Getting hot flushes? Menopause symptoms interfering with sleep? Should you consider hormone replacement therapy?
Sleep changes a lot for women around the time of the menopause and after menopause. For some they get prominent hot flashes which can cause sleep disturbance whereas for others across and then after the menopause sleep feels gradually lighter and more readily disturbed. Many of the changes in sleep around and after the menopause are due to reductions in hormones such as oestrogen and progesterone. Is replacing these with hormone replacement therapy (HRT) worth considering?
NOTE: This aim of this post is to provide you with background information on hormone replacement therapy and it’s use in menopause, particularly with regards to sleep. However, decisions about whether you should use hormone replace therapy, should be made in consultation with your healthcare professional, after considering the potential risks and benefits for you specifically.
What is hormone replacement therapy?
Menopausal hormone replacement therapy, sometimes called HRT, is the term used to describe two hormones, oestrogen and progestin, that are given to relieve bothersome symptoms of menopause.
- Oestrogen – is the hormone that reduces menopause related symptoms such as hot flashes. However, if used by itself in women with a uterus (those who haven’t had a hysterectomy), it can cause the lining of the uterus to overgrow and increase the risk of uterine cancer.
- Progestin – is a progesterone-like hormone that is given in combination with oestrogen in women with a uterus to prevent the development of uterine cancer.
Hormone replacement therapy comes in many forms:
- Patches – many experts prefer to use estradiol patches (e.g. Climara or Estraderm) rather than oestrogen pills because they may be associated with a lower risk of blood clots. Combination oestrogen and progestin patches (e.g. Estalis) are also available. Some need to be replaced every few days, while others are replaced only once a week.
- Pills – are also commonly used as they are convenient and well tolerated. Common pills available are Premarin (equine oestrogens) or Progynova (oestradiol).
- Vaginal oestrogen – is more commonly used for vaginal or urinary symptoms rather than hot flushes or other symptoms, as only a low dose of oestrogen gets absorbed in to the bloodstream. Examples are Vagifem (pessaries) or Ovestin (vaginal cream).
- Pills – used in combination with oestrogen in women with an intact uterus. Common examples are Primolut N (norethisterone) and Provera (medroxyprogesterone)
- Intrauterine progestin – hormonal implants in the uterus (IUDs) are usually used as a form of birth control (e.g. Mirena) but can be used in combination with oestrogen.
Hormone replacement therapy can be taken continuously or cyclically. For women in the perimenopause, who are still having menstrual cycles even if they are irregular, oestrogen can be taken continuously, but progesterone can be taken for 14 days each month, or 14 days every 3 months. When progesterone is stopped there will be a withdrawal bleed. For women without a uterus, or who are post-menopausal (at least 12 months since last menstrual period), continuous oestrogen and progestin can be used.
What are the potential benefits of hormone replacement therapy?
Some women develop depression for the first time in perimenopause. Some studies show that oestrogen treatment helps improve mood and reduce depression. However, some women also need treatment with an anti-depressant to best manage depression.
What are the risks of hormone replacement therapy?
There are risks associated with using hormone replacement therapy, which means that it should generally be used for as short a time as possible. For women aged 50-59, the risks of HRT are much lower than for women 60 or older, so HRT use is usually reserved for women under the age of 60, who are getting significant menopausal symptoms in the perimenopause or early post-menopause.
The main risks of hormone replacement therapy are:
- Heart attack – The risk of heart attack depends on age, and there appears to be no increased risk of heart attacks related to hormone replacement therapy for women aged 50-59 years when they take HRT.
- Breast cancer – when combination oestrogen and progestin therapy was used for 5 years, there were 6.8 extra cases of breast cancer per 1,000 women.
- Stroke – the increased risk of stroke is small, at 1 per 1,000 women when combination hormone replacement therapy was used for 5 years.
- Deep venous thrombosis / pulmonary emboli (blood clots) – there are 5 additional cases of blood clots per 1,000 women when combination hormone replacement therapy was used for 5 years.
If women have existing heart disease such as coronary artery disease, have a history of breast cancer or have had previous blood clots or strokes they should not use hormone replacement therapy. If they have significant menopausal symptoms, they should consider non-hormonal treatments.
Related posts & links:
- Jean Hailes Foundation – information on menopause
- Sleep and the menopause – SleepHub post
- The menstrual cycle and sleep – SleepHub post
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