Our menopause clinic recommends HRT or hormone replacement therapy for menopause symptoms. Hormone Replacement Therapy, when administered properly, can do a lot of good for perimenopausal and menopausal women, including helping to preserve bone mass, reducing vaginal dryness, and helping women sleep better.
It can also be a huge benefit for women who suffer from frequent, intense hot flashes.
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If you’re considering HRT for hot flashes but aren’t sure whether or how to start, ob/gyn and Gennev Director of Health Dr. Rebecca Dunsmoor-Su has some information for you.
Medical science isn’t entirely clear on what causes hot flashes, so the exact mechanism by which HRT turns hot flashes down or off is also not completely known, Dr. Rebecca says.
Here’s what we do know: hot flashes are caused, in part, by the lack of estrogen, though that isn’t the whole picture. Women in perimenopause have estrogen yet still have hot flashes, so it isn’t just the lack of the hormone that’s the cause.
“We think it also has to do with pulsality,” Dr. Rebecca says. “Your brain triggers the release of hormones by sending bursts of chemicals in pulses. These pulses help regulate the ovaries and keep everything working as it should. HRT provides an even, constant dose of estrogen that also helps to regulate the body.
According to Dr. Rebecca, the key thing to remember is that every woman’s body is different, every woman’s experience of menopause is uniquely her own, so it makes sense that women’s experiences of HRT will be unique as well. There are a lot of pros and cons for HRT depending on which ones you take.
Fortunately, there are lots of configurations and delivery systems to try, so if one doesn’t achieve the desired result, that doesn’t have to mean HRT is off the table.
Hot flashes are systemic, meaning they aren’t limited to one area of the body, like, for example, different vaginal issues like dryness. Therefore, for hot flashes, pills and patches are the usual methods of delivery because they provide hormones that travel throughout the body.
Dr. Rebecca suggests trying patches first, because they deliver a more even dosage throughout the day rather than a larger amount when the pill is swallowed. With patches, there’s less impact on the liver, meaning there may be a slightly lower risk of estrogen caused blood clots. Also, women who experience menopause nausea from HRT pills might do just fine with the patch.
“There are lots of dosage and delivery options,” Dr. Rebecca says, “and it’s a bit of a trial-and-error process to find the one that works best. You should start to feel relief from symptoms within a month, but I tell my patients to wait at least three months before shifting to a new configuration. Your body needs time to acclimatize to the new levels of hormones.”
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“If hot flashes are truly impacting your ability to live your life and/or do your job, let’s talk,” says Dr. Rebecca. “If you’re having one hot flash a week, or they’re more annoying than disruptive, then you probably don’t need hormones. But if you’re perimenopausal and have seven or more a day, or you can’t work because you have to change clothes three times a day, you might be a good candidate, especially since starting earlier, in perimenopause instead of full menopause, means you have fewer health risks.”
This depends on a lot of factors, says Dr. Rebecca. When did you start taking hormones, what are your risk factors for cardiovascular issues or blood clots? Are you active and making healthy dietary choices, do you smoke? All of these should factor into the decision.
“Generally, I tell my patients we’ll count on 3 to 5 years, then we’ll do a ‘trial stop’ to see where they are. If the symptoms come back and are disruptive, we can continue; if they find they can live with where there body is without HRT, then we can stop. It really depends on the woman, her lifestyle and risks, and her tolerance for whatever symptoms she experiences after coming off.”
Many women worry that if they stop taking HRT, the hot flashes will come roaring back. Will they?
“They probably will come back,” says Dr. Rebecca, “but they’ll likely be less intense and probably won’t last as long. We used to think HRT just postponed the inevitable, but now we think it probably allows women to skip some of the process. Also, we may be able to push back the symptoms to a time in life when you’re better able to handle them: maybe you’re working less or retired; maybe your kids are grown, so the occasional night of poor sleep won’t have as much impact on your family.”
If you’re experiencing impactful hot flashes, talk with your ob/gyn or primary care doc – or one of Gennev's menopause specialists – about all your options, including HRT.
If you need an expert's advice for HRT, a Gennev menopause-certified gynecologist can give you a trusted opinion, determine if medication is right for you, and they can provide prescription support. Book an appointment with a doctor here.
If you're on HRT or have been, or opted out, we'd love to hear all about how you decided and what you experienced. Please feel free to share your experience with us on our community forums!