• Hormone Replacement Therapy

What are the Signs That You Need Hormone Replacement Therapy?

Medically reviewed and edited by Dr. Danielle Weiss

Around 6 million women in the U.S. are on hormone replacement therapy (HRT).

According to the Centers for Disease Control and Prevention (CDC), women with surgical menopause (menopause triggered by removing both ovaries) are much more likely to use HRT to manage their symptoms than those who naturally reach menopause.

A 2021 survey showed that 73% of older women in the U.S. were not treating their symptoms of menopause, and 65% of them would not consider using HRT.

In this article, we'll discuss hormone replacement therapy, its risks, benefits, and how to tell if you might need it.

What is Hormone Replacement Therapy (HRT)?

Hormone replacement therapy is a treatment given to women and men to rebalance declining hormone levels. This treatment can relieve the symptoms of menopause and andropause (“male menopause”).

Hormone therapy for women is typically started around menopause and primarily involves estrogen and progesterone hormone therapy.

HRT for men involves testosterone replacement therapy (TRT), and it’s usually recommended to men who suffer from hypogonadism — a condition where the body cannot produce sufficient testosterone.

How Do I Know if I Need Hormone Replacement Therapy?

Sometimes the symptoms of hormonal imbalance overlap with other conditions. However, if you’re between the ages of 45 and 55, there’s a good chance that menopause is the reason behind your symptoms.

Women who experience premature or early menopause may be required to do a blood test to determine their hormone levels.

Signs that you may need hormone replacement therapy

If you experience one or more of the following, you may have a hormonal imbalance that HRT can correct:

• Hot flashes and night sweats

• Trouble falling asleep or staying asleep

• Anxiety or depression

• Mood changes and irritability

• Decreased libido (sex drive)

• Vaginal dryness or discomfort

• Pain or discomfort during sex

• Fatigue

• Thinning hair

• Headaches

• Weight gain

• Osteoporosis (fragile or brittle bones)

What Conditions Cause Low Hormone Levels?

If you're experiencing any of the above symptoms, you may be a good candidate for HRT.

However, to really understand the changes your body is going through, it's important to determine what’s causing your hormonal imbalance.

Listed below are some reasons you may be experiencing hormone fluctuations:

Menopause

Menopause is characterized by a natural decline in estrogen and progesterone that typically occurs when a woman reaches her mid-40s or 50s.

The symptoms of the hormonal changes that occur during menopause range from mildly uncomfortable to severe, and HRT can be used to make this “change of life” transition more bearable.

Early or premature menopause

If a woman reaches menopause between the age of 40 to 45, this is regarded as early menopause. Younger than age 40 is premature menopause.

Similar to menopause, early menopause is characterized by low levels of estrogen. Because estrogen protects younger women from conditions like osteoporosis and heart disease, HRT can help restore estrogen levels and decrease the risk of developing these health conditions.

Premature ovarian failure (POF)

Sometimes called primary ovarian insufficiency (POI), premature ovarian failure affects 1 in every 1,000 women between 15 and 29, and 1 in every 100 women aged 30-39.

The symptoms of POF are similar to menopausal symptoms — hot flashes, night sweats, and decreased libido — but it occurs much earlier and the causes are often unknown.

Chronic kidney disease (CKD)

Chronic kidney disease has been associated with various menstrual disorders, early menopause, and lower fertility rates in women of childbearing age.

CKD has a direct impact on hormones because the kidneys help to regulate our sex hormones.

Removal of the ovaries

Sometimes the ovaries are surgically removed due to disease or to prevent the risk of certain cancers.

The ovaries produce estrogen, so if they are removed — especially before menopause — women will have less protection against conditions like heart disease, osteoporosis, stroke, or dementia.

HRT can help restore estrogen levels so that the risk of these conditions is decreased.

Eating disorders

Eating disorders, such as anorexia nervosa and bulimia, affect several hormones in the human body.

Very low levels of estradiol (a type of estrogen) have been associated with these disorders.

What are the Types of Hormone Therapy?

The two main hormones used in HRT are estrogen and progesterone — both of these hormones are secreted by the ovaries.

Combination therapy — which includes doses of estrogen and progestin (a synthetic form of progesterone) or progesterone — is commonly used, but estrogen-only treatment is given to women who've had a hysterectomy (womb removal).

The hormones used in HRT may be synthetic (chemically altered) or bioidentical hormones.

Systemic hormone therapy

This type of treatment involves higher doses of estrogen that can treat all the common menopausal symptoms.

This type of estrogen is administered via:

• Pills

• Patches

• Vaginal rings

• Gels

• Creams

• Sprays

Low-dose vaginal products

This type of treatment is used to relieve more mild menopausal symptoms — such as those related to the vagina or urinary system.

This type of estrogen is administered via:

• Creams

• Tablets

• Vaginal rings

What are the Side Effects of Hormone Replacement Therapy?

The risks of hormone replacement therapy vary depending on factors, such as:

• Your age

• Family history

• If you are pregnant

• If you've had cancer or have existing health conditions, such as liver or bleeding disorders

• The type of hormone replacement therapy you choose (route, frequency, length of treatment time)

The side effects of HRT are outlined in the table below:

Common Side Effects

• Swollen, tender, or painful breasts

• Vaginal bleeding or spotting

• Bloating and stomach cramps or spasms

• Vomiting or nausea

• Fluid retention

• Yeast infections

• Digestive issues, such as constipation or diarrhea

• Dizziness or neck pain

• Sore throat

Serious Side Effects

• Breast cancer, uterine cancer

• Heart attack or stroke

• Blood clots

• Dementia (in women 65 or older)

• Gallbladder disease

• Problems with the liver or pancreas

• High blood pressure

• Severe allergic reactions

• Vision loss

How Do I Know if Hormone Replacement Therapy is Right for Me?

If you're experiencing any of the menopausal symptoms mentioned here, HRT may bring you relief. If you are around menopausal age, it's unlikely that you'll need to test your hormone levels before starting HRT.

Hormone replacement treatments are not yet available over-the-counter, so you'll need to contact a doctor and discuss everything with them before you can obtain a prescription for HRT.

Who should not opt for HRT?

The FDA has cautioned people with the following problems not to start hormone therapy:

• Unusual vaginal bleeding

• Cancers, such as breast cancer or uterine cancer

• Family history of blood clots, strokes, or heart attacks

• Bleeding disorders or liver disease

• Allergic reactions to hormone medicine

What are Some Alternatives to Hormone Replacement Therapy?

Those who are unsuitable for hormone replacement therapy may want to consider the following treatment options to regulate their hormones and relieve the symptoms of menopause:

• Acupressure, acupuncture, and other alternative medicines

• Antidepressants and other medical treatments that stop hormone fluctuations

• Herbal and homeopathic remedies

• Adopting a healthier lifestyle that includes a balanced diet and moderate exercise

When Should I See a Doctor?

If your menopausal symptoms are starting to affect everyday life or the pain and discomfort become too much, you should make an appointment with your doctor.

They'll be able to offer medical advice on how to rebalance your hormones, and run tests that rule out underlying conditions — such as thyroid disease — that may be affecting your hormone levels.

Hormonal imbalances can lead to serious long-term issues, so it's best to get to the bottom of what’s causing your hormone fluctuations as soon as possible.

If your primary healthcare provider is unable to assist, they may refer you to an endocrinologist (a doctor specializing in hormone-related health issues) or fertility specialist.

Where Can I Learn More About Hormone Replacement Therapy?

Are you struggling with hot flashes or vaginal discomfort? Has sex become painful? You may be experiencing menopausal symptoms. Don't let the symptoms of menopause affect your quality of life. Make a telehealth appointment at LifeMD today, where you can talk to a board-certified physician from the comfort of your home (or anywhere). No insurance required!

Dr. Danielle Weiss

Dr. Weiss earned her MD from NYU School of Medicine, completed her residency at Scripps Mercy San Diego, and an endocrinology fellowship at Stanford University. She’s Board Certified in both Internal Medicine and Endocrinology, Diabetes, and Metabolism.

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