Question 11 - Natural Menopause And HRT

Question 11 - Natural Menopause & HRT

Dear Dr. N,

I am a fifty year old woman who has been on HRT for approximately 10 years. I still have regular (light) periods. I was put on HRT for hot flashes, night sweats, etc. Will I always have to be on HRT? What would happen if I went off of HRT on my own? I do not know of anyone else who has regular periods who is on HRT.

Also, everything that I have read concerning menopause and HRT says to expect decreased libido. However, my libido, if anything, has been on the increase, which is fine with me, but a little much for my husband at this stage of life (he is 57). Is this normal?

Barbara

Reply:

Hi Barbara,

You ask some very good questions that I think a lot of women need answers to. I’ll try and address one question at a time.

Will I always have to be on HRT?

You’re in charge. The decision to stay on HRT or go off is yours. The weight of medical studies suggest that your quality of life and your health will be better if you remain on HRT, but your own perceptions and comfort level must be taken into consideration. Many women believe that HRT is only for the relief of hot flashes and sweats and are not aware of the preventative health benefits it provides. You should read the HRT and Hormone Deficiency sections of the web site for a further discussion of this issue.

What would happen if I went off of HRT on my own?

The likelihood is that your flashes and night sweats would return. Menopausal hot flashes and sweats are more closely related to declining hormone levels rather than absolute hormone levels and discontinuing HRT would result in diminished levels. However, after a period of time ranging from a few months to 2 years the flushes will stop in approximately 75% of women. Alternatives to HRT, such as vitamin e and increasing intake of foods containing "plant estrogens" can be attempted but are nowhere near as effective and do not provide the preventative health benefits of HRT. Check out the "symptoms" section of the web site for more information on this topic.

I do not know of anyone else who has regular periods who is on HRT.

Menopausal women who are on a "cyclic program" of HRT consisting of daily estrogen plus a progesterone preparation 10-12 days a month experience monthly vaginal bleeding. This is quite different than the menstrual periods they had prior to their menopause. This is termed "scheduled withdrawal bleeding", and usually occurs 2 to 5 days after finishing their progesterone preparation. This certainly appears similar to a menstrual period but is different in that it is secondary to the effect of the dose and duration of the progesterone preparation on the lining of the uterus. Some women are on a "continuous combined" regimen of HRT where the progesterone preparation is given every day in combination with estrogen. The advantage of this type of regimen is that in the majority of cases there is no monthly "scheduled withdrawal bleeding". This sounds like a great idea as many women would prefer the prospect of not experiencing vaginal bleeding. Unfortunately, there is some evidence that daily progesterone may diminish the preventative health benefits of HRT. Until this issue becomes clearer, I would suggest the "cyclic" type of Hrt regimen. Check out the Hrt sections of the web site for more on this.

My libido, if anything, has been on the increase, which is fine with me, but a little much for my husband at this stage of life (he is 57). Is this normal?

The fact that your libido is not diminished is not unusual at all. Although your ovaries are producing little if any estrogen they still produce significant amounts of testosterone, the hormone most closely associated with libido. In addition you are replacing your estrogen with your HRT program. As men age their pattern of sexual desire and response changes in a number of ways. The frequency with which they desire sex diminishes. They may require more stimulation and a longer period of time to attain an erection. In addition the penis may not be as rigid as when they were younger. It may take longer for them ejaculate and the recovery or refractory time before they are again able to achieve another erection or ejaculate may be longer. They are often more easily distracted and it may be helpful to provide a quiet atmosphere without distractions or the possibility of interruption. Some men may have health problems that interfere with their libido or sexual performance such as diabetes, vascular disease, alcoholism, depression or hormonal deficiencies. There are medications such as certain antidepressants, heart and high blood pressure preparations that are capable of interfering with sexual desire and response as well. However, as with many things individuals differ, and some men seem to be unaffected by the aging process and retain their sexual vigor for some time.

Dr N