Commentary: What women need to know about menopause and HRT

There is no one way women experience menopause; there are many ways menopause manifests itself in women’s health. There is no one thing to know about hormone replacement therapy (HRT); there are many things to know about hormone replacement therapy.

If you are a woman with menopause symptoms or one who is considering the role hormone replacement may take in her menopause transition, you need a doctor who sees you as a whole person — your health as a whole, not just one system in isolation.

Things to consider include the severity of symptoms, other medical conditions, reproductive plans, menstrual patterns, mental health and risk factors for heart disease, osteoporosis and cancer. There is not a one-size-fits-all approach to managing menopause and the decision to take HRT is a personal one. Women who are contending with menopause symptoms deserve care tailored specifically for them.

Let’s start with those myths.

Twenty-five years ago, misinterpretation of the Women’s Health Initiative study cast a pall over the use of HRT for menopause symptoms. Women who had relied on HRT to manage night sweats, mood swings, headaches, and sleep disruptions were told to discard their pills immediately.

No alternatives given. No relief offered. Research into menopause and hormone therapy largely stopped. Lawsuits against manufacturers of HRT had a chilling effect on the entire industry, which is thankfully now starting to thaw.

As women’s voices become amplified and social taboos about menopause lift, the medical community is being encouraged to address menopause and women’s healthy aging in a more serious and intentional way.

Research is coming back to life, guidelines are being updated, and a new generation of physicians are starting to gain expertise in a treatment option that had been mothballed. This is great news for women who want to explore safe and effective ways to manage menopause symptoms.

The “black box” label was removed. What does that mean for you?

One of the reasons HRT is back in medicine cabinets around the country is that in November, the FDA removed the broad “black box” warnings for cardiovascular disease, breast cancer, and dementia from most menopause HRT products. The true risks and benefits are nuanced and highly individualized.

Seeking care that is tailored to your specific needs and overall health risks is important. Every day on my drive to work, I cringe when I pass storefronts advertising HRT patches along with Botox treatments and eyelash extensions. Hormone replacement therapy is a medical treatment, and those receiving it need and deserve medical expertise.

Even some of the ‘experts’ aren’t experts

It may sound hard to believe, but not all physicians, even gynecologists, understand menopause. Women may live up to 50% of their lives after menopause. Unfortunately, menopause was not a focal point in medical school and residency training. Thankfully this is starting to change.

Your community can help

The cliche that laughter is the best medicine? Laughter, connection and community are an integral part of overall health. The ability to laugh, talk, and come together — in person and virtually — shifts the social acceptability of discussing the menopause experience and reinforces every woman deserves support through this transition.

These hormonal changes are not easy on the body or the mind, and they bring with them increased health risks and some profound quality of life issues. Every woman should have a tribe of understanding guides who walk with her on her journey.

If your symptoms and health issues become more pronounced, if they disrupt your daily life, please don’t rely on the internet or your friend network for answers. You may need — and you deserve — expert care rooted in sound evidence-based medicine.

— Macdonald is a board-certified OB-GYN and menopause specialist at Hoag