I’m 62 and it’s been almost 11 years since my last period. Is it too late for me to start HRT? I’ve been having vaginal dryness for the past couple of years and it’s really affecting my quality of life!
- via Instagram
You can absolutely start vaginal estrogen, which is very effective for vaginal dryness and not considered menopausal hormone therapy or MHT (this used to be known as HRT). MHT is not recommended.
There are two ways to take hormones for menopause, in the bloodstream (also known as systemic, and this is MHT) and hormones that just stay in the vagina, this is considered local therapy. WIth local therapy the hormones stay put in the vagina and don’t get into the blood.
We don’t recommend hormones in the bloodstream, meaning MHT, for someone who is over 60 years or who is more than 10 years from their last period as in these situations In this situation, MHT is associated with an increased risk of dementia and cardiovascular disease. This is pretty clear from the data that we have. Starting hormones earlier than 60 or within 10 years of menopause is neutral for cardiovascular disease and dementia. Another issue with MHT is the levels in the blood are often not high enough to help the vagina. In fact, MHT only helps about 50% of the time with vaginal symptoms, so we don’t recommend starting it if vaginal symptoms are your only concern.
What does work very well is vaginal estrogen, and there are a variety of options, including vaginal tablets, vaginal suppositories, a vaginal ring that you change every 3 months, and a vaginal cream. There is also a hormone called DHEA that is converted by the body into estrogen, which is another option (this is a vaginal suppository). These products are excellent not just for treating symptoms, but also in reducing the risk of urinary tract infections and in decreasing overactive bladder.
The only person who needs in depth counseling about vaginal estrogen is someone with a personal history of hormone receptor positive breast cancer, especially if they are taking a class of drugs called aromatase inhibitors. Otherwise, anyone can use vaginal estrogen, even if with a history of blood clots.
If hormones are not an option for you, or you really want to try something else, vaginal moisturizers sold over the counter can be useful if dryness is the only concern. These products are less helpful when there are two or more symptoms, think dryness and itch or dryness and pain with sex. I prefer the hyaluronic acid products, but there are silicone-based and water-based. The “feel” of these is very personal, so people sometimes need to try a few to see which one they prefer. These products often perform as well as the lower doses of vaginal estrogen for relief of symptoms, so they can be helpful. These moisturizers will not prevent urinary tract infections and will not improve bladder symptoms.
Given the fact that bladder infections increase with age and can become a significant health issue for many women, I recommend vaginal estrogen as the first choice, but am absolutely supportive if my patient prefers to start a vaginal moisturizer first.
As there are so many options for vaginal estrogen, I’ll put up a post later this week on some factors to consider in making a choice.