HRT: The Risks, The Benefits, The Alternatives
Bonafide Medical Advisor
“Is it hot in here or is it just me?”Let’s face it; if you’re wondering what a hot flash is, you probably haven’t had one yet. Hot flashes and night sweats are the hallmark symptoms of menopause. These sudden surges of intense heat typically start from the neck and chest and quickly travel upwards. The face turns beet red and then the profuse perspiration starts, and, if you’ve experienced it, you know, it’s not pretty! This is all due to lower circulating estrogen levels and their effect on the body’s thermostat.
Prescription hormone replacement therapy is very effective for the treatment of this disruptive symptom. Systemic estrogen, be it in pill, patch, vaginal ring or topical gel form, works quickly to alleviate symptoms but poses potential risks for women, including breast cancer, uterine cancer, blood clots and cardiovascular disease. Estrogen is typically taken in combination with a progestogen for women with a uterus, in an effort to avoid cancer risk. In some cases, benefits of hormone therapy outweigh risks; in others, not so much. Similar concerns exist for compounded bio-identical hormone products.
For those who cannot or will not take hormones, other prescription options to address menopausal symptoms include select antidepressants, as well as gabapentin, which has been borrowed from the neurology world. Again, side effects, including sexual ones, must be considered.
Non-prescription products do exist as well to help alleviate the disruptive hot flashes and night sweats that can accompany menopause. Relizen® is composed of a unique proprietary blend of pollen derived from four specific Swedish flowering plants, and is clinically studied and shown to be well tolerated. This over the counter supplement reduces hot flashes and night sweats in just 3 months by helping to regulate your body’s natural internal thermostat. Relizen is unique. While some supplements contain phytoestrogens, which are plant-derived and can act like estrogen in the body, Relizen works differently to reduce the frequency and intensity of night sweats and hot flashes with no hormonal effect.
Maintaining a healthy weight, paced breathing exercises, stress reduction, regular exercise and avoidance of dietary triggers will help decrease some of the heat too; don’t forget to give them a try!
“My vagina feels like the Sahara it’s so dry!”Unlike hot flashes and night sweats, which will eventually cease over time, vaginal dryness that accompanies menopause, is chronic and progressive. In other words, left untreated, symptoms will unfortunately only worsen with time. With less estrogen comes a less elastic and much more delicate vagina. The result? Dryness, itching, burning, irritation, not to mention painful sex. Discomfort with intimacy and subsequent avoidance can take a toll on one’s relationship and self-esteem.
Locally applied vaginal estrogen has been available for years. Creams, rings and inserts can repair delicate tissue and restore “V” order. Although absorption is minimal, similar warnings exist for all estrogen containing products, with uterine cancer risk at the top of the list.
When hormones are contraindicated or just undesirable, vaginal moisturizers become essential. For my patients, I recommend Revaree®, a small, hyaluronic acid based, easy to use vaginal insert made with ingredients shown to be effective in as little as 9 days, with further improvements experienced with continued use, over time. Hyaluronic acid, a naturally occurring molecule in the body, can hold up to 1000x its weight in water. Just think… Ahhh, goodbye dryness and hello intimacy!” Take an active role; your vagina will thank you.
“I can’t get no satisfaction…"Looking to enhance your intimate experience? Who isn’t? Seems with less estrogen comes less blood flow to the vagina. Less blood flow means less lubrication which can lead to diminished enjoyment. Estrogen can surely help relieve dryness and enhance lubrication; while testosterone, a male hormone, often used for libido, isn’t FDA approved for women and can have side effects like acne and hair growth in typically “male places.” Ristela® is an over the counter supplement, composed of a unique combination of antioxidants and amino acids, that safely work to enhance genital blood flow during sex. More blood flow means enhanced sensation and stronger orgasm. Reclaim your mojo!
Hormones are not for everyone
When it comes to the common complaints of menopause, it’s good to know there are options. Hormones do work but are controversial; if you cannot or just will not take hormone therapy, consider non-hormonal options. Safe and effective choices are finally here!
Alyssa Dweck, MS, MD, FACOG, Bonafide Medical Advisor, is a practicing gynecologist in Westchester County, New York. She provides care to women of all ages and has delivered thousands of babies. A graduate of Barnard College, she has a Master’s Degree in Human Nutrition from Columbia University and her Medical Degree from Hahnemann University School of Medicine in Philadelphia, now named Drexel University. Dr. Dweck currently practices in Mount Kisco, NY and Carmel, NY and admits to Northern Westchester Hospital in Mount Kisco, NY. She has been voted “Top Doctor” in New York Magazine and in Westchester County and has authored three books to date: “The Complete A to Z for your V,” “The Sexual Spark,” and “V is for Vagina.”