4 Decisive Signs You Need Hormone Replacement Therapy

Feeling out of sorts due to hormonal changes can be incredibly frustrating and overwhelming. If you're experiencing unexplained changes in your body and mood, you're not alone. Hormonal shifts affect the quality of life for millions of people: 85% of women experience some degree of menopausal symptoms; nearly 500,000 men experience symptoms related to low testosterone.

But there's hope. In this article, we'll walk you through the signs that may indicate a need for hormone replacement therapy (HRT), a treatment designed to help support balance and manage symptoms. You deserve to feel your best, and understanding these signs is the first step toward finding relief and reclaiming your vitality. 

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What Is Hormone Replacement Therapy?

Hormone replacement therapy (HRT) is a medical treatment designed to address hormonal changes by supplementing or replacing hormones that the body is no longer producing in adequate amounts. This therapy is commonly used to manage symptoms associated with menopause, such as hot flashes, vaginal dryness, and mood swings, by replenishing estrogen and progesterone levels in women. Similarly, HRT can also be utilized in men to address low testosterone levels, which may manifest as decreased libido, fatigue, and muscle weakness.

HRT can be administered in various forms, including pills, patches, creams, gels, and injections, depending on the specific hormones being replaced and individual preferences. The treatment is typically customized based on factors such as age, medical history, symptoms, and hormone levels measured through blood tests.

HRT aims to manage symptoms, improve quality of life, and support the reduction of certain health risks (e.g., osteoporosis) associated with hormonal changes. As with any medical treatment, the decision to pursue hormone replacement therapy should be made in collaboration with a healthcare provider, weighing the potential benefits and risks based on individual circumstances and preferences.

Signs You May Consider Hormone Replacement Therapy

Changes in your body and mood can often be attributed to hormonal fluctuations. Here are some top signs you may want to discuss with a healthcare provider about HRT.

#1. Vasomotor Symptoms

Vasomotor symptoms, commonly known as hot flashes and night sweats, are hallmark symptoms of menopause and the most common menopausal symptoms for which women seek support. 

These symptoms result from hormonal fluctuations, particularly a decrease in estrogen levels, which can affect the body's temperature regulation system. Hot flashes manifest as sudden intense heat, often accompanied by flushing and sweating, and can significantly impact daily life. 

#2. Low Sex Drive

Low levels of testosterone can result in reduced libido for both men and women. 

Declining estrogen levels during menopause can also result in dryness and thinning of vaginal tissues, causing painful sex and further interfering with a woman's sexual desires and performance. 

#3. Mood Swings

Mood swings can often signal hormonal fluctuations, particularly during periods such as menopause or andropause. Estrogen and testosterone play vital roles in regulating mood, and changes in these hormones can lead to irritability, anxiety, and depression. 

Drops in estrogen that occur throughout the menopausal transition may trigger an "estrogen withdrawal," leading to symptoms of depression and anxiety symptoms. 

Progesterone potentiates the neurotransmitter GABA in the brain, having a calming effect. Progesterone fluctuations during the menstrual cycle and its natural decline during menopause may increase the risk of premenstrual dysphoric disorder (PMDD) and perimenopausal depression. 

Men with low testosterone levels report higher levels of depression. 

#4. Irregular Menstrual Cycles

Irregular menstrual cycles are often one of the first signs of perimenopause, a transitional phase into menopause characterized by a natural decline in ovarian function and reproductive hormone levels. 

For some women, perimenopausal symptoms can be disruptive and negatively impact their quality of life. In such cases, HRT may be discussed with a healthcare provider to help manage hormone levels, alleviate symptoms, and ease the transition through menopause. 

Side Effects of Hormone Replacement Therapy

Individual responses to HRT can vary. Some people may experience mild side effects when starting HRT. These may diminish over time as the body adapts to hormone therapy or as hormone doses are adjusted. Potential side effects include:

• Breast tenderness
• Vaginal spotting or bleeding
• Fluid retention, manifesting as bloating and swelling in the hands, feet, or ankles
• Headaches
• Nausea
• Changes to skin and hair, such as acne, oily skin, or increased facial hair growth (hirsutism) (6, 15) 

How Long Should You Continue HRT?

The duration of HRT in menopausal women is determined by carefully weighing the risks and benefits, taking into account factors such as the type of hormone therapy, dosage, duration of use, route of administration, and timing of initiation. The recommended length of time for combined estrogen-progesterone therapy is usually five years or less. (21) 

According to the North American Menopause Society (NAMS) Position Statement, HRT duration should be individualized based on a thorough assessment of each patient's medical history, risk factors, and treatment goals. Factors such as age, symptoms, quality of life, bone health, cardiovascular health, and breast cancer risk are all considered in this assessment. (21) 

For instance, women experiencing severe menopausal symptoms or at high risk of osteoporosis may benefit from longer-term HRT use, whereas those with a history of breast cancer may need a more cautious approach with shorter durations or alternative therapies. Additionally, the route of administration, whether oral, transdermal, or vaginal, can impact the risk-benefit profile of HRT. (21)

Weighing the Benefits and Risks of HRT

HRT can impact the risk of breast cancer, endometrial cancer, and heart disease differently based on the type of hormones used, duration of therapy, and individual health profiles. 

Estrogen-only therapy appears to pose a lower breast cancer risk compared to combined estrogen-progestin therapy, particularly with shorter durations of use. However, long-term use of combined therapy may slightly elevate breast cancer risk, especially after five years of use. (28) 

Unopposed estrogen therapy increases the risk of endometrial cancer. Combination therapy with progesterone mitigates this risk by opposing the estrogen's effects on the endometrium. (28) 

Heart disease risk with HRT is nuanced, with potential cardiovascular benefits observed when therapy is initiated close to menopause onset but increased risks, such as stroke and blood clots, in older women or those with cardiovascular risk factors. (1) 

For women aged younger than 60 years or who are within ten years of menopause onset, the benefits of using HRT for managing menopausal symptoms and supporting bone health may outweigh the potential risks. For women who initiate HRT more than ten years after the start of menopause or are older than 60 years, the benefit-risk ratio appears less favorable because of the greater absolute risks of coronary heart disease, stroke, blood clots, and dementia. (21)

What Happens When You Stop Taking HRT?

People may decide to stop taking HRT for the following reasons:

• Symptoms of hormonal imbalance are reduced
• The risks outweigh the benefits
• Taking medication becomes expensive or inconvenient 

Stopping HRT suddenly may result in the recurrence of hormonal symptoms due to a rapid drop in hormone levels. This is why it is often recommended to taper off hormones slowly by gradually reducing dosages over several weeks to months. (24) 

Menopausal Symptoms that HRT May Help Manage

HRT can effectively help manage various menopausal symptoms, including:

• Hot flashes
• Night sweats
• Vaginal dryness and discomfort
• Urinary problems
• Irregular periods
• Thinning hair
• Mood swings
• Sleep disturbances
• Bone loss and osteoporosis
• Difficulty with memory and concentration (2, 16) 

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Key Takeaways

Hormone replacement therapy can be a valuable option for addressing a range of bothersome symptoms associated with hormonal changes in both men and women. From hot flashes, night sweats, and vaginal dryness in women to fatigue, decreased libido, and mood disturbances in men, HRT has shown potential in managing these symptoms and supporting overall quality of life. 

HRT is not without potential risks related to cancer and cardiovascular disease, particularly with long-term use. Therefore, patients considering HRT should engage in discussions with trained healthcare providers to weigh the benefits and risks of treatment and determine whether initiating HRT is the right choice for them.