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What Women Should Know When Considering Hormone Replacement Therapy

By Aleece Fosnight November 13, 2021 Health and Fitness

Whether it’s for menopausal symptoms or decreasing the risk of UTIs and incontinence, hormone replacement therapy can be a solution for many issues women experience throughout their life. With that said, women interested should have a deep understanding of the types of hormone replacement therapy (HRT) available as well as the many benefits and potential risks associated.

Typically, women begin hormone replacement therapy in their early 50s when their menopausal symptoms take off and they no longer experience their period for at least a year. This process begins when a woman’s ovaries decrease the production of estrogen, testosterone, and progesterone, three key hormones that affect your brain, bone, heart, urinary, and vaginal health.

However, there is no set age when women can start exploring hormone replacement therapy options. Some women begin therapy 10 years before they officially start menopause, often as a result of perimenopause symptoms.

Women who experience perimenopause in their late 30s and early 40s will begin to see changes to their bodies including mood swings, cognitive recall issues, hot flashes, and genital changes, also known as genitourinary symptoms of menopause. 

Benefits of HRT

Hormone replacement therapy has many benefits including the following:

  • Relieves hot flashes and night sweats
  • Lowers chances of dementia
  • Decreases pain with penetration
  • Decreases the risk of UTIs
  • Improves pelvic floor prolapse
  • Decreases stress and urinary incontinence
  • Increases sexual satisfaction and improving arousal by increasing nerve sensitivity 

Different Types of HRT

Hormone replacement therapy can be systemic and/or localized therapy. Systemic therapy sends hormones into your bloodstream, traveling all the way from your head to toe, except for the genitals. HRT is often used by women who are experiencing moderate to severe hot flashes from menopause, are looking to prevent bone loss or fractures and are experiencing perimenopause or have an estrogen deficiency.

With this type of therapy, women can apply hormone cream on their skin, through a topical patch, or orally. In addition, they will need to use a form of localized hormone therapy that they can apply on their vagina.

When applied to the vulvovaginal tissues, the majority of the hormone is absorbed by the local receptors leaving very little in the system which is why it’s important for women to use both in order to receive optimal treatment.

Localized genital hormone replacement therapy only affects a specific or localized part of the body and is typically applied inside the vagina in either a ring, cream or vaginal tablet/suppository form. Unlike systemic hormone replacement therapy, this is designed to treat the vaginal area and not raise systemic hormones.

This form of therapy is recommended for women who are experiencing what’s known as vaginal atrophy; the thinning, drying and inflammation of the vaginal walls. Women often start to notice these changes when experiencing perimenopause, the natural transition period into menopause.

If beginning therapy late, therapy becomes more problem-focused rather than preventative. In this case, the therapy will often need to be more aggressive. If the genitals are already thinning and you have already gone through many hormonal changes, it can take 3-4 months or longer to really see changes unfold and the rebuilding of your structures.

When beginning localized genital therapy, a burning or itching sensation can be normal and a sign that your vagina is healing and should subside after a couple of uses. 

There are many different forms of localized genital HRT that are recommended based on a woman’s dexterity and preference. One popular type of HRT is in cream form, specifically, estrace cream which has estradiol properties that treat vaginal dryness, burning and itching. In addition to creams, women can receive HRT in the form of a ring.

For example, an Estring, similar to a contraceptive ring. There are also ovules women can insert into the vagina that will release hormones as they’re absorbed – Imvexxy and Intrarosa are popular brands. 

Safety of HRT

Short-term systemic hormone replacement therapy is known to be safe for most women going through menopause. However, it’s recommended that you speak with your healthcare provider to see if another hormone replacement option is best for you based on your specific medical history.

It’s also important to note that it is possible to start too late with estrogen replacement therapy and women should avoid this type of HRT 10 years after beginning menopause. HRT is not recommended for women who have: 

  • History of cardiovascular issues: heart attack or stroke and/or increased risk for vascular disease
  • Unexplained vaginal bleeding
  • Active or past breast cancer
  • Fibrocystic breast disease
  • Active liver disease
  • Endometrial cancer
  • Gallbladder disease
  • High risk for blood clots or a history of blood clots

Deciding If HRT Is Right for You 

Hormone replacement therapy can be the solution to a range of health issues and is most popularly known for its benefits in menopausal women. While it may not be for everyone, it’s important to consider risk factors such as age, the length of time since menopausal symptoms began and medical history. There’s no question that HRT yields great benefits. That is why discussing options with your healthcare provider will help determine if it’s right for you.

What was your menopause like? Are you going through it now? How many UTIs do you remember experiencing in the past couple of years? Was HRT part of your therapy at any time? What did you notice in terms of effects and efficacy?

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The Author

Aleece Fosnight, MSPAS, PA-C, CSC-S, CSE, NCMP, IF is a Medical Advisor to Aeroflow Urology. She is a provider of comprehensive sexual and reproductive health, basic urologic care, and gynecological care for Western North Carolina and the Southeast and has opened up her own private practice in June 2020, Fosnight Center for Sexual Health, in Asheville, NC.

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