Originally I was going to write a post about whether to try or not to try Hormone Replacement Therapy (HRT) for relief of some of my menopausal symptoms. Most notably, the symptom that was doing me in was disturbed sleep due to hot flashes and night sweats. I used to be a great sleeper, but for the past few years my sleep has gotten worse and worse with no end in sight.
When I went to Kincardine for the Kincardine Women’s Triathlon I shared a room with a lifelong friend. At night, she just put her head down and slept, then woke up in the morning. What? When I asked her about her enviable sleeping ability, she attributed it to HRT. She just slaps on a bit of estrogen gel in the morning, pops a progestin pill at night (to counterbalance the influx of estrogen so that there is no build up in the lining of the uterus, thereby minimizing the risk of uterine cancer), and away she goes.
Bam! No more hot flashes. No more night sweats.
Besides taking care of the hot flashes, HRT has a few other benefits. According to this article, the benefits of HRT include:
- less vaginal dryness, bladder leaks and recurrent urinary tract infections
- better sex drive
- reduced risk of bone fractures associated with osteoporosis
- reduced risk of bowel cancer
I’ve not had all of the issues they point to, but I have lost a bit of mojo. And who wouldn’t want to reduce the risk of osteoporosis and its associated bone fractures and of bowel cancer?
But there are also some risks associated with HRT.
I’ve had the conversation about HRT with my doctor in the past. She did her due diligence and explained that the current state of knowledge indicates some slight increase in certain health risks. The research shows that it slightly increases your risk of the following conditions: breast cancer, ovarian cancer, blood clots (embolisms), deep vein thrombosis, and stroke. That’s not great.
In the past, I decided that rather than take on any risk for symptoms that seemed, at the time, more like inconveniences than serious health issues, I would tough it out. But the fact of the matter is that over time, poor sleep quality has become more than a minor inconvenience.
So this time when I spoke to my doctor I asked her to candidly review the risks with me again. Given my medical history and family medical history–no breast cancer that I know of in the family–the increase in risk is akin to the health risks associated with drinking two alcoholic beverages per day. My reasoning (specious, I’m sure) was that I don’t drink at all, so there’s room to take on a bit of risk.
When the research first came out, my mother had been on HRT for 15 years. Back then, it was thought to be a magic solution that women could stay on for the rest of their lives. But when news of risk came, many women, including my mum, abandoned HRT.
The latest studies suggest that there is a safe period of time–5 years–that a woman can be on HRT for menopause and have the benefits outweigh the risks. My doctor explained all of this to me and I decided I wanted to give it a shot. So she prescribed the same thing my friend was using: estrogel in the morning and progestin at night.
I started the very same day I got the prescription, not waiting until the morning. The gel dose is measured out in pumps. The recommended amount on the package is two pumps. My doctor recommended starting with one pump a day for a week. If that did nothing, then go to two pumps.
After a week, I was experiencing no change at all, so I increased the dose. Every morning after my shower I rub two pumps of estrogen gel over a large-ish area of my body, moving to different parts on different days on my doctor’s recommendation. Sometimes it’s both arms, or my abdomen, or my inner thighs.
Two weeks went by, and still it seemed not a lot better. Then, just this past week, I’ve been seeing a change. I haven’t had a hot flash during the day in over a week. And remarkably, I haven’t had my sleep disturbed by night sweats in a few days. And despite the flood that destroyed my condo on the weekend, I’ve been sleeping peacefully, not tossing and turning nearly as much as I have been for the past couple of years.
One thing I want to make clear is this: menopause is not on its own what I would call a health issue. It’s not an illness or anything like that. It’s a change that brings with it some inconveniences. I could have put up with the occasional hot flash and for a long time that’s exactly what I intended to do. But consistently poor sleep is, as far as I’m concerned, a health issue. Things came to head for me this spring and summer when I hit a wall. If I didn’t find a solution to my disrupted sleep, I could not continue with the training I was doing. And so for the summer, I’ve really backed off on my training in favour of sleeping longer to make up for sleeping poorly.
Now that I’ve had a few days of better sleep, I’m kind of excited at the prospect that the HRT will continue to help me in that area. I’m really glad that I roomed with my friend in Kincardine or I may never have considered revisiting the conversation about HRT with my doctor. I’m also glad to have a doctor who is willing to take the time to explain to me the pros and cons of HRT. And what a gift to be able to live the next five years with good quality sleep!
If you’ve entered menopause and are suffering because you’re not sleeping, it’s worth having the conversation with your doctor. Not every woman is a good candidate for HRT — it depends on a lot on your and your family’s medical history. But those of us who can benefit from it with only a slight increased health risk may decide, as did I, that the benefits are worth the risk.
For more about HRT, read this primer on the Mayo Clinic website.