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At 58 years old, Jane Emlyn was experiencing "debilitating" hot and cold flashes, dry eyes, itchy skin, joint pain and heavy bleeding. She was gaining weight and could barely concentrate.
"I was crying all the time," Emlyn told Yahoo Canada.
In the small town of Lillooet, B.C., she sought help from several doctors. She was prescribed antidepressants, sent for psychological help and admitted to the hospital for a cervical biopsy because they thought she might have cancer.
Luckily, the results came back clear, but she describes the procedure as the "worst experience of [her] life. A million times more painful than childbirth."
"If I had only known then that HRT would have helped me with all of this," she said, referring to hormone replacement therapy
Hormone replacement therapy (HRT), or more commonly referred to as menopausal hormone therapy (MHT) in Canada, is a medical treatment used to alleviate symptoms associated with hormonal changes during perimenopause (the stage before menopause where someone is still menstruating) and menopause.
According to a 2023 study published in the Canadian Medical Association Journal, hormone therapy should be the first treatment offered to women under the age of 60 who are suffering from hot flashes, night sweats and other symptoms of menopause — much like Emlyn was experiencing.
After much of her own research and outreach to doctors, Emlyn was prescribed hormones that have nearly alleviated all of her symptoms.
At 62 years old, she now sleeps seven hours a night, has a regulated mood and is no longer in pain from her joints. "I have my life back," she said.
And though hormone therapy may not be the complete answer for women in perimenopause and menopause, considering a healthy diet, exercise and non-hormonal treatments can help, it may be an important consideration for Canadians who are struggling with their symptoms.
Yahoo Canada spoke to an expert on the ins and outs of MHT and what you can expect.
What does menopausal hormone therapy look like?
In Canada, commonly prescribed forms of MHT include estrogen-only or combined estrogen and progestogen therapies.
Dr. Susan Goldstein, a Menopause Society certified practitioner and an assistant professor at the University of Toronto, told Yahoo Canada estrogen is the main hormone that helps with menopausal symptoms such as hot flashes, mood swings and vaginal dryness.
"Progestogen has other benefits, but the main one is to protect the lining of the uterus," she added.
Estrogen and progestogen can be administered through various methods such as oral pills, patches or gels, tailored to meet individual needs.
"The regimen that we use for menopausal hormone therapy differs depending on whether or not we're starting to treat women before they've had their final menstrual period or after," Goldstein said.
If women are still having their period, they will usually be prescribed a combination of estrogen and progestogen in a cyclic manner, which is a pattern similar to a birth control pill.
In contrast, Goldstein said that once women have stopped having their periods, they are given continuous regimens of hormones so they're taking estrogen and progesterone every day.
When treating postmenopausal women, other hormone regimens include TSEC (or a tissue-selective estrogen complex), which is a product that includes a combination of estrogen and a selective estrogen receptor modulator. And lastly, a product called STEAR (selective tissue estrogenic activity regulator), which is a sex steroid and hormonal product that has estrogenic, progestogenic and androgenic properties.
Goldstein said both the TSEC and STEAR products are used once a day and do not contain progestogens.
As a resource for practitioners and people who want to know more about menopause and different hormone therapies, Goldstein recommends using the Menopause Quick 6 (MQ6) assessment tool, which discusses symptoms and provides tables showing different available products.
What are the benefits of menopausal hormone therapy?
MHT can offer several benefits for women experiencing menopausal symptoms, including:
Relief from hot flashes and night sweats
Prevention of bone loss and lowers risk of osteoporosis
Improved vaginal health including dryness and reduced risk of urinary tract infections
Are there any risks?
Hormone replacement therapy was previously considered too risky due to an influential 2003 clinical trial done by the Women's Health Initiative (WHI). The clinical trial linked hormone therapy with a higher risk of breast cancer, blood clots, stroke and heart disease. Many doctors have since said the trial exaggerated the dangers of the treatment, particularly for younger women, and follow-up studies have debunked the WHI data.
"Menopausal hormone therapy is quite safe in appropriately chosen women," said Goldstein.
She added women still need to be screened appropriately because hormones can make women more prone to having blood clots, just as the birth control pill can.
For women under 60 who are within 10 years of their final period, Goldstein said MHT is quite safe and can potentially even benefit healthy younger women.
Goldstein said non-hormonal options might be offered to women farther up in menopause or are older when they’re seeking treatment, or for those who have medical conditions that put them at higher cardiovascular risk.