Perimenopause and HRT

Perimenopause and HRT

You’re feeling “off.” You’re having trouble getting to sleep and staying asleep, and you feel tired when you wake. You can’t remember where you left your keys. You can’t think of words. You’re experiencing joint pain. You’re more irritable than before. Welcome to perimenopause.

At my practice, I’ve seen firsthand how perimenopause can often catch women off guard. As hormone levels start to fluctuate (sometimes years before the menstrual cycle officially ends), it can bring on symptoms that range from manageable to downright disruptive. This is where the conversation about perimenopause and HRT comes into play. Hormone Replacement Therapy (HRT) can be a powerful tool in helping to restore balance and provide relief, allowing you to feel more like yourself again. Let’s discuss your options.

What Is Perimenopause?

Perimenopause is the phase leading up to menopause, typically starting in a woman’s 40s but can begin as early as mid-30s. During this time, hormone levels, especially estrogen and progesterone, begin to fluctuate, causing various physical and emotional symptoms. Many women immediately think “hot flashes” when they think of menopause symptoms, but hormone fluctuations can produce many different symptoms. 

Symptoms of Perimenopause:

  • Irregular Periods (bleeding more or less, longer/shorter cycles)
  • Vaginal Dryness
  • Difficulty Sleeping
  • Irrritability
  • Skin and Hair Changes
  • Decreased Libido
  • Painful Sex
  • Weight Gain & Slowed Metabolism
  • Changes in Appetite
  • Brain Fog
  • Hot Flashes/Night Sweats
  • Joint Pain
  • Headaches
  • Chronic Fatigue
  • Increased Incontinence
  • UTIs

As these symptoms can significantly impact quality of life, many women start to explore options like Hormone Replacement Therapy (HRT) to help restore balance and find relief during this stage.

Understanding Perimenopause and HRT

Hormone Replacement Therapy, or HRT, is a treatment used to replenish hormones that naturally decline during perimenopause. By learning about how perimenopause and HRT work together, women can better understand how hormone supplementation might help improve their quality of life during this transitional stage. HRT for perimenopause can include a variety of hormone combinations to address different symptoms. Here’s an overview of the key hormones used and how they may help:

Types of HRT for Perimenopause

Estrogen Therapy (ET)

Estrogen is often the primary hormone used in HRT for perimenopause, as it helps to alleviate many common symptoms, such as hot flashes, night sweats, and vaginal dryness. Estrogen therapy is available in several forms, including pills, patches, gels, and creams. For women who’ve had a hysterectomy, estrogen alone may be sufficient; however, those with an intact uterus typically combine it with progesterone to reduce the risk of endometrial cancer.

Progesterone Therapy

This hormone plays an essential role in regulating the menstrual cycle and maintaining a healthy uterine lining. Adding progesterone to HRT helps balance estrogen, reducing the risk of uterine complications. Progesterone can also help with symptoms like mood swings and sleep disturbances, making it an important part of HRT for many women during perimenopause. For these reasons, it can be used without estrogen.

Testosterone Therapy

Though less commonly thought of as a hormone that affects women, testosterone plays a big role in the female body. Testosterone levels decline naturally with age and can contribute to symptoms such as fatigue, low libido, and reduced muscle strength. In some cases, adding a low dose of testosterone to HRT can help improve these symptoms, leading to enhanced energy, mood, and sexual health. Testosterone therapy is typically administered via gels, creams, or pellets and should always be closely monitored by a healthcare provider to ensure safe and effective results.

 

Benefits of HRT and Perimenopause

For those experiencing challenging perimenopause symptoms, HRT offers numerous benefits:

  • Symptom Relief: It reduces the frequency and severity of hot flashes, night sweats, sleep disruption, low libido and other perimenopausal symptoms.
  • Bone Health: Perimenopause and HRT are often discussed together in terms of osteoporosis prevention, as HRT helps protect against bone loss.
  • Mood and Mental Health: HRT can alleviate mood swings, improve mental clarity, and enhance overall well-being.
  • Cardiovascular Protection: if taken within ten years of the onset of menopause, HRT can significantly reduce all-cause mortality and cardiovascular disease (CVD). (1)
  • Neuroprotective Benefits: a 2023 meta-analysis found that women who took HRT for more than ten years had a 26% lower risk of dementia.  (2) A new study provides new evidence for significant associations between brain estrogen receptor density and memory function in women of menopausal age. (4)

Addressing Fears around HRT

Concerns about HRT were heightened by the 2002 Women’s Health Initiative (WHI) study that reported increased risks of breast cancer and cardiovascular disease associated with hormone replacement therapy. This led to widespread concern and discontinuation of HRT. However, the findings of the WHI were later understood to have been misinterpreted, leading to confusion about the actual risks. For a detailed overview of how insights into menopausal hormone therapy have changed, read our article on What’s Changed in Menopausal Hormone Therapy.

Why a Functional Approach to HRT is More Comprehensive

A functional approach to Hormone Replacement Therapy (HRT) goes beyond simply supplementing hormones. It considers how your body metabolizes and detoxifies hormones, as well as how it handles environmental toxins and xenoestrogens—synthetic compounds that mimic estrogen in the body. Here’s why this holistic perspective is beneficial:

  • Hormone Metabolism: Understanding how your body metabolizes hormones, particularly estrogens, can help tailor HRT to your unique needs. Functional medicine providers often look at hormone metabolites through specific testing to determine if you’re processing hormones in a way that promotes balance and minimizes risks. This approach ensures that the types and doses of hormones used in HRT are aligned with your body’s natural pathways, reducing the likelihood of adverse effects.

  • Detoxification Pathways: Your liver plays a critical role in breaking down and clearing hormones, including estrogen, from the body. A functional approach evaluates the efficiency of your liver’s detoxification pathways and may include support for liver health through targeted nutrients like B vitamins, glutathione, and milk thistle. This can help prevent the build-up of hormone metabolites that could potentially cause symptoms or increase health risks.

  • Addressing Xenoestrogens: Xenoestrogens are found in various environmental sources, such as plastics, pesticides, and personal care products, and they can disrupt hormone balance by mimicking estrogen in the body. A functional approach considers these exposures and offers strategies to reduce xenoestrogen intake and enhance the body’s ability to detoxify them. This might involve lifestyle adjustments, such as switching to natural cleaning products, avoiding plastics, and choosing organic foods when possible.

  • Supporting Gut Health: The gut is another essential component of hormone metabolism, particularly through the estrobolome—bacteria that help regulate estrogen levels. A healthy gut can support effective hormone detoxification and prevent reabsorption of estrogens. Functional approaches often include probiotics and dietary recommendations to foster a balanced gut microbiome, which in turn supports overall hormone health.

By focusing on these aspects, a functional approach to HRT not only addresses perimenopausal symptoms but also enhances your body’s ability to process and detoxify hormones safely and effectively. This comprehensive strategy helps create a more balanced hormonal environment, reducing symptoms and supporting long-term wellness.

Final Thoughts on Perimenopause and HRT

Perimenopause can be a challenging time, but with the right approach, it’s possible to find relief and reclaim your vitality. Whether through HRT, lifestyle changes, or a combination of therapies, a functional perspective ensures that your body’s unique needs are addressed holistically. Our bodies are complex, and the hormone system is influenced by more than just age—factors like stress, lifestyle, environmental exposures, and the way our bodies respond to these influences all play a role. Remember, perimenopause is a journey, and with the right support, you can navigate it with resilience and clarity.

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About Tringali Vibrant Health

Founded by Functional Medicine Expert Elizabeth Tringali, PA-C, Tringali Vibrant Health is a Functional Medicine and Integrative Practice that looks for the root causes of your health issues to restore optimal, VIBRANT health.

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