Perimenopause symptoms are common, but you don't have to live with them. Learn more about how hormone replacement therapy (HRT) can improve your quality of life.
For nearly 15 years, Susan Odum, 58, experienced debilitating symptoms — including hot flashes, insomnia and weight gain — related to perimenopause and menopause that affected every aspect of her life.
"I was tired of not feeling well," Susan says. "I went on a quest to figure out what changes I needed to make to feel better."
Susan decided to explore hormone replacement therapy (HRT). Rachel Murray, a nurse practitioner and Menopause Society Certified Practitioner at Atrium Health Women's Care Sexual Health, explains how HRT can benefit many women at this stage of life.
The Most Common Perimenopause SymptomsA woman is considered to be in menopause when she hasn't had a menstrual period for one full year. Perimenopause is the transitional time four to eight years prior to menopause. During perimenopause, estrogen levels start to decrease, which can cause symptoms like:
- Hot flashes
- Night sweats
- Insomnia
- Changes in cognition or forgetfulness
- Anxiety
- Joint pain
- Vaginal dryness
- Low libido
- Fatigue
Perimenopause symptoms can last the entire time a woman is in perimenopause and well after she's gone into menopause.
Hormone Replacement Therapy: What to ExpectHRT can help address these often debilitating symptoms using either estrogen or estrogen and progesterone to increase hormone levels. Murray says HRT can also be potentially beneficial for protecting heart and bone health.
Murray says it's important to first rule out other possible causes of symptoms, such as a thyroid disorder or arthritis. If a patient is a candidate for HRT, Murray will start her on a four- to eight-week trial period to see how she feels and if she has side effects from the treatment.
HRT comes in several forms:
- Pill
- Patch
- Gel
- Spray
- Vaginal ring
- Intrauterine device (IUD)
"If a woman still has her uterus, she'll need to use some form of progesterone in addition to estrogen," Murray says.
Is Hormone Replacement Therapy Safe?Like any medication, HRT can come with side effects and risk factors. Possible HRT side effects include:
- Headache
- Breast tenderness
- Irregular bleeding
"If side effects happen, we track them and make adjustments," Murray says. "Women tend to feel so much better with HRT. Nine times out of 10, we get the right balance pretty quickly."
HRT slightly increases the risk of blood clots, but this risk is lower than with combined oral contraceptive pills and lower than risk of clot during pregnancy, demonstrating the fact that clots are very rare. It's important to discuss the risks versus the benefits with your provider, including sharing your personal and family health history to make an informed decision.
"The small risk of blood clots when using estrogen has only been demonstrated in oral forms" Murray says. "For those at higher risk of heart disease, such as individuals with high cholesterol or blood pressure, we'll talk about safer alternatives like creams, gels or sprays, along with their risks and the benefits."
Murray says the benefits generally outweigh the risks in women who are within 10 years of menopause or who are younger than 60.
There are also many misconceptions about the safety of HRT.
"A lot of the information online is black and white — HRT is either 'terrible' or the 'best thing ever,'" Murray says. "I think it's amazing and can help so many women, but I wouldn't give it to every single person. It's important to have a conversation with a knowledgeable health care provider who can help you determine what's right for you."
Susan's Experience Using HRTSusan has hypothyroidism and underwent a hysterectomy to remove her uterus and ovaries when she was 42, which immediately put her into menopause.
"As soon as I had a hysterectomy, my symptoms started and I was miserable from age 42 on," Susan says. "I thought that's just how it was and that I'd be miserable for the rest of my life."
Susan recalls having hot flashes accompanied by panic attacks and nausea at work that were distracting and embarrassing. She also struggled to get a good night's sleep, which affected her work life and how she felt on a daily basis.
Susan was referred to Murray by Ashley Phillips, PA, at Atrium Health Primary Care Randolph Internal Medicine about two years ago. At first, she was hesitant to explore HRT. After discovering flaws in the old data and reviewing new information on HRT, Susan, a scientist and statistician, realized the benefits outweighed the risks for her.
Murray prescribed an estradiol transdermal patch and low-dose progesterone to address Susan's symptoms.
"It became a balancing act of getting my thyroid and hormones stabilized," Susan says. "Rachel was wonderful in helping me to do that."
The results of HRT have been life-changing for Susan.
"After 15 years of symptoms, HRT absolutely changed my life," Susan says. "It opened up a world for me to live a healthier lifestyle because I was sleeping better and felt better."
And she's thankful she took her physician assistant's advice.
"For so many years the medical community has felt women should just suffer through menopause, but that is changing," Phillips says. Women like Susan no longer need to endure debilitating hot flashes, sleep issues and weight gain. The Women's Care Sexual Health Clinic has providers with the expertise to make menopause bearable and I am so glad my patients have found this."
Susan hasn't experienced any side effects from HRT and has seen an improvement in her labs. She now exercises regularly, doing a combination of strength training, yoga, boxing and walking. She also eats much healthier than she did before.
Murray encourages women to advocate for themselves and not assume they must live with perimenopause symptoms.
"I came into this field because I wanted to help women understand their bodies," Murray says. "This is an area that hasn't gotten enough attention. If you feel like your provider isn't receptive to helping you address perimenopause symptoms, find a clinician who's a certified menopause practitioner by the North American Menopause Society (NAMS)."
Susan says she wishes she hadn't waited so long to explore HRT. To other women experiencing similar symptoms, she shares the following advice:
"Don't wait. It's about your quality of life, not just your symptoms," Susan says. "Once you start feeling better, everything else improves."
