If there’s ever a time in a woman’s life when her own hormones seem out to get her, it’s menopause. And though it’s long been famous for wreaking all sorts of havoc on the body and mind, ‘the change’ doesn’t have to be traumatic. One potential solution, according to many health professionals: replacing those plummeting hormones.
Menopause hormone therapy (MHT) is the use of prescription estrogen (and sometimes progesterone) to alleviate symptoms related to estrogen decline, according to gynecologist Alyssa Dweck, M.D., O.B.G.Y.N., author of The Complete A to Z for Your V and Chief Medical Officer with Bonafide Health. “It can help manage vasomotor symptoms, like hot flashes and night sweats, and may also help protect against bone loss and other health shifts associated with estrogen decline,” she says.
But while MHT is becoming more common, few people in the menopause transition understand what the therapy entails. We tapped a team of menopause specialists and hormone health experts for all of the details, so that you can make an informed decision about whether MHT is the move for you.
- ABOUT OUR EXPERTS: Alyssa Dweck, M.D., O.B.G.Y.N., is a gynecologist, author of The Complete A to Z for Your V, and Chief Medical Officer with Bonafide Health. Catherine Hansen, M.D., F.A.C.O.G., F.R.C.S.C., N.C.M.P., M.P.H., is a physician who heads Pandia Health’s menopause hormonal care offering. Sean Bourke, M.D., is a hormone specialist and board-certified obesity medicine physician, and the founder and chief medical officer at JumpstartMD.
The Hormone Replacement Therapy Rebrand
Hormone Replacement Therapy (HRT) remains the most widely used term for the act of supplementing your natural hormone output with synthetic (meaning, lab-made) options to balance levels and ease symptoms. However, in clinical settings, and especially among menopause practitioners, the regimen is now being called Menopausal Hormone Therapy (MHT). Why? For increased accuracy.
The term replacement implies that people are taking these hormones because their body is malfunctioning, says physician Catherine Hansen, M.D., F.A.C.O.G., F.R.C.S.C., N.C.M.P., M.P.H., who heads Pandia Health’s menopause hormonal care offering. But actually, it is normal and healthy for individuals to experience declines in estrogen, progesterone, and testosterone as they age, she says. Throughout the menopause transition, for example, estrogen levels can drop up to 90 percent.
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The thing is, while these declines are natural, they can bring some unpleasant symptoms with them—and that’s when MHT can help. “MHT adds estrogen into the body to alleviate symptoms related to estrogen decline, including hot flashes, night sweats, sleep disturbances, mood changes, and bladder and vaginal issues,” Hansen says. The goal isn’t to fix something broken, but to support the body through a natural transition and ease symptoms that can get in the way of daily life.
The Hormone At The Heart Of It All: Estrogen
Estrogen is best known for its role in breast development, pubic hair growth, and menstrual function. Indeed, the reproductive hormone is a key driver in the production of these secondary sex characteristics, but its role goes far beyond that.
“Estrogen binds with receptors in multiple tissues throughout the body, including the brain, bones, heart, blood vessels, urinary and vaginal tracts, skin, and hair,” says hormone specialist and board-certified obesity medicine physician, Sean Bourke, M.D., founder and chief medical officer at JumpstartMD. There, the multitasking hormone regulates everything from mood and memory to bone density, skin elasticity, and cardiovascular health.
Throughout perimenopause, the first stage in menopause transition, your ovaries begin to wind down. Estrogen levels fluctuate before permanently dropping—and although menstrual cycles may still occur, they do so irregularly. Eventually, the ovaries completely cease hormone production. “This dip in estrogen—which impacts a multitude of other hormones and neurotransmitters—can set off a series of systemic changes, such as muscle loss, bone loss, cardiovascular changes, cognitive decline, and more,” says Hansen.
What MHT Involves—And Why It Helps
MHT involves supplementing with a lab-made form of estrogen, often bioidentical estradiol, which mimics the structure of the estrogen your body naturally produces, according to Dweck. This is known as estrogen-only hormone therapy and is typically reserved for people who have had a hysterectomy, since estrogen alone can increase the risk of uterine and endometrial cancer in those with a uterus.
For women who have not had a hysterectomy, a synthetic form of progesterone called progestin is typically also prescribed, says Bourke. This is known as combined hormone therapy, or estrogen plus progestin therapy. The addition of progestin protects the uterus and may also help manage hormone-related symptoms in some individuals.
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MHT is available in a variety of doses and has multiple modes of administration (e.g. oral, transdermal, vaginal), depending on patient preferences, according to Dweck. Once inside the body, these hormones bind to the same estrogen and progesterone receptors as the ones your body naturally produces. That means they can help maintain the regulation of key systems—including the brain, bones, heart, and pelvic tissues—as they did before menopause. In turn, this can relieve (if not eradicate) symptoms associated with hormone decline, she says.
Take night sweats and hot flashes, for instance. Estrogen works on a part of the hypothalamus, the part of the brain colloquially dubbed the body’s natural thermostat. When estrogen levels fluctuate and fall, the hypothalamus becomes hypersensitive to even small changes in core temperature, sending the body into overdrive with sudden sweats or chills, explains Bourke. “Replenishing estrogen and progesterone can stabilize the hypothalamic centers in the brain, diminishing the frequency and intensity of flashes and supporting sleep,” he says.
MHT can also help relieve many of the bladder or vaginal symptoms that come with menopause, according to Hansen. Because estrogen receptors are highly concentrated in the pelvic tissues, declining estrogen during menopause can cause vaginal dryness, irritation, painful sex, urgency, and recurrent urinary tract infections, she says. (This cluster of symptoms is now known as genitourinary syndrome of menopause, or GSM.) Increasing estrogen levels can help ease some of these uncomfortable issues.
Who Might Benefit From MHT
Anyone experiencing symptoms related to the menopause transition may be a candidate for MHT, according to Hansen.
The current body of research suggests MHT is both safest and most beneficial when started within 10 years of menopause or before the age of 60. “When MHT is prescribed many years after menopause—particularly after age 60 or more than a decade from the final menstrual period—there may be increased risks, such as cardiovascular disease or stroke,” she explains.
MHT may also be prescribed to and beneficial to those who are in the perimenopause, notes Hansen. During this stage, MHT can combat any unwanted symptoms, “though it’ll be prescribed in a slightly different manner to ensure that bleeding remains predictable,” she says. “MHT is considered safe and well tolerated in perimenopause under the care of a specialized menopause provider.”
Other Ways To Support Your Health During Menopause
MHT can be incredibly effective, with research showing that most users report a “significant benefit.” Still, it’s not the only tool available for managing the symptoms associated with perimenopause and menopause.
“There are alternatives to MHT for those who cannot or prefer not to take hormones,” says Dweck. According to the American College of Obstetricians and Gynecologists, taking hormones is contraindicated for individuals with hormone-sensitive cancers, blood clotting disorders, and liver disease. Others prefer to avoid adding hormones to their system out of personal preference or due to past side effects with hormone-based treatments or medications.
Fine-tuning your lifestyle habits is the best thing you can do to support your body during menopause—and that stands whether you’re utilizing MHT or not, according to Hansen. Here are five best practices everyone should prioritize.
1. Eat Healthy
A Mediterranean-style eating pattern that focuses on vegetables, fruits, whole grains, legumes, nuts, extra-virgin olive oil, and fatty fish (like sardines and salmon) has been shown to support heart health, promote hormone balance, and help you feel your best during menopause, according to Hansen.
2. Minimize Alcohol Consumption
While moderation is generally a perfectly okay policy, during the menopause transition, it’s typically best to limit alcohol intake as much as possible, says Hansen. Alcohol can worsen hot flashes, cause sleep disruptions, and mess with hormones, often exacerbating the symptoms you’re already experiencing due to menopause.
3. Exercise Regularly
“You should engage in regular aerobic and strength exercises to preserve lean mass, protect bone mass, and enhance metabolic, mental, and physical health,” says Bourke. Specifically, he suggests resistance training at least twice per week to support muscle and bone mass, as well as doing high-intensity interval training (HIIT) once per week for a healthy heart and metabolism.
“Mind-body practices such as meditation, yoga, or Tai Chi on rest days can help regulate stress hormones like cortisol, in turn supporting more stable sex hormone production,” he adds.
4. Consider Supplements
Adequate nutrient levels are essential for hormone production, brain health, energy regulation, and more. Supplements—such as vitamin D and creatine for bone health, as well as targeted probiotics for vaginal health—can be helpful as women reach mid-life. Many brands offer women’s wellness solutions specific to menopause, such as Solaray’s HerLife Stages and Health & Her’s Menopause Multi-Nutrient Support.
The Takeaway
Menopause is an inevitable part of the aging process for women, but it doesn’t have to compromise your quality of life or dull your sparkle. When combined with healthy habits, MHT can help provide relief from symptoms so you can feel like yourself again.
To figure out if it’s right for you, talk to a healthcare provider who specializes in menopausal health about your symptoms, family history, and overall health. If you need help finding one, check out The Menopause Society’s directory.
This article was reviewed by Brian Tanzer, nutritionist and Director of Scientific and Regulatory Affairs at The Vitamin Shoppe.