Hormone Therapy for Menopause and Perimenopause
The Long Goodbye continued...
Not that every woman is miserable during the transition. Right now,
Charlotte Pierce, a 51-year-old mother of two who runs a home-based publishing
company, is only mildly bothered by irregular periods and occasional
forgetfulness. That’s true for plenty of women, says Margery Gass, M.D.,
director of the University Hospital Menopause and Osteoporosis Center in
Cincinnati. You’re just less likely to hear about those who cruise through with
little disruption to their lives.
But if you’re less fortunate than Pierce, there is help, whether you’re
struggling with wildly unpredictable periods, annoying hot flashes, or sexual
difficulties. What will work best depends on your symptoms. Here’s a guide to
the new hormone decisions you may confront.
If You Have Irregular or Heavy Bleeding
Early in perimenopause, the time between menstrual cycles frequently
shortens. Later, it’s typical for cycles to both shrink and expand as
out-of-whack hormones stop triggering ovulation and releasing progesterone like
clockwork. Skipped periods are common, sometimes contributing to heavier
bleeding in the next cycle. Don’t be fooled by those missed months: Pregnancy
is still a real possibility.
Will hormones help? Yes, if your problem is hormonal. Your
doctor may prescribe birth control pills, which suppress ovulation and provide
more even levels of estrogen and progesterone. Another option for some women is
taking progestin (the synthetic form of progesterone) alone, to help regulate
cycles. But very heavy or prolonged bleeding could also signal fibroids,
polyps, or possibly precancerous growths, so be sure to see a gynecologist to
find out what’s behind your symptoms, says Marcie Richardson, M.D., director of
the Menopause Consultation Service at Harvard Vanguard Medical Associates in
If You Have Hot Flashes and Sweats
Getting a close-up of global warming? As hormones fluctuate during
perimenopause, roughly three out of four women experience hot flashes. One in
10 is truly miserable. During the day, these episodes, which last one to five
minutes, range from mild to wildly uncomfortable and deeply embarrassing. At
night, they can cause major misery, as sleep becomes an idle dream.
Will hormones help? Lifestyle changes may help you cool off
sufficiently. But if not, hormone therapy (HT) does ease hot flashes and
sweats. Indeed, that’s one of the three FDA-approved uses of HT (the others are
treatment of vaginal dryness and osteoporosis prevention). For some women, like
Tricia Droney, 52, who was having up to 40 hot flashes a day, HT is the most
reliable remedy. You’ll need the kind that works systemically — pills (many
brands, including Prempro, Femhrt), patches (Vivelle-Dot, CombiPatch), gel
(Divigel, EstroGel), spray (Evamist), lotion (Estrasorb), or one type of
vaginal ring (Femring).
Unless you’ve had a hysterectomy, it’s standard for doctors to prescribe
estrogen combined with progestin to block overgrowth of your uterine lining
(which can lead to endometrial cancer). Combination therapies can be continuous
(both hormones daily) or cyclic (typically, progestin added 10 to 14 days a
month). Medically speaking, none of these regimens has clear benefits over the