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In a sort of funhouse mirror to the macho testosterone conversation, it feels like every woman of a certain age on the internet is talking about perimenopause and what to do about symptoms. One popular social media post I saw envisions a music festival called “Perimenopause-a-looza” where women rock out to legends of the ‘90s like Alanis Morisette and Tori Amos, complete with hot flash cooling stations and “HRT on tap.”
HRT is shorthand for hormone replacement therapy, where women are treated with estrogen and progestins that mimic the sex hormones that decline in our bodies during the menopausal transition.
Can menopausal hormone therapy make you feel better? And should starting HRT be just another female rite of passage like learning to use maxi pads when you get your first period?
Family physician Dr. Mara Gordon addresses these questions in the latest edition of her Real Talk with a Doc column for NPR. Hormone replacement therapy is safe for most women, Gordon writes, but she’s seeing a lot of misinformation that over-promises on what it can do.
Where evidence is strong:
🔥 Hot flashes
The primary reason doctors recommend systemic hormone therapy is to treat what are called vasomotor symptoms of menopause, otherwise known as "hot flashes." Up to 80% of women get hot flashes during the menopausal transition, and they can really impact quality of life, Gordon writes. Some patients tell her that hot flashes disrupt their sleep and ability to focus, and sometimes are so disruptive that they don’t want to leave the house. In cases like these, Gordon says taking hormones can be life-changing.
🦴 Bone health
Systemic hormone therapy can help prevent fractures for those at high risk of osteoporosis. It also helps keep bones strong as women age. However most medical organizations don’t recommend prescribing hormone therapy for bones alone. (Another way to keep bones healthy is weight-bearing exercise.)
😬 Dryness or irritation ‘down there’
Dryness and irritation in the vulva also often get better with hormone therapy. These symptoms often improve with an estrogen treatment in the vagina, such as a cream or a ring; systemic hormone therapy can help too.
Where there’s not enough data to say:
Most major medical organizations do not recommend hormone therapy for longevity, preventing chronic conditions, or youthful-looking skin and hair.
There’s not yet a consensus on whether HRT has an impact on heart disease. But it appears that timing makes a difference: There’s a body of research showing that hormone therapy taken before age 60 or within 10 years of menopause might help prevent heart attacks and strokes. But other studies show that hormone therapy taken after age 60 has no cardiovascular benefit at all or may even increase heart disease risk.
Who should avoid HRT, or proceed with caution:
If you’ve had breast cancer, blood clots or heart disease and are interested in hormone therapy, have an in-depth conversation with your doctor. That's because hormone therapy can increase your risk of recurrence or make those conditions worse, Gordon says. If there’s breast cancer in your family history, she recommends doing a formal risk assessment before trying HRT, and consider getting genetic testing for high-risk mutations. If you’re not a candidate for hormone therapy, there are other medications that treat hot flashes, including certain antidepressants.
Read Mara Gordon’s article for more.
Got a health question you want a doctor to answer? Send your query to Dr. Gordon at thrive@npr.org, and she might address it in her monthly column.
And: Why the 'mad scramble' to fill hormone therapy prescriptions for menopause |
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Among the many questions facing parents-to-be, a crucial one is where to give birth. In an increasing number of places in the U.S., the closest maternity care is far from home, according to a new report from the March of Dimes on maternity care deserts. More than half of counties lack hospital-based labor and delivery services, and about one-third have no birthing facilities or obstetric clinicians at all. The biggest gaps are in the Midwest and the South. "We know that those women who live in maternity care deserts are more likely to have bad outcomes when it comes to their pregnancies,” says Dr. Michael Warren, chief medical and health officer for the March of Dimes.
Midwife Nadia Gramby of Chelsea, Alabama, fills in some of those gaps by driving hundreds of miles to support families from pregnancy through the post-partum period, as NPR’s Kristin Wright reports. Licensed and certified midwives like Gramby are trained to perform many of the same functions and procedures as doctors when women are having babies in low-risk situations. Research shows midwife births lead to lower rates of both cesarean section and complications.
Gramby says that compared to a doctor, she’s able to provide more personalized care. "It is about 'How are you doing emotionally, spiritually, physically? What support do you have? Who's around you that's going to be with you throughout the pregnancy?'" she tells NPR. Gramby works with many Black mothers, a population that suffers higher rates of maternal death compared with white women.
A maternity workforce shortage and the closure of labor and delivery units across the country are contributing to the problem. Also, Trump's One Big Beautiful Bill Act passed by Congress last year creates additional barriers to accessing maternity care, the March of Dimes says. The law significantly cut Medicaid funding and did not extend tax credits that would have kept Affordable Care Act insurance premiums cheaper.
Read the full story and learn more about what advocates are doing to expand access to midwives.
Plus: She's trying to open a birth center near a maternity desert. It's not easy |
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Erin Hooley/Chicago Tribune/Getty Images |
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We hope you enjoyed these stories. Find more of NPR's health journalism online.
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Andrea Muraskin and your NPR Health editors |
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