HRT (Hormone Replacement Therapy)
Before I hit menopause, I rarely—if ever—took prescription drugs. If I had a bad headache or cramps, I reached for the Advil. Extra-strength Tylenol got me through oral surgery. Claritin solved the issues of my occasional springtime allergies. But when I entered menopause at age 52, I was so overcome by the symptoms, I’m not sure I would have survived without HRT (hormone replacement therapy).
I experienced my first signs of menopause on a cool spring night four years ago. I was lying in bed, my window open just a crack, when suddenly I awoke drenched in sweat. My body was cold, my sheets were damp, and it felt like all the life had been drained from me. Days earlier, I’d had a hysterectomy, an operation that threw me into menopause quickly, forcefully, almost brutally.
About two months prior, my gynecologist had detected something abnormal during a checkup and encouraged me to have a sonogram. The sonogram discovered a polyp on my cervix; and during a procedure to remove it, I was found to have the early stages of endometrial cancer, a growth of irregular cells in the uterine wall. The discovery was startling in that I’d had no abnormal vaginal bleeding, no spotting, and no other signs of the illness. In fact, I’d felt healthy and was getting regular periods. In my mind, the onset of menopause was still years away. All that changed, however, when I underwent a hysterectomy in May 2009 to stop the spread of the cancer. As a precaution, both my uterus and ovaries were removed, so my body stopped producing estrogen and progesterone, my periods ceased, and my hormone levels dropped quickly.
While some women ease into menopause over the course of months or even years—in a phase known as perimenopause—my transition was sudden, ushering in symptoms with a vengeance. Aside from experiencing regular night sweats, which interrupted my sleep and caused me to be foggy the next day; I had frequent hot flashes, which felt as if combustible gases burned inside me. There were also eruptive mood swings that had me sobbing uncontrollably and feeling rageful, fluctuations that frankly frightened my then 10-year-old daughter.
At first, my doctor suggested I try a natural formulation called Estroven Maximum Strength to help relieve the symptoms. These over-the-counter tablets, taken once or twice daily, contain ingredients such as black cohosh, soy isoflavones, magnolia bark, and vitamin D that are meant to reduce hot flashes, night sweats, and irritability. Since my inclination was to avoid prescription drugs altogether—including HRTs—I was willing to try Estroven for several months. I supplemented the tablets with a few acupuncture sessions, and switched from coffee to green tea. (Known for its antioxidant and therapeutic properties, green tea contains far less caffeine than coffee, which was making me more irritable.) But as the summer wore on, my symptoms didn’t let up.
In September 2009, about four months after the surgery, I was walking to my doctor’s office in Manhattan for a follow-up visit. As I pushed through the crowded sidewalks, I felt a certain hormone-fueled rage come over me. Suddenly, I wanted to shove the other pedestrians into oncoming traffic. When I arrived at the office and told my doctor of my experience, she grew concerned and advised that it was perhaps time to move on to something stronger. She prescribed a low dose of Premarin, an estrogen-based HRT, that has been known to reduce night sweats, hot flashes, and hormonal mood swings in women. The drug has also been shown to help prevent osteoporosis, another byproduct of menopause.
Premarin comes in five oral doses, ranging from .3 mg to 1.25 mg per tablet. My doctor and I decided I would start on the lowest dose–3 mg—to see whether I would feel an improvement. On the market since 1942, Premarin is classified as a conjugated equine estrogen, meaning it is made up only of estrogen. Estrogen-only HRTs have been said to increase slightly the risk of endometrial cancer in women, so they generally are prescribed to women who have had their uterus removed via a hysterectomy. Other women are prescribed HRTs that combine both estrogen and progestin, which reduces the risk of uterine cancer.
Estrogen-only therapies have also been linked to a slightly higher risk of blood clots and heart attack in some women, particularly as compared with estradiol, a natural bioequivalent form of estrogen. In a recent study conducted by the University of Washington School of Public Health and the Group Health Research Institute, researchers observed 384 postmenopausal women aged 30 to 79 who visited the Group Health Cooperative in Seattle from 2003 to 2009. Of the women studied, those who were prescribed estradiol had fewer blood vessel clots in their legs and lungs than those who took Premarin. Women who were given estradiol were also at a somewhat lower risk for heart attack than those prescribed Premarin.
After weighing the pros and cons, I decided to start on the Premarin right away. Within days, I began to feel much better. My moods stabilized almost immediately, and within weeks the night sweats and hot flashes largely went away. Furthermore, I felt no side effects from the drugs, which, for some women, include stomach upsets, nausea, weight gain, headaches, bloating, and tenderness of the breasts, among others.
It’s been more than 4 years since I’ve been on Premarin, and in some ways, it’s been a lifesaver. From the time I got my period at age 10-1/2 until the time I went into menopause at age 52, I was a prisoner of premenstrual syndrome, hormonal fluctuations, and mood swings. Now, for the most part, my moods are stable. I’m also not troubled by night sweats, hot flashes, vaginal dryness or burning, or any of the other physically uncomfortable aspects of menopause. That said, I’ve been diligent about seeing my oncologist every six months and my internist at least every 12 months for checkups. I also make sure to get an annual mammogram to check for breast cancer. What’s more, I’ve stayed on the .3 mg dose of Premarin, with continued good results.
It’s hard to say when—and why—I might stop taking the drug. And it’s possible I may try to cut back on the amount I use and consider alternative therapies down the road. (Over the years I’ve seen both a Chinese herbalist and acupuncturist who believe they can help with menopausal symptoms.) But at least for now, I feel that the benefits of Premarin outweigh the risks. So even though I’m not a big proponent of prescription drugs—unless absolutely necessary—for the foreseeable future, I plan to make no changes.
