Hormone replacement therapy

Is it right for you?

Louisville businesswoman finds relief from menopause symptoms

Shaunna Hartnett did not enjoy being 47. That’s the age when her mood swings and hot flashes — about 25 a day — kicked into high gear.

“It was terrible,” she said. “It wasn’t just a matter of getting hot all over all of a sudden. It’s like my insides were on fire and it erupted through my face. And I’d be so mild-mannered and then the littlest thing that would go wrong would change my entire mood.”

Fast-forward just one year, and Hartnett feels like a brand new woman — or at least more like the woman she used to be before menopause.

“I have absolutely no hot flashes whatsoever, not one,” said Hartnett, who owns a Louisville nail salon. “I don’t have the mood swings from calm to crazy. I feel like I am ‘normal’ and even-tempered.”

Nancy J. Newman, M.D., Hartnett’s OB/GYN, introduced her to a transdermal hormone therapy patch, which contains the hormones estrogen and progestin. When applied twice a week, the patch provides a continuous release of hormones through the skin and directly into the bloodstream — helping to treat moderate to severe symptoms associated with menopause, a time when levels of estrogen decrease.

“Most patients going into menopause present with several symptoms,” Dr. Newman said. “Among them are hot flashes, night sweats, weight gain, heart palpitations, sleep disturbances, vaginal dryness and lack of concentration. A lot of the complaints may not seem gynecological on the surface, but when you start looking at the big picture, they are related to hormones.”

Changing hormones, Dr. Newman said, are completely normal during menopause, the time in a woman’s life when she stops having menstrual periods, usually around age 51.

“The question is how much do you treat them?” Dr. Newman said. “There is not a straight therapy that works for every patient. The risks and benefits for one patient are not the same for another patient. But the symptoms are very, very treatable.”

Along with relieving symptoms, hormone therapy can also help prevent bone loss that can occur after menopause.Estrogen helps preserve bone and works with other hormones to increase bone mass, according to the American Congress of Obstetricians and Gynecologists (ACOG). Hormone replacement therapy is the answer for many, but not all, women.

“It’s not going to be right for everyone,” Dr. Newman said.

“Women who have had blood clots, liver disease or breast cancer, or who have a family history of breast cancer and cardiovascular disease, are not candidates for hormone replacement therapy.”

The Women’s Health Initiative, a study by the National Institutes of Health, found that the use of oral hormone therapy could increase the risk for heart attacks, strokes, blood clots and breast cancer in some women, according to the ACOG.

“In 2002 there was a strong push that everyone should go off hormones because of the increased risks,” Dr. Newman said. “But we have a lot more knowledge about hormones today. We know that hormone replacement therapy is best and safer if it is started early, within five years of menopause. More than 10 years out from menopause, it is not as safe. That’s when we see the increase in heart disease and stroke.”

Along with age at menopause, Dr. Newman says hormone replacement therapy is tailored for each individual based on symptoms and family history. Once determined if the therapy is appropriate for a patient, the physician decides how it will be administered — orally, vaginally or transdermally (through the skin). Dr. Newman usually prescribes transdermal hormones to her patients in the form of patches, gels or creams.

“I think long-term transdermal is safer,” she said. “Recent studies indicate that if used in a low dose, it does not increase the risk for blood clots.”

Hartnett has been wearing her low-dose hormone patch since September. She changes it twice a week, placing the new one on her abdomen.

“Right now we’re going to stay at the dosage I am at,” Hartnett said. “If my symptoms come back, perhaps she’ll raise the dosage. I trust Dr. Newman’s judgment 100 percent.”


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