Question:

Do menopausal women need to take estrogen and progesterone?

Answer by OB-GYN Karen Carlson, MD:

No, menopausal women do not need to take estrogen and progesterone. However, they can be helpful in treating hot flashes and night sweats for certain patients.

Every woman is different. Some may not experience bothersome symptoms associated with menopause, which occurs 12 months after a woman’s last period. The average age for menopause is 51, though it can begin much earlier or later.

Perimenopause, the transition to menopause, can begin up to 10 years before menopause. As women approach menopause, they may experience:

• Hot flashes. Also known as a vasomotor symptom, hot flashes involve a sudden feeling of intense heat accompanied by sweating and flushing.
• Night sweats. These are episodes of excessive sweating that occur during sleep, often causing women to wake up drenched in sweat.
• Vaginal dryness. This happens when the vagina lacks sufficient moisture, potentially leading to discomfort, itching and painful sex.
• Recurrent UTIs. Bacterial growth caused by an increased vaginal pH can lead to frequent UTIs.
• Mood changes. Up to 70% of women experience some degree of anger, irritability, anxiety, depression or loss of self-esteem during menopause or perimenopause.
• Insomnia. Women may have trouble falling asleep, staying asleep or waking too early.
• Weight gain. Many women experience weight gain or a redistribution of body fat.

Treating menopausal symptoms

Hormone replacement therapy, or HRT, can be used to treat vasomotor symptoms. If you are having hot flashes and night sweats that are interfering with your quality of life, you may be a candidate for HRT.

Along with reducing vasomotor symptoms, HRT can help lower your risk of heart disease and osteoporosis. While it may slightly increase your risk of breast cancer, it is not as dangerous as once believed. A trusted provider can help you decide if the benefits outweigh the risks in your case.

If you still have your uterus, you need to take progesterone along with estrogen to protect you from uterine cancer. The best forms of HRT are estrogen patches and oral progesterone. Compounded creams and pellets are not recommended, as they are not FDA approved or regulated.

The best time to begin HRT is within 10 years of your final period and before the age of 60. For women who can’t or don’t want to take HRT but are experiencing bothersome symptoms, other treatments are available.

Seeing the right doctor

While unconventional approaches to “hormone balancing” are becoming more popular, it is important to partner with the right doctor to find the best treatments for your individual needs.

HRT is helpful for many women, but when prescribed inappropriately, it can lead to serious problems. Additionally, some clinics run expensive tests and hormone panels that are not necessary.

Your best bet is to find a board-certified OB-GYN who is up to date on the most current research regarding HRT and other treatments for menopausal symptoms.