Friday Q&A: Menopause Mashup

8 subscriber questions about menopause; the safety, timing & delivery systems of hormone therapy; and why not birth control pills

ICYMI

• 👉 My convo with OBGYN Dr. Mary Claire Haver: Should You Take Hormone Therapy?

• 👉 Recent newsletters:

  • The Food Group You May Be Missing

  • How Much Alcohol is Okay?

  • Six Reasons Why Therapy Might Not Be Working For You

---

Click here to submit your questions (about anything) for future Q&A posts!

Disclaimer: The views expressed here are entirely my own. They do not reflect those of my employer, nor are they a substitute for advice from your personal physician.

---

QUESTION #1

When would it make sense to consider HRT before menopause? - Sara

Dear Sara,

Menopause is defined as having gone a full calendar year without a menstrual period, but we don’t have to wait the full year to begin treatment. It makes sense to initiate hormone replacement therapy if a woman is experiencing menopausal symptoms such as hot flashes, vaginal dryness, and insomnia and if low estrogen (i.e. perimenopause) is the clear explanation for those symptoms. In other words, we treat the patient, not the clock. 👍

For the North American Menopause Society’s expert recommendations, click here.

Photo by Vonecia Carswell on Unsplash

QUESTION #2

What about women over 60? I am 66 and have been on HRT for over 10 years. Why is it considered safe for women under 60? Is it unsafe for women over 60? Should I stop? - Adnil

Dear Adnil,

Much of the risk associated with menopausal hormone therapy (MHT) stems from starting it too late, i.e., after a woman has developed underlying conditions that MHT can exacerbate. In general, MHT is considered safe for most healthy women when it is started within 10 years of menopause (as it sounds like you did). When initiated within that window, MHT has the greatest potential to prevent cardiovascular disease, premature cognitive decline, and osteoporosis, to name a few. MHT can be continued indefinitely as long as the benefits continue to outweigh the potential downsides. When and if to discontinue MHT depends on the patient developing any new health risks or conditions to tip the risk/benefit scale. For example, a woman who develops a blood clot likely would discontinue systemic hormone therapy. Risk/benefit ratios are dynamic, which is why it’s important to follow up regularly with your doctor to reassess your health over time. 

---

If you like what you are reading, hit the ❤️ button on this post so more people can discover my writing on Substack! 🙏

---

QUESTION #3

Could you speak about women taking hormone replacement after 65? - Mary Anne