What Are the Signs You Need Hormone Replacement Therapy?

Hormone replacement therapy with estrogen and often progestin can reduce the severity of menopause symptoms in women.

Medically speaking, menopause refers to the absence of menstrual periods for 12 months. The transitional years that precede the cessation of menstruation are called perimenopause, during which women may start to experience symptoms of irregular periods, hot flashes, night sweats, and mood swings. 

Menopause usually occurs between ages 45 to 55, and the average age for women to experience menopause is 51 years.

Symptoms of menopause include: 

• Hot flashes
• Night sweats
• Sleep problems
• Vaginal dryness
• Vaginal itching, burning, pain, or discomfort
• Painful sexual intercourse
• Irregular periods/spotting
• Memory problems
• Bladder or urinary problems such as incontinence
• Depression
• Irritability
• Anxiety
• Decreased sex drive
• Weight gain
• Thinning hair

Menopause is usually a natural biological process that occurs as women age. As women get older, their bodies make less estrogen and progesterone, the female hormones that regulate menstruation. Eventually the ovaries stop producing eggs.

Other causes of menopause include:

• Hysterectomy, with removal of the uterus and both ovaries (total hysterectomy and bilateral oophorectomy) 
• Cancer treatment including chemotherapy and radiation
• Primary ovarian insufficiency, which occurs when women under the age of 40 fail to produce adequate levels of hormones. This is usually a result of a genetic condition or autoimmune disease. 

Menopause is diagnosed starting with an assessment of a woman's menstrual cycle history and a history of menopausal symptoms. In general, if a woman is over 45 years and presents with menopausal symptoms such as irregular menstrual periods, hot flashes, sleep problems, and mood changes, she would be considered in perimenopause (the transition to menopause) and no diagnostic testing is needed. 

Blood tests that may be indicated include:

• Human chorionic gonadotropin (hCG) to rule out possible pregnancy
• Follicle stimulating hormone (FSH)

For women 40 to 45 years who present with menopausal symptoms, blood tests to check for other conditions may include:

• Human chorionic gonadotropin (hCG) to rule out possible pregnancy
• Prolactin to rule out hyperprolactinemia
• Thyroid stimulating hormone (TSH) to rule out hyperthyroidism 

Many women with mild symptoms of menopause do not require treatment. 

If symptoms such as hot flashes, vaginal dryness, depression, and other mood problems are bothersome to severe, it may be a sign hormone therapy could be helpful. Hormone therapy to treat menopause usually involves a combination of estrogen and progestin, although women who have had a hysterectomy and no longer have a uterus often only require estrogen. 

Hormone therapy is available as a:

• Pill (oral)
• Skin patch
• Vaginal ring
• Topical preparation for the skin - gel, cream, or spray

Other treatments for hot flashes include:

• Gabapentin (Neurontin) - usually used to treat seizures, it also relieves hot flashes in some women

Antidepressants

Paroxetine (Brisdelle, Paxil) is the only antidepressant drug approved in the U.S. for hot flashes, however some other antidepressants have also been shown to work in relieving hot flashes:

• Venlafaxine (Effexor)
• Desvenlafaxine (Pristiq)
• Citalopram (Celexa)
• Escitalopram (Lexapro) 
• Oxybutynin (Ditropan) - usually used to treat overactive bladder and urinary incontinence, but may be effective for treating hot flashes
• Progesterone (Depo-Provera) - helps to reduce hot flashes but is not commonly used

Plant-derived estrogens (phytoestrogens) are often marketed as "natural" or "safer,” and are found in many foods, including chickpeas, lentils, soybeans, flaxseed, lentils, grains, fruits, and vegetables. Studies gauging their effectiveness for menopause symptoms are mixed and women who have a history of breast cancer should avoid phytoestrogens.

Cognitive behavioral and other treatments may be helpful for some women though study results are inconsistent.

• Stress management
  • Yoga
  • Relaxation techniques
  • Deep breathing
  • Yoga 
  • Hypnosis
• Stellate ganglion blockade (numbing of a nerve in the neck with an injection)
• Acupuncture reduce hot flashes
• Other treatments for menopause symptoms include:
• Antidepressants for depression
• Vaginal estrogen, vaginal moisturizers, or lubricants for vaginal dryness