So What Exactly IS MHT?
What exactly ARE the hormones in menopausal hormone therapy?
I've spent the last few blogs talking both specifically and in general about menopausal hormone therapy. But what exactly is it?
First off, FDA-approved indications for starting menopausal hormone therapy include:
Vasomotor symptoms (hot flashes and night sweats).
Preventing osteoporosis.
Genitourinary syndrome of menopause (vaginal dryness).
However, other health benefits of MHT may be considered when deciding whether to start MHT. These might include:
Decreased risk of colon cancer
Improving mild or moderate depression. Improving mood.
Slowing the accumulation of visceral fat
Slowing the loss of muscle mass
Slow wrinkle formation
Improve sleep
Reduced risk of diabetes
Improve vaginal dryness
HORMONE #1:
ESTROGEN
Estrogen is the hormone that brings relief. It remains the single most effective way to relieve hot flashes, night sweats, and vaginal dryness related to the genitourinary syndrome of menopause.
There are different types of estrogen, but the way you take it is what matters most. Oral estrogen (pills) has a higher risk of blood clots and stroke. Transdermal estrogen (patch, spray, ring) is the safer and preferred way to take estrogen as it has no increased risk of blood clots or stroke and less (or maybe no) risk of breast cancer.
There are several options for transdermal estrogen. Patches (Vivelle, Dotti) are applied below the level of the breasts, usually on the hip or butt, and changed once or twice a week. They provide a steady dose of estrogen, so you don't experience hormonal fluctuations. However, you may be allergic to the adhesive or face difficulties keeping it adhered if you spend a lot of time swimming or in a hot tub.
Gels, sprays, and emulsions (Divigel, Evamist, Estrasorb) are applied daily to the arm. The skin takes time to absorb the estrogen, so you can't wash the area or apply moisturizer for one hour.
A vaginal ring (FemRing) is placed into the vagina for 90 days. It's convenient as you can set it and forget it!
Local (or vaginal) estrogen provides excellent relief for vaginal dryness associated with menopause but doesn't get blood levels high enough to relieve other symptoms of menopause. More to come on this.
HORMONE #2:
PROGESTERONE
Progesterone is necessary for women with a uterus to protect the lining of the uterus (endometrium) from getting pre-cancer or cancer. Like estrogen, there are a couple of ways to take progesterone.
A progesterone-containing IUD (like a Mirena) is a small device that goes into the uterus and lasts eight years. It can significantly help with heavy, irregular periods associated with peri-menopause and provides effective contraception.
Micronized progesterone (Prometrium) is a natural progestogen pill you take daily by mouth. It can make you sleepy, so it is best to take it at night. You CANNOT take it if you have a peanut allergy.
Synthetic progestins include medroxyprogesterone acetate (MPA), the most studied progestin. However, micronized progesterone is preferred as it has fewer risks than synthetic formulations.
Combined products contain BOTH estrogen and a progestogen and include low-dose birth control pills, combined patches, and combined pills.
A PROGESTERONE alternative:
Duavee is a combined estrogen and a SERM (bazedoxifene).
A SERM acts like estrogen on certain parts of your body and anti-estrogen on other parts. Bazedoxifene acts like estrogen on the bone and anti-estrogen on the uterine lining and breast tissue. This might be a good option for women who want MHT for hot flushes or osteoporosis but can't tolerate a progesterone.
Remember, it can take 6-12 weeks to see the effects and know if it works for you, so stick with it for three months before deciding on any changes!
