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How to Choose Hormone Replacement Therapy

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Every woman is different. Hormone replacement therapy for menopause symptoms should be tailored to each woman to account for her age, health, and whether or not her uterus is intact, or a partial or full hysterectomy has been performed.

During perimenopause and menopause, choosing the right treatment can help to alleviate some uncomfortable symptoms. For many women, simple lifestyle modifications can be very helpful (dressing in layers, plenty of air circulation, and use of vaginal lubrication), but for others, hormone replacement therapy (HRT) may be more effective.

Why Are There Different Hormone Replacement Therapies?

Estrogen-only HRT is safer than combination HRT, but should only be taken by women who have had a hysterectomy. Estrogen causes the lining of the uterus to thicken, without the balancing effects of progesterone. This can increase the risk for endometrial cancer. Women who have a uterus must have HRT as an estrogen and progesterone combination.

Menopause symptoms can be debilitating for some women. Working closely with your GYN specialist, it’s best to understand YOUR personal risks, so that you can make the most informed decision.

The loss of estrogen over time is what begins to put women at risk for heart disease, osteoporosis and vaginal dryness.


From the Mayo Clinic:

“Your individual risk of developing heart disease depends on many factors, including family medical history, personal medical history and lifestyle practices. Talk to your doctor about your personal risks. If you’re at low risk of heart disease, and your menopausal symptoms are significant, hormone therapy is a reasonable consideration.

Risk differs for women with premature menopause or premature ovarian failure. If you stopped having periods before age 40 (premature menopause) or lost normal function of your ovaries before age 40 (premature ovarian failure), you have a different set of heart and blood vessel (cardiovascular) health risks compared with women who reach menopause near the average age of about 50. This includes a higher risk of coronary heart disease…

Who should not take hormone therapy

If you’ve already had a heart attack, hormone therapy is not for you. If you already have heart disease or you have a history of blood clots, the risks of hormone therapy have been clearly shown to outweigh any potential benefits.”

From the Cleveland Clinic:

“What can be done to reduce the risk of heart disease for menopausal women?

First and foremost, “traditional” risk factors should be addressed. Women with the lowest risk of heart disease are those who:

  • Avoid or quit smoking
  • Lose weight and/or maintain their ideal body weight
  • Participate in aerobic exercise for 30 to 40 minutes, three to five times per week
  • Follow a diet low in saturated fat (<7 percent daily amount); low in trans-fat (partially hydrogenated fats such as margarine or shortening); and high in fiber, whole grains, legumes (such as beans and peas), fruits, vegetables, fish, and folate-rich foods
  • Treat and control medical conditions such as diabetes, high cholesterol, and high blood pressure that are known risk factors for heart disease”

CIGC Specialists can help women who have begun menopause (either naturally or due to a hysterectomy) understand their specific needs, and create the right treatment plan.

Book a consultation with Paul MacKoul MD, or Natalya Danilyants MD, co-founders of The Center for Innovative GYN Care.

Get to know more about Dr. Paul MacKoul MD.