Menopause affects every woman differently, but for those who suffer from extreme symptoms, the experiences tied to menopause can be physically and emotionally exhausting. Hormone replacement therapy (HRT) may be helpful in many cases, but some options may be risky. (Yes, there are options!) Here’s how estrogen therapy stacks up against the other options.
Over 80% of women nearing or having completed menopause (defined as one year with no menses) experience hot flashes, mood changes, and other symptoms that can affect sleep and quality of life. Doctors believe a few different factors contribute to these uncomfortable manifestations, but changes in hormone levels appear to be the major trigger.
Estrogen replacement can ease many symptoms, and it can also protect against osteoporosis, which affects nearly a quarter of women over 65, but it may not always be safe. Why? Estrogen stimulates the uterine lining and can feed certain malignancies; as a result, long-term estrogen therapy can contribute to uterine and breast cancer. Adding progesterone to the regimen may reduce some risks, as can taking lower-dose or transdermal options, but many women are still taking their chances.
Women who aren’t at immediate risk for osteoporosis may want to consider taking progesterone on its own. Research has shown that progesterone-only therapy can reduce menopausal symptoms by 55% without increasing cancer risks, and it’s as effective as estrogen in protecting the blood vessels. One significant benefit is that progesterone-only therapy may also help improve sleep quality.
SSRI and SNRI antidepressants are other possible options. According to some studies, these drugs may reduce menopausal symptoms by as much as 64% for some women. However, unlike progesterone-only therapy, they can have several side effects, and some cause withdrawal symptoms that can make menopause feel like a walk in the park — so please consult the appropriate professional before embarking on this path.
Many women swear by alternative therapies. Low-dose vitamin E supplements may be helpful for some. Plant-based options and herbs including wild yam, black cohosh, flaxseed, and Chinese medicinal herbs, may or may not be as effective as proponents claim so explore these with caution and eye toward the research, although many people believe they make a real difference. Always consult a physician before consuming herbs.
Cannabis might be another alternative. According to Healthline, its active components, endocannabinoids, interact with estrogen receptors, which could have effects similar to estrogen supplements. Cannabis can be sedating, which may help with mood swings and sleep disturbances but its psychoactive properties might also worsen brain fog and depression. It’s still illegal in some regions, and the verdict is still out on possible adverse health effects, so potential users should follow local laws and exercise caution as well as consult a physician to confirm that it won't interact with any existing medications.
While it's true that we can find health at any size, some women find relief from their symptoms after a small amount of weight loss or by avoiding hot flash triggers like alcohol and spicy foods. Even small steps like keeping the room cooler, turning on a fan or avoiding heat-trapping clothing can help in the short term.
Menopause can be a difficult time for many women as symptoms feel all-consuming, but relief is available. Estrogen isn’t always the best approach, though, and each of the alternatives have their weaknesses and strengths, so sufferers should see their doctors for direction if they’re not sure where to start. Remember to consider family history and individual risk before beginning any type of HRT therapy.
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