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Hormone Therapy for Menopause and Perimenopause

If You Have Hot Flashes and Sweats continued...

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 others.

If You Have Vaginal Dryness

As you enter menopause, vaginal walls thin and become drier. This is one symptom that doesn’t settle down with time — if anything, it can grow worse. Sex may be painful, and you may become more prone to urinary tract infections because the urethra, which carries urine from the bladder, is more easily irritated.

Will hormones help? Estrogen works well to rejuvenate and lubricate vaginal walls. Unless you’re also having bad hot flashes, both the FDA and the North American Menopause Society advise that you try a product that you apply locally (but not Femring, which is a systemic product). Since minimal estrogen spills into the bloodstream, these products are a better option if you have health issues that rule out pills or patches. Choices include a vaginal ring worn for three months (Estring), cream (Estrace), or suppositories (Vagifem). You may also want to try hormone-free personal moisturizers (such as Replens), which you apply twice weekly, and in-the-moment lubricants (such as Astroglide and K-Y Silk-E) before or during sex.

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