Menopause is actually a very mysterious period in which your body decides to make some major changes. From mood swings and weight gain to hot flashes and muscle pain: no, it’s not fun. But don’t worry, ladies! Hormone replacement therapy could be the tip to make this bumpy ride a little smoother.
Gynecologist Dr. Frans Lim from the IJsselland Hospital and gynecologist Mary Beshay from the Haaglanden Medical Center are happy to share their insights on this.
What is hormone therapy?
Hormone therapy, also known as hormone replacement therapy (HRT), is a medical treatment used to replenish or replace hormones in the body. It is often prescribed to women during (peri)menopause to relieve symptoms such as hot flashes, night sweats, mood swings, vaginal dryness and sleep problems.
How does it work?
During menopause, the body’s production of estrogen and progesterone decreases, leading to a range of uncomfortable symptoms. ‘Because your ovaries produce less estrogen, women suffer from hot flashes. It disrupts your body temperature,” Beshay begins. Hormone replacement therapy can help reduce these symptoms by properly replenishing hormone levels. ‘Hormone therapy consists of the addition of estrogen and aims to combat the annoying menopausal symptoms,’ she explains further. ‘In women who still have their uterus, estrogen tends to thicken the uterine lining. That is why, to protect the endometrium, a progestogen is often added to the treatment.’
Which hormone therapy works during menopause?
Hormone therapy comes in different forms. There are tablets with both estrogen and progesterone, or only estrogen for women without a uterus. “The transdermal form, such as patches, gel or spray administered through the skin, is preferred,” says Lim. ‘This is because the estrogen enters directly into the bloodstream without first passing through the liver, which is what happens with tablets. There are tablets for progesterone, but a hormone-containing IUD is also available. The progesterone tablet can cause drowsiness, which helps women sleep better if they take it before bed.” Finally, vaginal suppositories and creams containing estriol are available. Estriol is a mild-acting estrogen that is only used topically. It is prescribed to women who mainly suffer from vaginal or bladder complaints due to a decrease in estrogen.
The choice of treatment depends on several factors, including the severity of symptoms, the patient’s health history, and personal preferences. Beshay: ‘If the therapy works well against heat complaints, such as hot flashes, then it will automatically create a positive domino effect. As a result, they experience a better night’s sleep, which ensures a better mood the next day, better concentration and they are most likely also less irritable.’
When and for which complaints is hormone therapy recommended?
If menopausal symptoms affect your daily life, hormone replacement therapy might be an option. The following complaints can then be alleviated:
- Hot flashes – Sudden feelings of heat that may warm the face, neck and chest and cause sweating.
- Night sweats – Excessive sweating at night, which can lead to disturbed sleep.
- Mood swings – Mood changes, including irritability, anxiety, depression or mood drops.
- Sleep problems – Difficulty falling asleep, staying asleep or waking up unrested.
- Vaginal dryness – Dryness and thinning of the vaginal tissues, which can lead to pain during intercourse.
- Loss of bone density – Loss of bone density (osteoporosis) due to decreasing estrogen levels, which increases the risk of fractures.
- Decreased libido – Loss of sexual desire due to hormonal changes.
- Joint pain – ‘In some cases, hormone replacement therapy (HRT) may be recommended to correct the hormonal imbalance that contributes to joint pain,’ says Beshay.
The goal of hormone therapy is to relieve these symptoms by replenishing or replacing hormone levels in the body. It is usually recommended for women who experience severe symptoms that affect their quality of life and who have no contraindications to hormone therapy, such as a history of breast cancer, uterine cancer, or blood clots.
What are the disadvantages and risks of hormone therapy?
Let’s remember that every body is different, so what works for one person may not work for another. So before immersing yourself in the world of hormone therapy, it’s always a good idea to talk to your doctor. Together you can find the best approach for you.
“The risks of hormone therapy differ per woman and depend on various factors, including diseases, BMI, alcohol use, medication use, history and conditions in family members,” Beshay explains. And while hormone replacement therapy can be effective in relieving menopausal symptoms, it also comes with risks and side effects. Fortunately, most women only experience mild side effects, such as headaches or nausea, which usually go away on their own. However, it is good to know that there is also a chance of more serious side effects, such as an increased risk of blood clots, strokes, breast cancer and uterine cancer. “Studies have shown that hormone therapy can be used for 5 years without any problems and that after that the risk of breast cancer may be slightly increased,” says Lim.
That’s why it’s always important to talk to a doctor during menopause about the pros and cons of hormone replacement therapy before starting it. Furthermore, research shows that hormone replacement therapy is not effective for treating belly fat in middle-aged women.
How long can you use hormones during menopause?
“It is advisable to start before the age of 60, but within 10 years after the last menstrual period,” Lim advises. ‘And preferably not for longer than 5 years.’ If this period is exceeded (by the doctor), it is important to critically evaluate this, due to a slightly increased risk of developing endometrial cancer and a slightly increased risk of breast cancer.’
In addition, according to Beshay, it is important to have any vaginal bleeding checked after menopause, i.e. if you have not had any bleeding for a year. ‘This helps detect any malignant cells in the uterine lining so you can receive targeted treatment if necessary.’
How much does menopause hormone therapy cost?
The cost of hormone therapy for menopause can vary depending on several factors, including the type of therapy, the duration of treatment, the country in which the treatment takes place, and whether the treatment is covered by health insurance. In general, the costs may include consultation costs, costs for medication and any additional examinations. It is advisable to contact a healthcare provider or health insurer for specific information about the costs of hormone therapy for menopause in a specific situation.
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Dr. Frans Lim is a gynecologist at the IJsselland Hospital in Capelle aan den IJssel, where he specializes in problems surrounding menopause and urogynecology. Since 2016, he has set up a menopause clinic together with Dr. Paula Schmitz, where they, together with two nurse menopause consultants, treat women with serious menopausal complaints during consultation hours.
Mary Beshay is an all-round gynecologist who sees women at the Haaglanden Medical Center (HMC) with all kinds of gynecological help questions such as cycle disorders, abnormalities of the vulva and cervix, contraception and menopause. Her professional background includes training at Leiden University, followed by specialization at the Leiden University Medical Center (LUMC), HagaZiekenhuis with differentiation Menopause at the OLVG in Amsterdam.
