Did you know that hormone therapy is the most effective therapy to manage the symptoms of perimenopause and menopause? These include hot flashes, night sweats, vaginal dryness and itching, and pain or discomfort during sex. It is also effective at mitigating other menopausal symptoms, including mood and sleep changes, brain fog, and low libido.

These symptoms are caused by the fluctuations and drop in ovarian hormones, especially estrogen, that occurs as women approach menopause and for many years thereafter. Many menopausal hormone therapies involve a prescription for estradiol (sometimes supplemented with progesterone) in the form of a patch, pill, or cream.

In most women, menopause symptoms begin in perimenopause, the transitional period leading up to menopause, typically starting a few years before a woman’s last period (the average age of menopause is 51). If you are experiencing any of the following menopause symptoms, you may want to consider hormone therapy:

1. Hot flashes/night sweats

The sudden feeling of intense heat rushing through the body, concentrated especially in the face, neck, and chest, are one of the hallmarks of menopause. Night sweats are hot flashes that occur during the night and result in sudden sweating. Labeled moderate-severe by most women, and lasting between 1-10 minutes, hot flashes are severe enough for 25% of women to seek relief from a physician. The duration of hot flashes lasts on average 7.4 years, persisting several years after a woman’s last period. Estradiol is scientifically proven to reduce hot flash frequency by 75%, and significantly reduce the severity of the hot flashes.

2. Vaginal dryness

A common, uncomfortable symptom of low estrogen levels is vaginal dryness, clinically known as atrophic vaginitis. Declining estrogen levels cause an increase in vaginal pH, a decrease in vaginal secretions and blood flow, and a thinning of vaginal walls—all resulting in the experience of vaginal dryness. Hormone therapy counteracts these changes, leading to more comfort during and after menopause, including during sex.

3. Mood changes

Estrogen is closely linked with women’s emotional well-being. Its fluctuations are implicated in mood disruptions that only occur in women, like premenstrual syndrome and postpartum depression. So it should come as no surprise that it is tied to mood changes that occur during menopause, especially during the menopausal transition when estrogen is fluctuating up and down. In fact, there is a 2-4 fold increased risk of clinical depression during the menopausal transition and early postmenopause, as well as an increased risk of a major depressive episode in women who have previously experienced major depression (MDD).

Estrogen's ties to mood and emotional health are complex and not fully understood. But we do know that there are many estrogen receptors in the brain, that estrogen increases available serotonin and boosts the production of endorphins when a painful experience occurs, and that it is involved in nerve growth and repair. Studies show that estrogen therapy can help stabilize mood swings that affect women during perimenopause, as well as decrease their levels of depression.

4. Sleep changes

Mood changes and sleep changes are closely related, and have a bidirectional relationship (mood impacts sleep, and sleep impacts mood). So it is difficult to talk about one without talking about the other. Women suffer from insomnia at nearly twice the rate of men. Low estrogen levels can make it harder to fall asleep and stay asleep throughout the night, and rates of reported sleep disorders rise after menopause.

Post-menopausal women spend less time in deep sleep and REM cycles, leading to less restful sleep. Studies analyzing the impact of estrogen on sleep have shown that it reduces the average time to fall asleep, increases the amount of time spent in deep and REM sleep, and increases the overall quality of sleep. Lastly, estrogen therapy is effective at reducing hot flashes and night sweats, which themselves disrupt sleep.

5. Weight changes

‍Weight gain and body fat redistribution as women enter menopause is a very real phenomenon that virtually all women will experience. While some of this is caused by the decline in activity levels and the aging process itself, these are a few of the changes that happen to women as they age:

• Lower metabolism: as estrogen levels drop, so does a woman’s resting metabolic rate, or the number of calories that she burns at rest. The difference is small (equivalent to about 50-70 calories per day on average), but accumulates over time.
• Less muscle mass: lean mass decreases when estrogen drops. And lean mass is more metabolically active than fat, and therefore burns more calories at rest. The more muscles you have, the more calories you burn.
• More visceral fat: lower estrogen leads to a shift in fat distribution, with more fat around the middle, surrounding the organs—known as visceral fat. Visceral fat is particularly unhealthy as it is correlated to higher risk of chronic diseases like heart disease, hypertension, and diabetes.

Hormone therapy has been shown to help somewhat with these weight changes, especially to counter increases in visceral fat, but it will not completely eliminate or reverse these changes as aging itself is a major contributing factor.

6. Painful sex

‍Estrogen is critical to maintaining women’s sexual responsiveness and comfort. When estrogen supply is low, blood flow to the vagina decreases as does natural vaginal lubrication, leading to thinning, tightening, dryness, and atrophy (decrease in muscle tone) of the vagina and vulva. These changes can cause irritation, soreness, and even pain during sex, known as dyspareunia, which affects half of postmenopausal women and can lead to anxiety or dread associated with sexual activity. Additionally, low estrogen can lead to delayed clitoral reaction time, thought to also be due to decreased blood flow to the region.

7. Low bone density/osteoporosis

After menopause, women become more susceptible to bone loss and osteoporosis due to the role estrogen plays in bone health. Importantly, estrogen helps to limit the number of osteoclasts (cells that break down bone), and increases the number of osteoblasts (cells that build bone). During the menopausal transition period, the drop in estrogen leads to more bone resorption than formation, which can result in osteoporosis later on. Hormone therapy prevents bone loss and reduces the risk of fracture in the spine and hip.

8. Brain fog

Menopausal brain fog is commonly experienced by women during the menopausal transition, and for a short time post-menopause. It is not the same as age-related cognitive decline, and is not permanent. The disruption and fluctuations in estrogen that occur during this period are thought to play a major role in brain fog thanks to estrogen receptors located throughout the brain. If brain fog is one of several menopause symptoms you are experiencing, you may want to consider trying hormone therapy.

9. Unhealthy cholesterol profile

Estrogen plays an important role in regulating cholesterol levels, helping maintain a healthy lipid profile. Many women who have never had reason to be concerned about their cholesterol find themselves, after menopause, facing an unhealthy lipid profile for the first time. According to Dr. Samia Mora, an associate professor of medicine at Harvard Medical School, "going through menopause often results in lipid and cholesterol changes for the worse."

Over the longer term, low estrogen levels can lead to increased levels of “bad” LDL cholesterol as well as triglycerides in the blood, and decreasing levels of “good,” protective HDL cholesterol. Estrogen therapy may improve the overall lipid profile in some postmenopausal women.

If you have struggled with any of these menopausal symptoms, you may want to try hormone therapy. If you want to know whether you are a candidate, you will need to talk to a provider who treats menopause and complete a detailed assessment.

To work with the menopause experts at Evernow, complete our online health profile. We’ll ask about your age, blood pressure, symptoms, and other medical information relevant to your treatment. Then we’ll connect you with an Evernow OBGYN or NP who will review your answers in-depth and create a detailed treatment plan for you. Our process incorporates guidelines of professional medical societies such as ACOG (American College of Obstetricians and Gynecologists) and NAMS (North American Menopause Society).