Perimenopause and menopause are difficult times in every woman’s life. The symptoms of your menopause, such as hot flushes, night sweats, brain fog, and joint pain, can be quite debilitating. To control this, many millions of women are switching to a very effective medical treatment.
Hormone replacement therapy (HRT) is also called menopausal hormone therapy. It’s a medical therapy in which a physician gives estrogen and sometimes progesterone to replace the hormones that the ovaries no longer produce as you get older.
It is FDA-approved and has been used by women for many years. But its reputation has been marred and influenced by one big study in the early 2000s whose results were misinterpreted.
But given that you are taking a strong hormone in your body, it is important to know about the side effects of hormone replacement therapy.
Why HRT Is Prescribed?
It’s important to know why doctors prescribe HRT before discussing the potential side effects of hormone replacement therapy. It is prescribed because its benefits are quite real and significant.
Hot flashes and night sweats: The most common reason women choose to take HRT is hot flashes and night sweats. On average, hot flashes last from 7 to 11 years, and 40% of women in their 60s and 10–15% of women in their 70s still have hot flashes. HRT is the most effective therapy for vasomotor symptoms. This is more effective than any non-hormonal option that is currently available.
Genitourinary syndrome of menopause (GSM): Vaginal dryness, sexual pain, urgency, and recurrent urinary tract infections are all associated with the drop in estrogen. For managing these signs, HRT is the first-line treatment, especially for low-dose preparations that are administered locally to the vagina.
Osteoporosis: Estrogen is directly involved in bone density. HRT may be a useful choice for women at increased fracture risk because it prevents bone loss after menopause and lowers the risk of fractures in certain women.
Mood, sleep, and cognitive function: Many women say they feel more stable in their moods, sleep better, and think better when they take HRT. A study revealed that HRT was linked to a decreased risk of diabetes mellitus over 20 years.
Premature menopause: Women who enter menopause before age 40, either naturally or surgically, have an increased risk of health problems. HRT can be strongly recommended for them until the average age of natural menopause, approximately 51.
Common Side Effects of Hormone Replacement Therapy
These are the most common side effects women feel when taking HRT for the first time. These typically occur within the first couple of months while the body gets used to it. Usually, they’re easily controlled and pass on their own.
1. Breast tenderness or swelling
The tissues in your breast are very sensitive to the effects of estrogen. Swollen, tender breasts are a very common side effect of HRT, especially when you begin it. This typically passes after a few months, as your body adapts.
2. Nausea and Bloating
Estrogen can irritate the stomach lining. When you feel unwell, it is likely that you are getting too much or taking it without food.
If you take oral HRT with food, this can reduce nausea significantly. Most women do not experience this side effect after switching to a patch, gel, or spray.
3. Headaches
Headache and especially migraine are a problem for some women when they begin or change their HRT dosage. This is usually due to changes in the levels of the hormone(s) and not the high levels.
Regular hormone administration through a weekly patch instead of a daily pill helps to stabilize hormone levels and reduce the number of headaches.
Headaches that are severe or unusual should be discussed with your health care provider.
4. Breakthrough Bleeding
If you still have your uterus and are on some combination of estrogen and progesterone, you may see some irregular spotting.
This is normal during the first few months until your uterus stabilizes.
4. Bloating & Puffiness
Estrogen can retain water in the body, which can result in bloating or puffiness. This is particularly in the first few months.
A few women may experience minor weight gain, but all studies have found that HRT does not result in any substantial weight gain. This is usually corrected in 2-3 months, especially if you drink plenty of water, cut back on sodium, and allow the body to adjust.
Lower doses of HRT or estrogen patches may also be beneficial.
5. Mood changes and irritability
Estrogen affects the serotonin levels in your brain, which control your mood. Your brain has to get used to your new level of hormones when you take HRT for the first time.
So, it is possible that you experience some short-term anxiety, mood, or irritability. Typically, this balances out after a few months of taking the medicine.
6. Changes in Libido
Your sex drive is directly influenced by hormones. In some women, estrogen and testosterone, when prescribed, will enhance libido.
The initial hormone shifts, however, can have the opposite effect for some, resulting in a temporary decrease in desire for intimacy.
Which Type of HRT Is Safest?
It’s one of the most crucial questions in HRT management, and has changed significantly in recent years. It is important to recognize that HRT safety is dependent on three factors: timing, route, and dose. These are the very factors that have been documented in recent clinical studies.
Patch Vs Oral Vs Gel
The patch and gel are safer than the pill for women with any cardiovascular risk factors, a clotting history, or elevated blood pressure. Oral pills have an increased risk of blood clots (venous thromboembolism) and stroke because the liver is forced to produce clotting proteins.
If you have any concerns about your heart or blood pressure, it is best to use transdermal estradiol at a low to moderate dose.
Progesterone Bioidentical Vs Synthetic
If you still have a uterus, you will need to use your progesterone to protect your uterus from uterine cancer.
However, you should be aware that there are two types: one is synthetic progestins, such as Provera, and the other is bioidentical progesterone, which is micronized progesterone.
It’s clear from clinical data that bioidentical progesterone HRT is safer than synthetic progestins for breast and cardiovascular effects.
So, it’s important to always request bioidentical progesterone from your provider. It’s a lot milder and gentler for your body.
How to Use HRT Safely
HRT should not be self-administered. You should always follow your primary care provider, who is in-network with your insurance plan and is familiar with these modern guidelines, to safely monitor you.
Here is what you should do:
1. Begin at Low Dose
It is never advisable to begin with a high dose. Your provider will start on the lowest dose of estrogen and only raise it if the hot flashes are still bothering you after a few weeks.
This reduces problems such as breast tenderness and mood swings.
2. Turn Your Patch Sites
To avoid skin irritation, you should never put the patch in the exact same spot twice in a row. It is best to rotate it from the lower abdomen to your hips and onto your upper buttocks.
If the adhesive does lead to a severe red rash, talk to your doctor about changing to a different brand to avoid the side effects of the estrogen patches.
3. Regular Monitoring
After beginning HRT, it is important that your blood pressure is monitored regularly, and you should get a pelvic exam and a mammogram as recommended.
Even for women taking a combination of hormones, annual mammograms are still important.
4. Pelvic health
For women taking combined HRT, it is important to check for any unusual bleeding from the vagina, which may require further investigation.
5. Lipid and metabolic panel
HRT may impact the levels of cholesterol and glucose in the body. Lab work before and after the treatment allows for a comprehensive evaluation of the body’s reactions.
Frequently Asked Questions
Q: Do the side effects of hormone replacement therapy go away on their own?
The most common side effects, such as breast tenderness, nausea, bloating, and spotting, subside after the first 2-3 months as your body adapts to the pill. If side effects last or get worse, always talk to your provider about them.
Q: Will HRT make me gain weight?
This is one of the top fears. Several studies have shown that HRT is not a direct cause of increased weight. The cause of weight gain in women around menopause is due to age-related metabolic changes, not due to HRT.
Indeed, certain women report improved sleep and reduced hot flushes with HRT, which in turn helps them to manage their weight better.
Q: How long will I be able to take HRT for?
This is a very personal choice. HRT may be continued for women over 65 years of age, provided they are counselled and risk assessed properly.
A new analysis proves women as old as 80 can benefit from hormone therapy, too. There is no fixed age limit. Your provider will make the decision based on your health and any symptoms you have.
Q: Can I take HRT if I have high blood pressure?
High blood pressure does not automatically mean that HRT is inconclusive. However, it does have an impact on which type and route is best.
Transdermal HRT is usually recommended over oral HRT for women who have hypertension, because it does not undergo liver metabolism activity which can have a negative impact on people with hypertension. Your provider should check your blood pressure regularly.
Bottom Line
The side effects of hormone replacement therapy may occur, but knowing them early helps you manage them. Please remember that HRT is a safe, evidence-based tool if used correctly.
Avoiding HRT because of fear is not a good idea. It is important to select the right type, the right route, and the right provider that will properly monitor you.
Medical data shows that it’s better to begin HRT early than late. Its window of benefit is the largest in the first 10 years after menopause, typically before age 60. When you begin it at the onset of symptoms, HRT actually helps to safeguard your heart and brain. The health risks increase if you wait to start until you are 65 or older.
If you live in Houston, TX, and are thinking about HRT, Lola, one of our integrative nurse practitioners, is here to look at your symptoms, your health history, your labs, and your goals.
We accept most major insurance plans to ensure you can easily get the routine blood panels and physical exams needed to protect your liver.
Reach out to us today!
