Hot flashes. Inability to sleep. Loss of libido. These are just some of the symptoms that can arise during menopause. But there’s no switch that happens instantaneously, where one day you wake up and you’re suddenly ‘in’ menopause, Dr. Dina Levin is quick to assure me. She’s a provider at PeaceHealth OB-GYN, where they perform a full range of obstetrics and gynecology. “We do everything,” Dr. Levin tells me. “Deliver babies, do surgery, talk to women about their hormones, talk to women about sex. Everything.”
As for menopause, she explains, “A lot of women come in asking, ‘Am I in menopause? How do I know?’ And really, we define menopause as when you haven’t had a period for a year.” A better way to talk about it is as a menopausal transition—and that transition means women experience a wide variety of symptoms at different levels of severity that can impact their quality of life. That’s where hormone replacement therapy comes in.
“Hormone replacement therapy is an effort to replace those hormones that you are now lacking because you’re not menstruating,” Dr. Levin explains. “The goal is to help you feel better, to stop hot flashes, to address whatever symptoms are bothering you.” And although some people become very focused on hormone levels, Dr. Levin is quick to note it’s not all about the numbers. “It’s more about, do you feel good? Do you not feel good? Is this working for you, is this not working for you?”
Hormone replacement therapy has been a popular treatment for decades now. But in 2002, a study published by the Women’s Health Initiative complicated patients’ and doctors’ feelings on the treatment. The study linked hormone replacement therapy with an increase in breast cancer, stroke, and heart attacks. As a result, after 2002, hormone use decreased by 80%. Dr. Levin explains that while the study was broad-reaching and they still use the data today, the findings don’t necessarily mean that hormone therapy increases those risks.
The problem with the study, according to Dr. Levin, was that they enrolled many women who were more than 10 years past menopause. “They’re older,” she says, “and they’re different than the people you usually start on hormone replacement therapy. What they found was more heart attacks and strokes and things you actually don’t have happen when you enroll younger women. So they basically studied the wrong people.”
The study had far-reaching effects. Dr. Levin describes a patient she saw in Portland. “She got taken off her hormones and she was miserable. She couldn’t sleep; she was really desperate. We found a hormone regimen that really worked for her, and her life was able to feel normal again.”
Menopause affects different women in different ways. For this particular woman, it was debilitating and heavily impacted her quality of life. Dr. Levin tells me this is common, and often not taken into consideration. “People don’t take into account that if women are really symptomatic, how many are crashing their cars because they can’t sleep, or they’re distracted, or they’re getting divorced? If I can give you a pill to make you feel better, why not?”
But for those who are still nervous about the risks sometimes associated with hormone therapy, there are other options. The most common symptom of menopause is dryness and discomfort with intercourse; a vaginal estrogen cream is available and doesn’t increase breast cancer risk. There are also online tests you can take to see if you’re at higher risk for breast cancer, and if you are, there are also prescription medications available to reduce that risk. Obesity and alcohol also increase risk, so lifestyle changes may be appropriate as well.
The attitude now towards hormone replacement is more balanced than in 2002. “It’s really good,” Dr. Levin assures me. “It’s not for everyone, but for some women, it’s really helpful.” If you think it might be helpful for you, be sure to ask your doctor at your next appointment.