When to Consider Hormone Replacement Therapy for Menopause

Most women experience menopause between the ages of 45 and 55 years, and 75% will experience estrogen deficiency symptoms. Menopause can be further classified as ‘early’ if it occurs before the age of 45 years and ‘premature’ if it occurs before the age of 40 years. Early menopause is associated with a reduced risk of breast cancer but increased risks of premature osteoporosis, cardiovascular disease and premature death. Hormone replacement therapy (HRT) might be an option for you if you meet certain criteria. Here are a few things you should know about hormone replacement therapy: 

Am I a Good Candidate?   

For women younger than 60 years or who are within ten years of menopause onset and have no contraindications, the benefit-risk ratio is favorable for treatment of bothersome vasomotor menopausal symptoms (VMS) and prevention of bone loss. For women who initiate hormone therapy more than ten years from menopause onset or who are aged older than 60 years, the benefit-risk ratio appears less favorable because of the greater absolute risks of coronary heart disease, stroke, venous thromboembolism, and dementia. Talk to a naturopathic doctor about your specific case to find out if HRT is right for you.  

Menopause Symptoms and HRT 

Treatments look different for everyone, but the end goal is the same – to get you feeling your best. Naturopathic doctors look at many factors of a patient’s health when determining if HRT is a good option to manage their menopause symptoms. HRT can help with many issues associated with menopause, including: 

Sleep 

Poorer sleep quality has been associated with mood fluctuations, memory problems, metabolic syndrome, obesity, and other CV risk factors. Hormone therapy in the form of low-dose estrogen or progestogen may improve chronic insomnia in menopausal women. 

Urinary Tract Symptoms 

Low-dose vaginal estrogen may provide benefits for urinary symptoms, including prevention of recurrent UTIs, overactive bladder, and urge incontinence. 

Sexual Function 

Both systemic hormone therapy and low-dose vaginal estrogen increase lubrication, blood flow, and sensation of vaginal tissues. 

Heart Health 

Before women enter menopause, estrogen protects women from cardiovascular disease due to increased regulation of cholesterol and triglyceride metabolism, thus decreasing the risk for atherosclerotic heart disease. With HRT, some women experience a decrease in total cholesterol. 

Bone Health 

Hormone therapy prevents bone loss in healthy postmenopausal women, with dose-related effects on bone density.  Hormone therapy reduces fracture risk in healthy postmenopausal women. Hormone therapy is FDA approved for the prevention of bone loss but not for the treatment of osteoporosis. 

Contraindications that would lead a doctor to not recommend oral and transdermal hormone therapy include:  

• unexplained vaginal bleeding 

• liver disease 

• prior estrogen-sensitive cancer (including breast cancer) 

• prior coronary heart disease, including stroke, myocardial infarction, or venous thrombosis; or personal history or inherited high risk of thromboembolic disease. 

If you are considering whether hormone treatment is right for you to treat symptoms of menopause, contact a doctor for an evaluation and recommendation. You can make an appointment with a naturopathic doctor and care team at a Bastyr Clinic in San Diego or Bastyr Center for Natural Health in Seattle today.  

Written by: Timothy Schwaiger, ND