What Are the Signs That You Need Hormone Replacement Therapy?

Hormones play an essential role in the development and daily functioning of our bodies. Whether expected or unexpected, the changes or imbalances in our hormones can cause challenging symptoms affecting our physical and mental health. For example, hormonal imbalances may contribute to discomfort or even painful symptoms experienced with sleep disorders, sexual disorders, period problems, or during natural transitions (such as menopause and aging). In some cases, hormone replacement therapy (HRT) may be an option for helping you improve your quality of life.

What is hormone replacement therapy?

The symptoms associated with decreased or low sex hormone levels may affect cognitive functioning, sleep, sex drive, and mood. In addition, certain autoimmune disorders, pituitary disorders, medications, chronic illnesses, or surgeries can lead to decreased levels of sex hormones and, thus, the symptoms associated with this decline.

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Hormone replacement therapy is commonly used to support women and individuals assigned female at birth (AFAB) during the menopausal transition — where estrogen and progesterone levels naturally decline. In some cases, it can be prescribed for men and individuals assigned male at birth (AMAB) experiencing low testosterone.

Hormone replacement seeks to replace one or a combination of the declining sex hormones to help alleviate disruptive symptoms. Additionally, HRT can protect against other issues associated with declining sex hormone levels, such as loss of muscle mass (in men and AMAB people) and osteoporosis (in women and AFAB people). Furthermore, estrogen- and progestin-based HRT has been shown to lower the risk of uterine cancer for individuals who still have a uterus.

Types of HRT

There are varying types of hormone replacement therapies, which have either one hormone or a combination of both sex hormones. HRT may also be administered orally or transdermally and is available in various forms, such as a hormone patch, subdermal pellets, vaginal inserts, cream, gel, pills, or tablets.

Your healthcare provider may need to prescribe different variations before deciding which will work best for you. In general, estrogen-based HRT may be prescribed first. Progesterone or progestin may be recommended in individuals who still have their uterus, as this hormone may protect against endometrial cancer. In men and AMAB, testosterone replacement therapy (TRT) is the hormone therapy that is commonly prescribed to treat low testosterone levels.

What are the signs that you need hormone replacement therapy?

HRT may be beneficial for people experiencing symptoms due to natural conditions (such as aging and menopause) or diseases and disorders that affect hormone levels. For example, the symptoms that are commonly associated with menopause due to decreasing estrogen and progesterone levels may not always resolve on their own, which can severely impact quality of life.

Additionally, as these symptoms can start from perimenopause and last through menopause, the discomfort experienced from them can last for many years. For men and AMAB individuals, HRT may aid with hormonal issues causing impotence, loss of muscle strength, cognitive issues, depression, and more. For some, HRT may be helpful for managing many of the common symptoms to ease your transition through menopause.

what are the signs that you need hormone replacement therapy
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Hot flashes and night sweats

For example, hot flashes are a very common menopausal symptom that is experienced by up to 75% of menopausal individuals. Hot flashes refer to the sudden onset of heat experienced at unpredictable times, which can significantly interrupt day-to-day life. This symptom is likely due to the decline in estrogen levels, the hormone that is linked to the regulation of body temperature. However, rather than happening in a linear fashion, estrogen instead declines in an erratic and irregular manner, hence the waves of hot flashes that many experience. These hot flashes can be followed by cold chills and sweating. When hot flashes occur at night combined with severe sweating that may be disruptive to your sleep, they are referred to as 'night sweats.'

Mood swings

Some individuals may experience sudden changes in their moods, such as quickly shifting from feelings of happiness to sadness or anger. Individuals who commonly experienced mood swings during their periods or who may have had postpartum depression may be more likely to suffer from mood swings during menopause. Severe mood swings can negatively impact relationships with others, natural coping mechanisms, and the ability to function at work, school, or home.

Vaginal dryness

Due to the decreased levels of sex hormones after menopause, the vaginal tissue can become thinner and drier over time — a condition referred to as vaginal atrophy. This accompanying dryness may make it considerably difficult or even painful to have intercourse, especially as small cuts or tears can occur during sex. While dietary and lifestyle changes combined with the use of over-the-counter vaginal lubricants or moisturizers may help mild cases, individuals experiencing severe vaginal dryness may be prescribed HRT to address such issues.

Hair loss

Due to the role sex hormones play in the hair growth cycle, their decline due to aging or other conditions may also lead to thinning hair or even hair loss. However, other factors can cause hair loss, including dietary or lifestyle factors, stress, certain infectious diseases, and even some medications, such as retinoids and certain antidepressants. As hair can be a very important part of a person’s self-identity, hair loss can be psychologically distressing for individuals who experience it.

Low libido

Reduced sexual desire is another symptom that may be correctable with HRT. Changes in estrogen and testosterone can affect the libido, resulting in a reduced interest in or perceived need for sex. In addition, symptoms such as vaginal dryness or the inability to maintain an erection can make it painful, difficult, or even impossible to have sex. Not only is this issue distressing for many, but dealing with low libido can also considerably impact personal relationships. For persons experiencing low libido due to changes in the sex hormone levels, HRT may be a beneficial strategy to improve quality of life.

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Insomnia

As sleep is the most restorative period of our daily lives, not getting enough of it can negatively impact our quality of life. Insomnia is a common sleep disorder characterized by difficulty “falling asleep, staying asleep, or getting good quality sleep.” Disruption in sleep can lead to daytime sleepiness, moodiness, fatigue, physical aches and pains, and other concerns. HRT may be beneficial in treating insomnia in cases where estrogen, progesterone, or testosterone are part of the root cause.

Irregular periods

If you have a noticeable change in the duration of your period or volume of menstrual bleeding, you could be experiencing irregular periods. Irregular periods may be experienced during menopause or may be caused by various issues, such as diabetes, uterine fibroids, bleeding disorders, and certain medications. It may be important to note here that hormonal therapy is often a first-line medical option for treating conditions or disorders characterized by menstrual cycle changes or dysfunction, including dysmenorrhea, endometriosis, primary ovarian insufficiency, and abnormal uterine bleeding.

Which type of hormonal therapy to choose?

HRT therapy must be tailored to each individual case. This may mean having to try different types of therapies before uncovering the best treatment plan for you. In addition, it's important to note that HRT is not recommended for use in certain individuals, such as those with a history of breast cancer, estrogen-based cancers, thrombotic diseases, clotting disorders, liver disease or dysfunction, or migraines accompanied by aura. Your healthcare provider will help you decide which type of HRT is best for your specific needs and conditions.

Does HRT have any risks?

While HRT can help improve the quality of life of individuals going through menopause, there are considerable risks associated with its use. HRT has been associated with blood and cardiovascular disorders, such as blood clots, heart attacks, and strokes. Studies have indicated an increase in gallbladder disease. Additionally, while some studies imply that HRT may be protective against cancer, other studies indicate a possible increase in the risk of breast cancer.

For this reason, the use of HRT will be carefully considered by your healthcare provider to help you both decide whether this course of therapy is the best one for you. In most cases where HRT is prescribed, the benefits are likely to outweigh the possible risks of complications.

Natural alternatives for HRT

A few natural alternatives for HRT to treat conditions such as menopause and low testosterone have been discussed. These include the following:

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  • Dietary changes. To maintain a healthy weight and avoid foods that trigger certain symptoms; for example, alcohol, spicy foods, and caffeine can worsen hot flashes during menopause.
  • Lifestyle changes. Ensuring regular exercise may help alleviate certain hormonal symptoms and improve sleep quality.
  • Vaginal lubricants or moisturizer. Lubricants or moisturizers can help manage vaginal dryness.
  • Relaxation techniques. Deep breathing, meditation, or yoga for anxiety and stress management.

Some individuals may also turn to herbal remedies to treat hormonal issues, such as menopausal symptoms. These remedies include black cohosh, dong quai, evening primrose oil, ginseng, and kava. Herbal remedies are believed to either mimic the activities of human hormones or help balance hormonal levels. However, such claims are not scientifically proven, and caution should be used when considering these remedies.

Natural hormone-associated conditions — such as age-related menopause and low testosterone — or disorders caused by or contributing to hormonal imbalances may cause symptoms that interfere with your daily quality of life. While mild symptoms may be remediated by lifestyle changes, such as improved diet and lifestyle factors, others may need additional support to better manage their symptoms.

HRT is a therapy provided to help alleviate these symptoms and may help you experience regained or improved cognitive functioning, energy levels, and mood regulation. In addition, HRT may lower the risk of certain diseases, such as osteoporosis, muscle loss, and breast cancer. While HRT is not without risks, your healthcare provider will evaluate your medical history and individual symptoms and needs to determine whether HRT will be a suitable option for you. If you’re experiencing any symptoms and wonder if HRT may be right for you, be sure to consult with a healthcare provider for personalized advice.

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