"HRT causes cancer." "HRT saved my life." Here are the actual numbers: what hormone therapy is, what it helps, what the 2002 Women's Health Initiative trial really found after 18 years, the remaining risks per 1,000 and per 10,000 women, why patches and pills differ for blood clots, and what "bioidentical" means.

Free 2-minute stage check: https://perimenostage.com/hrt/benefits-risks?utm_source=podcast&utm_medium=audio&utm_campaign=ep04_hrt

Chapters

0:00 Intro

0:26 What HRT is

1:02 What it helps

1:41 The 2002 headline

2:27 The risks, in real numbers

3:26 Choosing the type

4:10 The first three months

4:41 When to talk it through

5:05 Wrap-up

Sources

• Hot flashes about 75% less frequent on estrogen; low-dose vaginal estrogen improves symptom severity by 60–80%: JAMA review 2023, PubMed 36749328

• Sleep problems, low mood and anxiety with menopause; fracture risk on HRT: NICE guideline NG23

• Spine bone density −7.38% in the 3 years around the final period: SWAN, PubMed 21976317

• All-cause mortality 27.1% vs 27.6% after 18 years, WHI trials, 27,347 women: PubMed 28898378

• +12 / −19 serious events per 10,000 women a year at ages 50–59: WHI, PubMed 24084921

• Breast cancer, about 5 extra cases per 1,000 women on combined HRT for 5 years: NHS, HRT risks

• Blood clots, odds 1.58 for tablets vs 0.93 for patches, gels and sprays: UK case-control study, PubMed 30626577

• Benefits generally outweigh risks under 60 or within 10 years of the last period: The Menopause Society 2022, PubMed 35797481

• 86% of women didn't know compounded hormones aren't FDA-approved: US survey, PubMed 25692877

• Side effects in the first months: NHS, HRT side effects

For information only, not a substitute for advice from your own doctor. Pain or swelling in one leg, a new breast lump or bleeding beyond 6 months on HRT: get checked. Chest pain or sudden breathlessness: call 911.

Waking at 3 a.m., soaked or wide awake, is one of the most common complaints in perimenopause. In the SWAN study of 3,045 women, trouble falling asleep and staying asleep became more common through the transition. Here's why it happens (night sweats, hormones, mood and a learned wake-up habit) and what the research says helps you sleep again.

Free 2-minute stage check: https://perimenostage.com/?utm_source=podcast&utm_medium=audio&utm_campaign=ep03_3am

Chapters

0:00 Intro

0:19 What changes

0:44 Three reasons

1:27 When it counts as insomnia

1:42 What helps

3:16 At 3:07 itself

3:55 When it's something else

4:24 Why it matters

4:53 Wrap-up

Sources

• Sleep through the menopause transition, hot flashes, hormones and hormone use (SWAN, 3,045 women): PubMed 18652093

• CBT for insomnia by phone in women with hot flashes (insomnia score −9.9 vs −4.7 points; 84% vs 43% in the no-insomnia range at 6 months): MsFLASH trial, PubMed 27213646

• Menopause-specific CBT for sleep problems linked to hot flashes: NICE guideline NG23

• Hormone therapy and hot flashes (about 75% fewer): JAMA review 2023, PubMed 36749328

• Bedtime micronized progesterone in perimenopause (review, limited trial evidence): Prior 2011, PubMed 24753856

• Insomnia and fatigue among the top menopause symptoms in women 40–60: 2023 survey, PubMed 37667324

• Memory in SWAN: PubMed 19470968

• Sleep needs, long-term insomnia, sleep habits, sleeping pills: NHS, Insomnia

For information only, not a substitute for advice from your own doctor. Loud snoring with gasping or daytime sleepiness, or sleep problems with low mood, deserve a doctor's look.

A hot flash is a sudden wave of heat through the face, neck and chest. Between 50 and 75% of women get hot flashes or night sweats in the menopause transition, and in the SWAN study frequent hot flashes lasted a median of 7.4 years. Here's what's happening in your body, how long they last, and what the research says helps.

Free 2-minute stage check: https://perimenostage.com/?utm_source=podcast&utm_medium=audio&utm_campaign=ep02_hotflashes

Chapters

0:00 Intro

0:16 What a hot flash is

0:38 Why it happens

1:21 How common, and how long

1:59 At night

2:41 In the moment

3:09 Options that work

4:18 When it isn't menopause

4:46 Takeaways

Sources

• How common: PubMed 36749328; 2023 review, PubMed 37388717

• Why it happens (the brain's thermostat, neurokinin B): PubMed 37388717

• How long (SWAN, 3,302 women): PubMed 25686030

• Night sweats and sleep (SWAN): PubMed 18652093

• CBT for insomnia in women with hot flashes: PubMed 27213646

• Hormone therapy and non-hormonal options: PubMed 36749328; The Menopause Society 2022 position statement, PubMed 35797481; The Menopause Society 2023 nonhormone therapy statement, PubMed 37252752; NICE NG23

• Lifestyle and triggers: NHS, Hot flushes

For information only, not a substitute for advice from your own doctor. Sweats with a fever, cough or weight loss, or palpitations with chest pain, need medical attention.