Women's HRT: Care for Perimenopause and Menopause.

Menopause is the natural transition when menstrual periods stop permanently (diagnosed after 12 consecutive months without a period). Perimenopause is the years leading up to it when cycles become irregular and symptoms often begin. Common symptoms include hot flashes, night sweats, vaginal dryness, painful intercourse, low libido, sleep problems, mood changes (irritability, anxiety, depression), brain fog, joint pain, fatigue, weight gain, and bladder issues.

Systemic hormone therapy (estradiol): patches, gels, or pills. Best for hot flashes, night sweats, sleep and mood issues, and bone health. Local or vaginal hormone therapy: low-dose estradiol cream, tablets, or inserts. Primarily for vaginal dryness, painful sex, and recurrent UTIs. Non-hormonal medications for hot flashes: paroxetine, desvenlafaxine, or fezolinetant. Progesterone (micronized): required for women with a uterus who take systemic estrogen, to protect the uterine lining.

Systemic HRT is generally offered to women under age 60 (or within 10 years of menopause) with bothersome symptoms and no contraindications (for example, history of breast cancer, heart attack, stroke, blood clots, unexplained postmenopausal bleeding, etc.). Women aged 35 to 39 or 66 and older are typically only eligible for local or vaginal therapy.

Estrogen alone thickens the lining of the uterus and increases the risk of endometrial (uterine) cancer. Adding progesterone (or having a Mirena IUD) protects the lining and dramatically reduces this risk. Women who have had a hysterectomy are not required to take progesterone while on estradiol, but may choose to for symptomatic benefits or relief.

Vaginal estrogen: often 2 to 6 weeks. Systemic estrogen and progesterone for hot flashes, sleep, and mood: usually 4 to 8 weeks (sometimes sooner).

Vaginal estrogen: generally recommended indefinitely because genitourinary syndrome of menopause is progressive and does not reverse on its own. Systemic HRT: re-evaluated periodically. Many women choose to continue as long as benefits outweigh risks and they feel well.

Any vaginal bleeding after menopause is considered abnormal until proven otherwise. Contact your provider immediately. Do not wait for your next visit.

Contact your provider right away. Most side effects can be managed with dose adjustment, switching formulations, or adding supportive medications. Do not stop medications abruptly without medical guidance.

Low-dose vaginal estrogen is often considered safe and is frequently prescribed for breast cancer survivors with severe genitourinary symptoms, but this decision is made on a case-by-case basis in collaboration with your oncologist and menopause provider.

Yes. Routine age-appropriate cancer screenings (including mammogram, Pap smear/HPV testing, colonoscopy, and others as recommended) remain essential while on hormone therapy.