Who Can Use Hormone Replacement Therapy?
If you’re struggling with hot flashes, night sweats, and vaginal symptoms, is hormone replacement therapy (also called menopausal hormonal therapy) right for you? The answer is probably yes if you:
• Are younger than 60
• Are within 10 years of the onset of menopause
• Have no history of, or are not at high risk of, breast cancer, endometrial cancer, stroke, or blood clots, and do not have liver disease.
If you’re at substantial risk for breast cancer or cardiovascular disease, you should avoid hormone replacement therapy. Your doctor will work with you to select the safest and most effective dose, formula, and route of administration depending on whether you have specific risks and on the severity of your symptoms, or he or she may recommend a nonhormonal treatment instead.
But what if you are older than 60 or have had hot flashes for longer than 10 years? A study published in February 2015 in JAMA Internal Medicine found that hot flashes can persist for much longer than the three or four years previously thought. Most women in the study had hot flashes, night sweats, and other symptoms for seven years or more, and some had symptoms that lasted nearly 12 years.
The North American Menopause Society (NAMS) issued a statement in the July 2015 issue of Menopause supporting continued hormone replacement therapy use in women 65 years and older who have persistent moderate to severe vasomotor symptoms as long as the benefits still outweigh the risks, a viewpoint shared by the Endocrine Society and American College of Obstetricians and Gynecologists.
“Many women will continue to have hot flashes, night sweats, and other symptoms after age 65, and these symptoms can disrupt sleep and adversely affect health and quality of life,” says Wen Shen, M.D., assistant professor of gynecology and obstetrics at Johns Hopkins University School of Medicine in Baltimore.
“Each woman considering menopausal hormone therapy, no matter what her age, should work with her doctor to establish an individual benefit-risk profile,” she says. “After establishing a regimen, she should use the lowest dose of hormone therapy for the length of time that’s appropriate to meet her needs.”
If you decide to try it
Once you begin hormone replacement therapy, you should visit your gynecologist at least annually so you and your doctor can assess how the therapy is working and discuss whether to continue using it for another year. Your doctor should inform you of your increased risk of breast cancer during hormone therapy as well as after you discontinue it. He or she should set up a breast cancer screening schedule for you to follow. Also, be sure to let your doctor know about any unusual vaginal bleeding you’ve experienced.
Finally, continue to engage in healthy lifestyle habits such as getting adequate calcium and vitamin D to minimize bone loss, staying active, eating healthfully, and not smoking.