Hormone Therapy for Menopause and Perimenopause
If You Have Joint Pains
When millions of women stopped hormones after the WHI report in 2002, some
doctors were suddenly fielding fears about arthritis, says Dr. Richardson.
Kathleen Kalell, who started HT in her mid-40s for hot flashes, has been on and
off several times in more than a decade. “Each time I go off, my mobility is
really impaired,” she says. Exercising and even climbing stairs become
difficult because of her knee pain.
Will hormones help? HT is controversial here — taking
hormones for joint pain is definitely an off-label use — but there are women
and gynecologists who swear by it. “I don’t look like I’m 200 years old when
I’m walking,” says Kalell. If achiness is your only symptom, talk to your
doctor about other possible causes and other forms of relief first.
If You Are Moody
Hormonal spikes and dips may prompt bursts of irritability, anxiety,
depression, and overall moodiness. “It’s very much like PMS, but no longer
confined to the week before your period,” says Dr. Gass. “It’s one thing to
cope with it one week out of the month. Dealing with it randomly — and
sometimes many times a month — is more exasperating.” But don’t discount other
familiar midlife stressors, like combined demands of tweens, teens, work, and
aging parents, particularly if you’re also struggling with hot flashes and your
sleep is disrupted.
Will hormones help? Most women actually feel quite a bit
better once they’ve made it into the stable hormonal state of menopause, notes
Dr. Richardson. But if you can’t wait till then, talk to your doctor about
which options make sense for you. Depending on other symptoms, you might take
birth control pills to level out hormones during perimenopause, then, if you’re
still feeling out of sorts once your periods stop, switch to systemic HT. Some
women also benefit from antidepressants or antianxiety medications, along with
talk therapy or holistic strategies.
When (and How) to Get Off HT
Here’s the mantra: the lowest effective dose for the shortest time possible.
And, some doctors add, for no longer than three to five years. Sounds good, but
as much as half the time, symptoms recur when you stop, no matter what your age
or how long you used HT. So what then?
Plan ahead: Expect some rebound and be prepared with
alternatives to handle annoying symptoms — lubricants for vaginal dryness, for
example, or dressing in sheddable layers to cope with hot flashes.
Time it right: Sometimes menopause hits when women feel
they cannot deal with one more problem in their lives, says Dr. Gass. But
later, life may settle down, making even bothersome symptoms more manageable.
Just don’t try to stop in summer, when hot flashes are harder to deal with,
advises Dr. Richardson.