Will Hormone Replacement Therapy Help My Sex Life?

William Lee, an ob-gyn and associate professor of clinical obstetrics and gynecology at Vanderbilt University Medical Center, says most clinicians have moved away from oral options, partly because oral estrogen can decrease testosterone levels in a woman’s body, while other variants don’t. Many menopausal women already struggle with libido issues, and lower testosterone could make it worse, he says. Testosterone is a libido lifter.

Here’s how traditional hormone therapy — prescription-only and usually covered by insurance — can be administered, according to Slattery.

• A patch that releases estrogen is placed on the lower abdomen or upper buttock and changed once or twice a week. “It’s like a Band-Aid,” Slattery says.
• Gel comes in single-use packets and is rubbed daily on the lower abdomen, upper buttock, arm or leg.
• Spray, absorbed by the skin, is applied daily on the forearm, abdomen or butt.
• A vaginal ring releases estrogen into the vagina, where it is absorbed and spreads systemically through the body. The ring is replaced every three months.

And just for the record, oral estrogen is taken daily.

How HRT helps. Some women who are newly menopausal or in perimenopause don’t sleep well, sometimes due to hot flashes and night sweats, says Lee, adding that many women also experience a loss of libido, some of it a result of hormonal changes that occur as part of menopause.

Lee says hormone therapy can help eliminate hot flashes and night sweats, both of which affect sleep and produce brain fog. It can also help with vaginal dryness, which in turn affects sexual desire.

Kathryn Dumas, an ob-gyn at George Washington University in Washington, D.C., says hormone therapy can be “super helpful” with moodiness and joint aches and pains. It also reduces the risk of urinary tract infections, improves bone health, and is associated with a lower risk of cardiovascular disease if started within 10 years of a woman’s last menstruation cycle, she says.

“Women should not suffer with these symptoms because they are afraid of hormones,” says Marilyn Jerome, a retired gynecologist with over 40 years of experience. “For many women, especially women who are recently menopausal and healthy, the benefits outweigh risks.”

Why hormone therapy got a bad rap. A research study of 16,608 women by the National Institutes of Health, a subset of a larger randomized clinical trial called the Women’s Health Initiative (WHI), was terminated prematurely in 2002 due to concerns (later walked back) that the women in the study with a uterus on hormone replacement therapy had a higher risk of breast cancer, blood clots, stroke, and a cardiac event, according to Lee. The outcome: Most physicians stopped prescribing any hormone replacement therapy. 

In 2002, 30 to 40 percent of menopausal women in the U.S. were on hormone therapy, Lee says. Now, it’s less than 5 percent, according to the Menopause Society, an organization that educates health care professionals about menopause.

“Menopause is having a moment right now, and hormone therapy is getting a fresh look, but we’re still really behind. The Women’s Health Initiative did such a number on it,” says Lee. “A whole generation of women have been affected.” He believes there were “a lot of missed opportunities” to help women manage their symptoms. There’s still a long way to go before it becomes widely prescribed again, he says.

And what are the risks? Dumas says there is a very low risk (less than 1 percent) of developing a blood clot or stroke, and that the risk is further reduced when estrogen is administered through the skin. Similarly, there is an extremely low risk (less than 1 percent) of invasive breast cancer with hormone therapy.

People who might not be eligible for hormone replacement therapy, according to Dumas: women who have a history of stroke, mini strokes (known as TIAs), blood clots, heart disease, or certain hormonally sensitive cancers, such as breast or uterine. People with active liver disease or unexplained vaginal bleeding, or at a high risk for developing heart disease, are likely ineligible. It’s taken a long time culturally — even within the medical community — to get back on board with hormone therapy, Dumas says.

“Risks are associated with every treatment, and everyone’s care must be individualized. Generally, it is safe,” she adds. “Acceptance is starting to shift. There’s lots of chatter about it right now.”