A New Look at Estrogen Therapy for Menopause

Menopause is a natural stage of life. But for many women, symptoms such as hot flashes, night sweats, sleep problems, and vaginal dryness can have a significant impact on their quality of life.

If menopause is affecting your daily activities, the physicians at AHN Forbes Hospital can explain the latest guidance from the U.S. Food and Drug Administration (FDA) and help you decide whether estrogen therapy or another treatment may be right for you.

What is estrogen therapy?

Estrogen therapy, also called menopausal hormone therapy (MHT), replaces hormones that naturally decrease with age.

Perimenopause often begins in a woman's 40s. During this time, hormone levels begin to change and menstrual periods may become irregular. Menopause usually occurs around age 51, after 12 months without a period.

As estrogen levels drop, women may experience:

• Hot flashes
• Night sweats
• Sleep problems
• Mood changes
• Vaginal dryness
• Pain during sex
• Bladder and urinary issues

“Women in midlife are often balancing careers, families, and many other responsibilities while dealing with symptoms that can affect their daily lives,” says Diem K. Nguyen, MD, an obstetrician and gynecologist at AHN. “For the right patient, estrogen therapy can help them feel more like themselves again.”

Types of estrogen therapy

Estrogen therapy comes in different forms and may be taken daily, weekly, or less often.

The two main types are: 

• Systemic therapy, available as pills, patches, sprays, or gels, is often recommended for symptoms that affect the whole body.
• Local vaginal therapy, available as creams, tablets, or rings, is used when symptoms are limited to vaginal or urinary symptoms.

“The right treatment depends on a woman's chief complaints, health history, and personal preferences,” says Dr. Nguyen. “What works best for one patient may not be the best option for another.”

After starting treatment, your doctor will usually follow up within a few months to make sure it still meets your needs and make adjustments if side effects occur.

What to know before starting estrogen therapy

Many women previously avoided estrogen therapy because the FDA added “black box” warnings—the agency’s strongest warning label—to these products. The warnings were based on early studies that raised concerns about breast cancer, stroke, heart disease, and dementia.

Over the past 20 years, researchers have learned more about estrogen therapy and who benefits most from it. This updated understanding led the FDA to remove the black box warning from estrogen-only products.

Current research shows that, for many healthy women under age 60 or within 10 years of menopause, the benefits often outweigh the risks of estrogen therapy.

Still, some women should not use estrogen therapy, including those with:

• Estrogen-sensitive breast cancer
• Active liver disease
• A history of blood clots
• A history of stroke
• Unexplained vaginal bleeding

How AHN supports women through menopause

Menopause can affect more than hormone levels. It can impact physical health, emotional well-being, sleep, sexual health, and overall quality of life. The care team at Forbes takes a comprehensive approach to women's health care to address every aspect of your well-being during midlife and beyond.

Through women's midlife healthcare services at AHN, you have access to specialists who understand the physical and emotional changes that can occur before, during, and after menopause. In addition to estrogen therapy, they can connect you with services such as:

• Behavioral health support
• Pelvic floor therapy
• Osteoporosis care

Take the first step toward relief

You don’t have to wait until symptoms become severe to seek help. Dr. Nguyen encourages women to start the conversation early so they can learn about their options and find the treatment that is right for them.

Call 412-362-8677 to request an appointment or learn more about women’s health services at AHN Forbes Hospital.