Although menopause is strictly defined as exactly one year after menstrual periods stop, for many women, problems related to shifts in sex hormones happen many years prior, and continue through the menopausal transition for many years afterwards.

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These different stages often have different issues that arise; early perimenopause may be characterized by insomnia, heavy or frequent bleeding, or anxiety. Later in perimenopause, hot flashes/night sweats, brain fog, mood changes (low moods or rage) new joint pain, or libido issues are common.  During and after menopause itself, new pelvic symptoms (including bladder or localized pain or sexual issues) may start to show up, and new disease risks (heart disease, diabetes, osteoporosis) emerge.  But this is not inevitable, and science is increasingly showing us that lifestyle and preventative care can help modify these risk factors substantially and for the long term.  But it's also true that for many women and non-binary people who menstruate, hormone therapy can improve quality of life substantially, while the risks are very minimal, even when these therapies are prescribed for a decade or more. 

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For many years after the publication of the large US Women's Health Initiative trial in 2002, many providers in GYN and primary care were afraid to prescribe what was then known commonly as 'hormone replacement therapy' or HRT, due to concerns raised about increased risk of breast cancer and stroke.  But the way the study became understood broadly had little to do with whether hormone therapies (now known as MHT or menopausal hormone therapy) are helpful to manage symptoms within menopause, or for the years surrounding menopause. 

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Ultimately, the decision to try hormone therapy (whole body or pelvic applications) should come down to an individualized discussion with a provider who knows your history well, and based on the best current evidence for safety, and what studies tell us work in general for a specific symptom picture, or a given set of hormone related problems.  My goal with patients is always to make sure that they are well informed about what therapies are most likely to help, as well as taking into account a patient's menstrual and reproductive history, family history, current lifestyle, and preferences for care. 

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MORE INFORMATION COMING SOON

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