Menopause
Hormone Therapy - What are the Facts?
Few things cause midlife women more anxiety and uncertainty than the question of whether to seek hormone therapy (HT) to relieve menopausal symptoms.
Media hype and misleading reports about health studies have caused millions of women who would benefit from hormone therapy to not seek treatment.
The fact is that hormone therapy is still the best treatment available for menopausal symptoms and that the results of scientific studies have unfortunately been scientifically misconstrued.
Much of the confusion stems from the Women’s Health Initiative (WHI), a large randomized trial. Parts of the research were halted in 2002 and 2004 and the resulting media reports made it sound like hormone therapy had been shown to increase the risks of death from breast cancer and heart disease.
In fact, the study was designed to determine whether hormone therapy prevented certain diseases; it was never meant to test HT’s effectiveness on menopausal symptoms. Quite simply, it was a prevention study and not a treatment study. In addition, the study focused on older women, not those going through the worst of menopausal symptoms.
What’s more, the American Association of Clinical Endocrinologists reanalyzed the WHI data and announced in 2008 that the benefits of HT in women under age 60 far outweigh the risks. The increase in cardiovascular risk that was publicized in 2002 was seen in much older women, over age 70, who were several years from menopause and who had started “preventive HT” after years of not being exposed to these hormones.
Women on HT who start because of menopausal symptoms and take the HT for more than five years actually have a reduced risk of death and cardiovascular mortality if they start therapy at the time of menopause. Timing is everything!
Hormone Therapy Facts
So, while the vast majority of menopausal women have nothing to fear from HT, it’s important to realize that every woman is unique and hormone therapy needs to be tailored to each individual. The good news is that many women respond to lower doses of hormone than previously used, and there are multiple options.
There are some things to be aware of, however. It’s usually not generally advisable for women to start HT 10 to 20 years after the onset of menopause, especially if they’re taking it solely for non-specific disease prevention or to promote health. However, women who started on hormone therapy at the time of menopause and who have done well can continue on it into their 60s to relieve hot flashes, treat genital dryness and prevent osteoporosis. Women between 60 and 65 should discuss with their women’s health physician reducing the dose of estrogen to lower the risk of stroke, especially if they are on oral medication as metabolism changes.
HT is not recommended solely for prevention of cardiovascular disease, but there is little evidence that it hurts the heart. While HT is not a stand-alone treatment for depression, it does seem to help some women ward off the blues, particularly if those are exacerbated by the symptoms of menopause and night sweats which interfere with sleep.
HT generally is not prescribed for breast cancer survivors or women being treated for breast cancer because some breast cancers may grow when exposed to estrogen. However, local estrogen therapy for vaginal symptoms can be used and women treated for breast cancer premenopausally who became pregnant after breast cancer therapy appear to be fine.
Here is a breakdown of the risks and benefits of HT:
Hormone Therapy Benefits:
- Treats hot flashes
- Reduces the risk of hip fractures and problems with osteoporosis
- Prevents vaginal thinning, atrophy and dryness
- May be beneficial to skin and hair
- May reduce risks of diabetes mellitus type 2
- May reduce risk for colon cancer
Hormone Therapy Risks:
- Associated with increased risk of stroke (primarily in older women and with higher doses)
- Increases risk of gallbladder diseases and need for gallbladder removal (especially oral HT)
- Increases the risk of blood clots
- Estrogen alone systemically in a woman with a uterus, used without progesterone, can increase the risk of uterine cancer
- Women using long-term estrogen and synthetic progestin for more than 5-10 years have a slightly increased risk of being diagnosed with breast cancer. (Estrogen alone, in women with hysterectomy, conversely, is associated with reduced risk for breast cancer.)
There are alternatives for women who won’t or shouldn’t use HT. The best thing you can do is consult with your women’s health professional about your options. There is no need to suffer unaided through menopausal symptoms. And if you are fortunate enough not to deal with pesky hot flashes, don’t forget about your bones and the genital system (vagina, vulva and base of the bladder) as these tissues are exquisitely sensitive to the loss of estrogen.
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