen levels, which reduces the production of serotonin responsible for mood regulation.   

Reduced Energy and Quality of Life 

One of the most common menopause symptoms is an ongoing, persistent feeling of weakness, tiredness, and low energy. With fatigue might come irritability, and decreased attention span. The hormone estrogen, which regulates energy use at a cellular level, is reduced. When estrogen levels drop during menopause, so do energy levels.

Joint pain is one of the most common symptoms of menopause. Estrogen helps prevent inflammation in the joints, so low levels of estrogen during menopause can lead to increased inflammation, and increased joint pain.

Skin & Hair Changes 

When estrogen levels drop during menopause, it shows (sometimes first) in your skin. Collagen is the building block of healthy skin and is what keeps skin toned, fresh-looking, and resilient. As estrogen drops, so does collagen production. 

During perimenopause, a woman may notice her skin getting thinner, drier, less youthful-looking, and small wrinkles deepening. This is all related to the drop in estrogen which can be reversed with HRT.

Loss of Sex Drive & Painful Sex

In menopausal and postmenopausal women, the main cause of low sex drive is hormonal imbalance. Libido can also be impacted by other menopause symptoms such as vaginal dryness, pain during intercourse, and/or depression. 

When estrogen levels drop, the vaginal tissue becomes drier, thinner, less elastic, and the vagina can become smaller. Lack of lubrication can lead to sex becoming uncomfortable, and the vagina is frequently itchy, easily irritated, and more prone to infections. Hormone replacement therapy (HRT) can help with painful sex not only as a topical cream but also as a patch or tablet. Increasing your hormones can also improve your libido.

Weight Gain & Metabolism Changes 

Hormonal changes during menopause influence weight gain and the redistribution of fat. With menopause, not only are the hormones estrogen and progesterone decreased, so is testosterone. A decrease in testosterone can lead to less lean muscle and increased fatigue. These factors combined can result in a decreased metabolic rate and weight gain.

From menopause onwards, women need fewer daily calories. Hormone treatment can revitalize metabolism and assist with weight loss. Once we hit postmenopause, our metabolism can be at an all-time low. HRT can help speed it up again.

Vaginal Changes

Of all of the changes that occur as we age, one that is rarely discussed is vaginal changes or “genitourinary syndrome.”  The genitourinary syndrome can lead to changes in the bladder, vulva, and vagina, and affects almost half of postmenopausal women (1). Symptoms include vaginal dryness, burning, irritation, lack of lubrication, pain with sex, urinary urgency and frequency, incontinence, and recurrent urinary tract infections (1). When all of these symptoms are underdiagnosed, as they often are, it can adversely affect a woman’s personal relationships and quality of life.

Vaginal irritation and vulvar atrophy is extremely common problem for women postmenopause. There are many options to choose from that are easy, healthy, and safe to optimize vaginal health and lubrication. Seek help for vaginal discomfort. If left untreated, vaginal dryness can cause sores or cracks in the vagina’s tissues. 

Hormone replacement therapy (HRT) can help with genitourinary syndrome not only as a topical cream but also as a patch or tablet. Vaginal preparations restore vaginal epithelium, flora, moisture, and secretions, and normalize acidic vaginal pH. The use of vaginal estrogen can diminish urinary urgency and decrease the risk of recurrent urinary tract infections (1).

Incontinence 

Estrogen replacement can return the vaginal tissue to a more youthful state giving better support to the bladder and urethra. This can go a long way to improving urinary incontinence. Incontinence in menopausal women can be divided into three types. As estrogen levels drop, vaginal tissues supporting the bladder and urethra are thin and become weaker. This can manifest in several ways.

  1. Stress Incontinence – you pee while laughing, coughing, sneezing, or with exertion. This usually happens when the internal muscles fail due to age, surgery, or childbirth.
  2. Urge Incontinence – you are trying to ‘hold it,’ but your bladder doesn’t listen and empties. 
  3. Overflow Incontinence  – you are not fully aware your bladder is full and accidentally urinate.  

Guidelines for HRT Use

HRT remains the most effective therapy for vasomotor symptoms related to menopause (1). Additionally, there are fewer cases of diabetes and less heart disease when using HRT, but only in women that started when they were under the age of 60 or within 10 years of menopause. There may be an increased risk of coronary heart disease and stroke among women starting HRT after the age of 70 years. There are no increased health concerns among those starting HRT before the age of 60 years or within 10 years after the onset of menopause (1).  

Data have suggested a reduced risk of cognitive and mental dysfunction with taking HRT in women 50-59 (1). There is also a decreased risk of hip fracture by approximately 33%, and a combination of HRT can reduce the risk of colorectal cancer (1). In the decades of research conducted on HRT no significant increase in overall mortality was recorded for women using HRT, nor was HRT related to cardiovascular disease or cancer mortality (1).

Extended Use of Hormone Therapy

The American College of Obstetricians and Gynecologists and the North American Menopause Society, suggest that the decision to continue or stop hormone therapy should include assessment of its risks and its benefits, which include relief from hot flashes, protection against bone loss, and preservation of quality of life (1). Many women successfully continue their HRT for their entire lives. Always check with your doctor about your course of treatment.

Nonhormonal Therapies

Other options for postmenopausal symptom relief include changes in lifestyle. The old standard of using fans, keeping cooler indoor temperatures, wearing layered clothing, and avoiding spicy food, alcohol, cigarettes, and hot drinks can all help with hot flashes and night sweats. 

Nonprescription therapies black cohosh (which is associated with liver toxicity), Dong Quai, evening primrose oil, flaxseed, and red clover are not suggested – no matter how compelling the advertising (1). Trials of phytoestrogens and soy isoflavones have shown mixed results, and there is concern about cancer-causing effects (1).

Other types of treatment for hot flashes including stress-reducing therapies that involve mindfulness, hypnosis, acupuncture, exercise, and yoga for relief of vasomotor symptoms have shown inconsistent or negative results (1).

Non-Hormone prescription therapies that have been shown to reduce the frequency and severity of hot flashes include serotonin-reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, gabapentinoids (1). Antidepressants can work to relieve hot flashes within about 3 weeks (1).

Summary for Hormone Replacement Therapy

The best candidates for hormone replacement therapy (HRT) are women who are close to menopause. For example, women who are under the age of 60, or within 10 years of menopause. These women have experienced relief from their hot flashes, improvements in their sleep, and reported fewer cases of heart disease and diabetes. Women that fall under these categories can safely take hormone therapy and can minimize the risks. Check out Winona today to get relief from your symptoms.

References:

  1. https://www.nejm.org/doi/full/10.1056/NEJMcp1714787 
  2. https://lifegaines.com/blog/how-to-relieve-post-menopausal-symptoms-with-hrt/ 
  3. https://www.menopause.org.au/members/ims-menopause-live/991-hrt-and-cardiovascular-disease
  4. https://my.clevelandclinic.org/health/articles/16979-estrogen–hormones 

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