Hormone replacement therapy (HRT) has been shown to have many benefits for long-term wellness, including bone, cognitive, and cardiac benefits, as well as short-term effects, such as the reduction of hot flashes, vaginal dryness, and improvement of sleep. There are many different types and regimens of HRT, which are individualized to meet a patient’s specific needs.
Bleeding: This is what women dislike most about HRT. When HRT is begun in a cyclic or continuous fashion, or an HRT regimen is changed, approximately half of women will initially have some bleeding or spotting. Bleeding may be irregular at times or cyclic like a period. Blood may be bright red to brownish. Bleeding may persist for up to 6 months; bleeding after this interval needs to be evaluated. The good news is that by six months, less than 20% of women will bleed, and by one year only 1 in 10 (10%) of women will have any bleeding. On cyclic hormones (progesterone only part of each month), cyclic bleeding may persist, but it will usually be predictable and will diminish over time and often stop. Withdrawal bleeding is not necessary to ensure the uterine lining is OK and that the hormones are appropriate. Ultimately, an HRT regimen that does not produce bleeding is appropriate for most women. Please note that if you have a uterus and are on the Wiley Protocol, you are very likely to bleed (actually the hormones are increased until you bleed). In my experience, patients on pellets are the least likely to bleed due to the stability of the regimen.
HotFlashes: These will usually decrease by one month and continue to decrease for 3 to 4 months on HRT. An occasional hot flash or night sweat may occur, but overall these should be much less than before starting HRT. Alcohol, medications, and grapefruit consumption may increase hot flashes.
Vaginal Dryness: This often takes up to three months to improve after HRT has begun. If it continues to persist, direct vaginal estrogen application may help (available by prescription). Also consider modalities like the “O” shot, or Venus radio frequency stimulation of collagen.
Weight Gain: Women gain an average of 15-30 lb. in the few years around menopause. Women on HRT tend to gain slightly less weight than women not taking hormones. A woman’s metabolism slows significantly at menopause, and muscle mass decreases. To avert this, women should decrease their calories by approximately 20% in menopause and exercise daily. In a recent study, women must walk approximately 24 miles (4 miles six times a week) to compensate for the decreased metabolism and to preserve muscle mass. Unfortunately, our culture is fairly sedentary, and few people have significant physical activity during daily activities of living.
Breast Tenderness: Breasts are tender around menopause, with or without HRT. If breast tenderness is severe and persists more than three months, this will be addressed at your three month HRT follow-up visit.
Please keep a record of your bleeding and symptoms to bring to you next menopause appointment.
IT TAKES APPROXIMATELY THREE MONTHS TO BEGIN TO EVALUATE WHETHER AN HRT REGIMEN IS OPTIMAL FOR AN INDIVIDUAL PATIENT.
When to call the doctor’s office:
1. If bleeding is heavy during the first three months (more than 5 super tampons or 5 regular pads, saturated, per day–NOT panty liners).
2. If you notice adverse symptoms that are possibly due to HRT (such as leg swelling, oily skin, mood changes).
3. If headaches begin or become more frequent or severe.
Three months after initiation of HRT, evaluation and adjustments of your current regimen will be made. Please follow the instructions for an hormone blood level check. Even if you are satisfied with your current regimen, we need to check your blood level to ensure that you are on the correct dose of estrogen.
Please do not react to every article on HRT in the media. They are often sensationalized, and it is appropriate to schedule an appointment to discuss your particular situation before discontinuing any therapy.