Hot flashes and night sweats
Hot flashes are experienced by about three in four women around menopause. These sudden and intense sensations of heat can cause flushing, sweating, and an overall feeling of being too hot.
Hot flashes can happen at any time of the day or night, often disrupting sleep and leading to night sweats (heavy sweating during sleep). These intense episodes of sweating, often accompanied by a sudden feeling of warmth, can drench sleepwear and sheets. Night sweats may cause fragmented sleep, leading to fatigue and irritability during the day.
Thankfully these symptoms can be significantly reduced within two weeks of starting HRT. Some women report improvements even sooner, and frequently find that this symptom is completely eliminated. At the moment, there’s no other treatment that’s more effective than HRT in managing these symptoms.
Sleep quality
As mentioned above, the fluctuating levels of estrogen during menopause can result in night sweats, heat intolerance and occasional nightmares, which can lead to disrupted sleep and poor sleep quality. The impact of HRT on sleep is not fully understood yet and can vary from person to person. Some women may experience improved sleep quality within a few weeks of starting HRT, while others might require more time to notice improvements.
Research suggests that low-dose hormone therapy (as pills or patches) contributes to better sleep quality in menopausal women. Also, there seems to be a correlation between better sleep and the reduction of hot flashes and night sweats. So, by reducing the intensity of these symptoms, HRT can contribute to better sleep quality.
You can also consider implementing some lifestyle changes in combination with HRT, to improve sleep. Examples include limiting screen time before bed, sleeping in a cool environment, wearing lightweight, breathable sleepwear, and sleeping on moisture-wicking sheets.
Vaginal dryness and urinary symptoms
Vaginal dryness and urinary symptoms are common challenges that women may face during menopause due to hormonal changes. The decline in estrogen levels can lead to thinning and drying of vaginal tissue, causing discomfort, itching, and pain especially during intercourse. Changes in the urinary tract can also contribute to issues like urinary urgency, frequency and occasional leakage. These symptoms can impact quality of life and intimate relationships.
Vaginal dryness is typically the first indication that a person is developing vaginal atrophy. Vaginal atrophy is a condition where the lining of your vagina gets drier and thinner. This results in itching, burning and pain during sex, among other symptoms. The condition also includes urinary tract problems such as urinary tract infections (UTIs) and urinary incontinence. Recently, the term vaginal atrophy has been replaced with the newer term, genitourinary syndrome of menopause (GSM).
HRT provides relief from vaginal dryness and urinary symptoms associated with menopause. This not only improves comfort during intimacy but can also enhance libido and pleasure during sex. Additionally, problems like involuntary urine leakage during activities like coughing or playing sports, as well as the urgency to empty the bladder, are often reduced while taking HRT.
Reduced sex drive (libido)
Up to 40-50% of women experiencing perimenopause and menopause report a loss of sex drive. This decline is often linked to fluctuating estrogen levels, which can impact sexual desire and arousal. Challenges like vaginal dryness and discomfort during intercourse (dyspareunia), can also affect overall sexual satisfaction. Also, emotional factors, including stress, mood swings, and concerns about ageing or body image, may contribute to a diminished sex drive.
Estrogen-based HRT is often recommended to increase sexual comfort by enhancing pelvic blood flow (blood flow to your genitals) and vaginal lubrication. However, estrogen-only HRT is typically recommended for women who have undergone a hysterectomy or use a Mirena IUD (progestin-containing intrauterine device providing birth control). So, if this doesn't apply to you, you're likely using combined HRT. Combined HRT involves taking both estrogen and progesterone and is more suitable if you have a uterus.
If you were experiencing a low sex drive before HRT, you'll likely notice your sex drive improve after several months of treatment. But if HRT does not help restore your sex drive, you might be offered a testosterone gel or cream. It can help improve sex drive, mood and energy levels.
