Over 40 and hot: Hormone replacement therapy

HOUSTON – The symptoms sound minor, but premenopausal women know they're extreme.

“What happened that really made me seek help is the mood, the mood changes. I mean, I started to get depressive and angry for no reason,” Pauline Schloesser said.

The American College of Obstetrics and Gynecology (ACOG) says antidepressants can be used for mood swings and hot flashes, but estrogen can also work to relieve:

  • hot flashes and night sweats
  • can help to protect against bone loss
  • local types of estrogen relieve vaginal dryness
  • progestin can be used for insomnia

ACOG said combined estrogen and progestin may reduce the risk of colon cancer.

Dr. Susan Hardwick-Smith specifically recommends bioidentical hormones, which she said most closely resembles what our body makes.

“If you think about it, ovaries put estrogen into our bloodstream, not into her stomach. So, you can avoid hormones going through the liver, and deliver them right into your bloodstream by using a patch or a cream or even pellets that can be injected under the skin,” she said.

However, ACOG warns hormones may increase the risk of:

  • uterine cancer
  • heart attacks
  • stroke 
  • deep vein thrombosis
  • and women with a history of hormone-sensitive breast cancer should try other therapies first

Schloesser said the side effects (like fluid retention) were too much for her. Instead of staying on hormones, she found relief in yoga.

“The way I look at it is that menopause is a really great opportunity to make some important changes in life that will take you through the second half,” she said.

If you choose to take hormone therapy, regular follow-up is important. Doctors say benefits and risks also may change over time. 

Hardwick-Smith warns against patients spending thousands at specialty clinics for hormone therapy. She said no testing is needed, so be cautious of businesses that insist on taking blood work. She said doctors can treat with prescriptions based on symptoms, not blood tests.